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: 1123860
Sex: F
Age: 22
State: CA

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

Lab Data:

Allergies: no

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient complaining of bodyaches, fever, and chills.

Other Meds: N/A

Current Illness: no

ID: 1123861
Sex: F
Age: 72
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/20/2021
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: Flu shot

Symptom List: Anxiety, Dyspnoea

Symptoms: On March 20 a rash developed and spread to my back: chest;stomach . This is the 3rd adverse report I have sent

Other Meds: Valacyclovir8 1 mg; Aspirin; Atorvastatin; Benefiber

Current Illness:

ID: 1123862
Sex: M
Age: 38
State: MN

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: NA

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

Symptoms: Initially Fever Body aches and pains --all symptoms lasted for 12-14 hours

Other Meds: NA

Current Illness: NA

ID: 1123863
Sex: F
Age: 72
State: MO

Vax Date: 03/04/2021
Onset Date: 03/05/2021
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: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Chilled, Hard to stay warm, Tired

Other Meds: Vitamin B, Vitamin C, Vitamin D, Optimal Thyroid, Women's Multivitamin

Current Illness: None

ID: 1123864
Sex: F
Age: 70
State: CA

Vax Date: 03/17/2021
Onset Date: 03/21/2021
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: erythromycin, cefdinr

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

Symptoms: Sore throat lasting at least 2 days now Sticky build up of flem in back of throat lasting 2 days now Sharp and strong muscle ache intermittently about 8 hours on Sunday Low grade headache 6 hours on Sunday

Other Meds: atorvastatin, quinapril, montelukast, baby aspirin

Current Illness: none

ID: 1123865
Sex: F
Age: 53
State: MI

Vax Date: 03/20/2021
Onset Date: 03/21/2021
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:

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

Symptoms: FEVER, ACHES, SORE THROAT, SWOLLEN GLANDS, HEADACHE, STIFF NECK...SO FAR GOING ON TWO DAYS

Other Meds:

Current Illness:

ID: 1123866
Sex: F
Age: 32
State: IL

Vax Date: 12/30/2020
Onset Date: 12/30/2020
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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Severe pain in my arm from the time I received the shot. Could not use my entire left arm at all for a month. Tingling down to my fingertips. Required multiple trips to an orthopedic specialist. Multiple courses of medication. First diagnose' was SIRVA, followed by frozen shoulder. Still having pain and issues to this day. Limited use of my left shoulder. Injection site was too high.

Other Meds: Zoloft 100mg x daily, Xannax .25mg x PRN,

Current Illness: None

ID: 1123867
Sex: F
Age: 37
State: IA

Vax Date: 02/06/2021
Onset Date: 02/13/2021
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: 1 week after vaccination, developed 2 lumps under arm in lymph nodes in arm pit the same arm as vaccine. Was seen by doctor and having follow up visit

Other Meds:

Current Illness:

ID: 1123868
Sex: F
Age: 46
State: NM

Vax Date: 03/05/2021
Onset Date: 03/01/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: hallucinating; Delusional; Eyes are swollen; Night terrors; She was really really sick; her is red red; her body hurts; fever 102; A spontaneous report was received from an consumer concerning a 46 years old, female patient who experienced hallucination, delusional, swollen eyes, night terrors (sleep terror), was really sick (illness), her is red (erythema), body hurts (myalgia) and fever 102 (pyrexia) The patient's medical history included COVID-19. Concomitant product use was not provided by the reporter. On 05 Mar 2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: 036A21A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The patient experienced the events she was really sick, fever 102, her body hurts, her is red, hallucinating, she was delusional, she had night terrors, like on drugs and her eyes are like swollen, like little bag under her eyes all since an unknown date in Mar 2021. The event hallucination was considered medically significant. Treatment for the event included Tylenol. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the events hallucination, delusional, swollen eyes, night terrors, was really sick, her is red, body hurts and fever 102 were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1123869
Sex: F
Age: 42
State: IL

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: tst

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt reports "I was extremely weak, fatigued, high fever, swollen lymph nodes in my left arm pit and elbow. my right arm (injection site) is red, swollen, tender and warm to touch"

Other Meds:

Current Illness:

ID: 1123870
Sex: F
Age: 28
State: WA

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: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: No treatment needed other than ice and otc analgesic/antipyretic

Other Meds:

Current Illness: diabetes insipidus, interstitial cystitis, rheumatoid arthritis

ID: 1123871
Sex: F
Age: 94
State:

Vax Date: 03/05/2021
Onset Date: 03/08/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Patient reports a very sore/painful arm, which radiated up her neck and across to her back. After 3 days of rest, the pain has completely resolved.

Other Meds:

Current Illness:

ID: 1123872
Sex: F
Age: 42
State:

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:

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

Symptoms: Client has previous allergies to cows milk and aloe. Reported her face was hot and swelling after vaccine. Family member in car with client confirmed her face was swollen as not visible initially. Client tearful and panicked. Reclined in car seat and Dr and Epi Pen called for. Dr spoke with client and examined the swelling, stating her Uvula was swollen. He administered an epi pen to left thigh muscle. 0.3ml . Blood pressure was 135/75 with pulse of 82 RR22 and oxygen saturation of 100%. EMS on site. Epi pen was administered on 12.10 pm. Client responded quickly and stated the she felt much better. second vital signs in 5 minutes were blood pressure 133/77 pulse 78 RR 18 and oxygen saturation of 97%. Transported by EMR to hospital.

Other Meds:

Current Illness:

ID: 1123873
Sex: F
Age: 56
State: TX

Vax Date: 03/13/2021
Onset Date: 03/13/2021
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: AUGMENTIN, LATEX, PENCILLIN

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

Symptoms: WHEN SHOT WAS BEING ADMINISTERED I FELT IT TRICKLING DOWN MY ARM. WHEN I LET THE NURSE KNOW AND SHE LOOKED AT IT AND PULLED IT OUT NEEDLE CAME OFF THE SYRINGE AND FELL TO THE FLOOR. I AM NOT SURE IF ANY OF THE VACCINE GOT ADMINISTERED. THIS HAS CAUSED ME TO LOSE MY PEACE OF MIND. THEY SAID THEY CANNOT GIVE ME ANOTHER DOSE BECAUSE THERE WAS NO WAY TO TELL HOW MUCH ACTUALLY WENT IN AND AN OVERDOSE CAN BE HARMFUL. I WAS TOLD TO JUST COME FOR MY SECOND DOSE AS SCHEDULED AND I WOULD BE ALRIGHT. I NEED SOMEONE MORE KNOWLEDGABLE TO ASSURE ME OF THIS.

Other Meds: VITAMINS, FISH OIL, CALCIUM, FOLICE ACID, BIOTIN, CLARITIN

Current Illness: RHEUMATOID ARTHRITIS

ID: 1123874
Sex: F
Age: 56
State: CT

Vax Date: 02/04/2021
Onset Date: 02/16/2021
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: Fish Percocet

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

Symptoms: Rash on right breast and lower right scapular area. Prescribed prednisone and valtrex

Other Meds: Prevacid Citalopram Vitamin B Vitamin D

Current Illness:

ID: 1123875
Sex: F
Age: 74
State: CA

Vax Date: 02/01/2021
Onset Date: 03/02/2021
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: One time only reaction to Ibrance 125mg lowered to 100 mg

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

Symptoms: #2 shot Feb 28th - March 2 headaches,pain in lungs, extreme fatigue-went to bed for a few days then I was able to walk around but chills,fatigue for 3 weeks

Other Meds: Ibrance,Xgeva,Fasolodex D3,Cod Liver Oil,Zinc, Tumeric/Curcuman, Hair,Skin Nails,

Current Illness: Stage 4 cancer

ID: 1123876
Sex: M
Age:
State: WI

Vax Date: 02/14/2021
Onset Date: 03/01/2021
Rec V Date: 03/22/2021
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: Stroke; A spontaneous report was received from a consumer concerning her husband, a 75 years old, male patient who received Moderna (mRNA-1273) vaccine and experienced Stroke (Cerebrovascular accident). The patient's medical history was not provided. Concomitant products known to have been used by the patient, within two weeks prior to the event, included: prefervifion. On 14-Feb-2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: 031M20A)intramuscularly for prophylaxis of COVID-19 infection. On 1-Mar-2021, the patient had a stroke and was hospitalized on the same day. The patient is still hospitalized. No laboratory details were provided. On 14 Mar 2021, the patient has their second shot scheduled. Treatment information provided by the reporter included: Aspirin, prolix, cleft, lovenox. Action taken with mRNA-1273 in response to the event was unknown The outcome of the event, Stroke was considered Not resolved.; Reporter's Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1123877
Sex: F
Age: 84
State:

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 03/22/2021
Hospital: Y

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: Weakness Shortness of breath Covid-19

Other Meds:

Current Illness:

ID: 1123878
Sex: U
Age: 34
State: FL

Vax Date: 03/22/2021
Onset Date: 03/22/2021
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: Percocet/Zithromax

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt coughing/SOB. Pt hx of asthma that became symptomatic after vaccination. Pt triaged and assessed by MD. No audible wheezing. MD decided to escalate to ER for further evaluation.

Other Meds: unknown

Current Illness:

ID: 1123879
Sex: F
Age: 57
State: CT

Vax Date: 03/15/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies: Dust mite and cat dander allergy

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

Symptoms: I developed a non stop under eye twitch on my left eye 2 days post vaccine. Today is 6 days later and it's still twitching. I also feel extra fatigue.

Other Meds: Gabapentin, lisinopril, loratadine, vit d3, melatonin, turmeric. I did not take the last 4 supplements day before or a few days post vaccine.

Current Illness:

ID: 1123880
Sex: M
Age: 30
State: KS

Vax Date: 12/17/2020
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: General Message: Patient left voicemail regarding his COVID-19 positive status after being fully vaccinated. He had spoke with physician over the weekend who said another physician might be interested in testing him for variants.

Other Meds:

Current Illness:

ID: 1123881
Sex: M
Age: 16
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None Stated

Symptom List: Unevaluable event

Symptoms: Dose give outside of the recommended age range.

Other Meds: None Stated

Current Illness: None Stated

ID: 1123882
Sex: F
Age: 61
State: IL

Vax Date: 03/21/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Around noon the following day I started feeling achy and tired. My eyes burn and I have chills. Just feel like I'm coming down with something.

Other Meds: aspirin 250mg qd Lisinopril Metoprolol

Current Illness: N/A

ID: 1123883
Sex: F
Age:
State: NY

Vax Date: 01/30/2021
Onset Date: 02/24/2021
Rec V Date: 03/22/2021
Hospital: Y

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: Emergency room for gallbladder; Could not get out of bed; A spontaneous report was received from a 85-year-old female patient who had to go to Emergency room for gall bladder/ gallbladder disorder NOS and could not get out of bed/bedridden after receiving Moderna's COVID-19 vaccine (mRNA-1273). Medical history or concomitant product use was not reported. On 30 Jan 2021, the patient received first of two planned dose of mRNA-1273 (batch number: 032L20A) intramuscularly for prophylaxis of COVID-19 infection. On 24 Feb 2021, the patient went to the emergency room for gallbladder and was admitted same day. On 26 Feb 2021, the patient had a procedure done and had a bag for drainage. On 01 Mar 2021, the patient was admitted to rehabilitation facility and remained there as of 10 Mar 2021. The patient was planned to receive the second dose of mRNA-1273 on 27 Feb 2021. Since the patient was in the rehab facility, the pharmacy provided the vaccine on 04 Mar 2021 but the patient could not get out of bed to go to the pharmacy. Action taken with mRNA-1273 in the response to the events Emergency room for gall bladder and could not get out of bed was not reported. The outcome of the events Emergency room for gall bladder and could not get out of bed was unknown.; Reporter's Comments: Very limited information regarding the events has been provided at this time. Further information has been requested.

Other Meds:

Current Illness:

ID: 1123884
Sex: F
Age: 89
State: TX

Vax Date: 03/15/2021
Onset Date: 03/16/2021
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: levaquin, flagel, iodine

Symptom List: Injection site pain, Menorrhagia

Symptoms: The night of the vaccine she developed fever and chills. 3/17 she had bowel and urine incontinence and her daughter told her to rest and then she insisted on getting into the shower because she was upset about the incontinence 9:15 am she had gotten in the shower and her other daughter was close by when she had bowel and urine incontinence again and then lost consciousness and then she came to and had bowel and urine incontinence for a 3rd time. The bowel movements were massive diarrhea. Reporter believes she had a TIA event (Mini stroke). She was cared for at home by her daughter who is a nurse. In the past, when she has high fever and chills she tends to have TIA events.

Other Meds: labetalol, pravastatin, gabapentin, donepezil, zyrtec, vitamin B6, Centrum Silver Multivitamin, Acetaminophen, ibuprofen, Calcium, Magnesium, Biotin

Current Illness: No

ID: 1123885
Sex: F
Age: 41
State: OH

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

Lab Data:

Allergies: None

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

Symptoms: Diarrhea, racing heartbeat, heart palpitations, headache, nausea all started at 1.5 hours post injection.

Other Meds: Synthroid 75 mcg Vitamin D3 125 mcg

Current Illness: None

ID: 1123886
Sex: M
Age: 49
State: TX

Vax Date: 03/03/2021
Onset Date: 03/13/2021
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: approx 6" area around injection spot on arm was pink in color/irritated/warm to touch for a couple of days (which began over a week after injection); a Google search identified all these symptoms as "Covid arm" which matched it perfectly...after 3-4 days symptoms went away no issues since then; my second shot scheduled for 3/31/21

Other Meds: OTC multi-vitamin daily

Current Illness: none

ID: 1123887
Sex: F
Age: 50
State: TX

Vax Date: 03/12/2021
Onset Date: 03/21/2021
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: Penicillin Vancomycin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Bump and rash on left arm one week after shot.

Other Meds: Calcium Tumeric

Current Illness: N/A

ID: 1123888
Sex: M
Age: 44
State: IL

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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: None

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

Symptoms: Vertigo. Tremors.

Other Meds: None

Current Illness: None

ID: 1123889
Sex: M
Age: 21
State:

Vax Date: 03/21/2021
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: RA

Lab Data:

Allergies: Sulfa

Symptom List: Nausea

Symptoms: Chills @ 5 am till 6 am Lightheadedness @ 5:30am Vomit @ 5:45 am Fever & night sweats from 6 am till 1pm

Other Meds:

Current Illness:

ID: 1123890
Sex: M
Age: 0
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: Lortab; Bactrim; Terazosin; Green Tea weight loss formula

Symptom List: Injection site pain

Symptoms: External rash. Treated with antihistamines

Other Meds: Unknown

Current Illness: Patient has a rash on 12-11-2020

ID: 1123891
Sex: F
Age: 84
State: LA

Vax Date: 03/08/2021
Onset Date: 03/16/2021
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: Unknown

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

Symptoms: Patients husband called to report incident. Patient developed Bells Palsy on 3/16/21, which was 8 days following the 1st dose of Moderna Covid-19 vaccine. She was treated by PCP and also by a specialist. Ongoing tests and follow-up were scheduled. She was started on several medications that the husband reporting did not know at the time. The incident was reported to the pharmacy several days after incident.

Other Meds: Unknown

Current Illness: Unknown

ID: 1123892
Sex: F
Age: 74
State: CT

Vax Date: 01/25/2021
Onset Date:
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:

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

Symptoms: exacerbated multiple sclerosis; weakness; fatigue; chills; fever; A spontaneous report was received from a consumer, who is a 74-year old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced weakness/ asthenia, fatigue, chills, fever/ pyrexia and exacerbated multiple sclerosis (MS)/ multiple sclerosis relapse. The patient's medication history included multiple sclerosis and COVID infection on 27 Dec 2020. No relevant concomitant medications were reported. On 25 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: not provided) intramuscularly in left arm for prophylaxis of COVID-19 infection. On an unspecified date, after receiving vaccine, the patient experienced weakness, fatigue, chills, fever and exacerbated multiple sclerosis (medically significant). No treatment information was reported. Action taken with mRNA-1273 in response to the events was unknown. The second dose of the vaccine was scheduled on 25 Feb 2021. The outcome of the events was unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds:

Current Illness: Multiple sclerosis

ID: 1123893
Sex: M
Age: 70
State:

Vax Date: 01/23/2021
Onset Date: 01/30/2021
Rec V Date: 03/22/2021
Hospital: Y

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: Pneumonia Acute hypoxemic respiratory failure due to COVID-19 (CMS/HCC) COVID-19 virus infection

Other Meds:

Current Illness:

ID: 1123894
Sex: M
Age: 33
State: MD

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

Lab Data:

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: Had a syncope episode right after vaccine lasting a few seconds.

Other Meds: none

Current Illness: none

ID: 1123895
Sex: M
Age: 73
State: FL

Vax Date: 03/12/2021
Onset Date: 03/19/2021
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: Using V Safe I reported mild symptoms of soreness & swelling at the injection site which abated by day 5. V Safe stopped communicating by Friday, 3/19. I'm trying to make the CDC aware that they are missing reportable adverse react because of limited follow-up. I developed itching at the injection site on 3/20 in the a.m. I note approximately a 15 cm area of erythema around the injection site. On 3/20, after a 5 mile walk I felt similar symptoms that I had in the first couple of days after the injection of lightheadedness and felt poorly enough to have to rest the remainder of the day. I am better today and was able to function, but not ready to resume exercise. How many others have had a delayed reaction that is being missed because V Safe stops the follow-up when initial signs & symptoms disappear?

Other Meds: PreviDent

Current Illness: None

ID: 1123896
Sex: F
Age: 26
State: TX

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

Lab Data:

Allergies:

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

Symptoms: Vaccine error. The patient received Dose 1 Moderna 2/24/2021 (lot 012A21A) and received the second dose of Pfizer 3/22/2021 (lot EN6206) in error. The dose should have been Moderna. The event occurred at a large vaccine site administered jointly. This event is being reported as a vaccine error to assist in data collection and process improvement. CDC recommendations are that no further action is needed at this time. Patient was counseled by a doctor .

Other Meds:

Current Illness:

ID: 1123897
Sex: M
Age: 37
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient started breathing heavily a few minutes after receiving the vaccine, was able to say words not full sentences. said he was feeling hot. he lost muscle control and uncontrollably urinated. EMR was contacted; patient retained muscle control and got back to normal in about 2 minutes after the start of the adverse events. and was able to walk with the EMR outside to get medical check.

Other Meds:

Current Illness:

ID: 1123898
Sex: F
Age: 66
State: OK

Vax Date: 03/11/2021
Onset Date: 03/12/2021
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: Sulfa - rash, severe headache

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

Symptoms: Approx 12 hr after receiving the 1st dose of Moderna, she states she woke at 3am due to a strong perfume scent. She feels the smell comes from her nose. She has not lost her sense of smell. The perfume smell is always there, but she can smell other odors as well (eg- toothpaste, peanut butter) The odors are just combined. The perfume scent is less prominent at times, but always there.

Other Meds: Vit D3, multi vit, calcium citrate Atenalol as needed

Current Illness: None

ID: 1123899
Sex: F
Age: 45
State: IN

Vax Date: 03/20/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Aspirin, Ibuprofen, naproxen, Latex. Almond food allergy.

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

Symptoms: MAY NOT BE CONSIDERED ADVERSE EVENT BUT WANTED TO REPORT IT: About 10 minutes after shot I experienced a sharp pain in my bottom right occipital lobe/base of skull. Later only about 1 min. Also experienced tingling sensation in my eyes and vision interference that lasted about 20 seconds tops. Immediately following, however, my vision appeared sharper. I also experienced sharp pain about a few hours later in bottom left occipital/base of skull that only lasted about 30 seconds. Other than that I feel great! Given the newness of the vaccine I felt it important that you know.

Other Meds: Albuterol rescue inhaler (only prescription). Ashwaghanda, probiotics, krill oil, cinnamon and cranberry herbal supplements. Regular daily vitamin and regular metamucil.

Current Illness:

ID: 1123900
Sex: F
Age: 39
State: TX

Vax Date: 01/21/2021
Onset Date: 01/28/2021
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: Penicillin

Symptom List: Pain in extremity

Symptoms: I had really bad pain started in the middle of the night pain on my left side traveled from left arm to upper back. I went to ER thought I was having a heart attack. The lymph nodes was swollen had Cardiac work up and Xray(muscular).

Other Meds: Tylenol

Current Illness: No

ID: 1123901
Sex: F
Age: 55
State: VA

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: N/A

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

Symptoms: On 3/21/21 - 30 minutes after the shot I developed a bad headache. Took Tylenol. 3/22/21 - At 1:30 AM body aches, legs and feet throbbing. Left-arm very painful. Intense headache. 4:00 AM chills and severe pain in my limbs. Limbs felt heavy. 12:00PM soaked feet in Epsom Salt for pain relief. 1:15 PM felt queasy then had diarrhea. Afterwards, nn my way upstairs legs felt heavy, flash of heat in my head and almost fainted. Been in bed and symptoms have not subsided. Still taking Tylenol.

Other Meds: Bupropion xl 300mg Lexipro 10 my Iron 28 my Multi-Vitamin

Current Illness: None

ID: 1123902
Sex: M
Age: 17
State: MD

Vax Date: 03/15/2021
Onset Date: 03/15/2021
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: No adverse events reported - patient was out of age range of Emergency Use Authorization.

Other Meds:

Current Illness:

ID: 1123903
Sex: M
Age: 73
State: OK

Vax Date: 03/02/2021
Onset Date: 03/02/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient received a Pfizer dose after having been given a Moderna dose previously.

Other Meds:

Current Illness:

ID: 1123904
Sex: F
Age: 71
State: OR

Vax Date: 03/06/2021
Onset Date: 03/06/2021
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: Penicillin, sulfa, ambien, fosamax, fentanyl

Symptom List: Vomiting

Symptoms: 6 hour post injection: stabbing headache with pains every min or so. Temp 100 . 12 hours post: headaches continued with temp 100.5 - acetaminophen tried several times with no relief 18 hours post: temp rise to 101.5; headaches still stabbing - took oxycondon 6 hours a part 3 times - was able to sleep 24 hours: temp 101 headaches still present, not as constant 36 hours: temp 99 and feeling better with only occ headache Resolved within 6 more hours

Other Meds: Xarelto, esomeprazole, ambrisentan,calcitriol, atorvostatin, levothyroxin, furosemide, famitidine

Current Illness: None

ID: 1123905
Sex: M
Age: 67
State: CO

Vax Date: 03/03/2021
Onset Date: 03/10/2021
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: Mild headache and flu-like light-headiness for approximately 12 hours. No other symptoms.

Other Meds: None

Current Illness: None

ID: 1123906
Sex: F
Age: 44
State: IA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Began itching as soon as vaccine received- took 50 mg of Benadryl po and no further c/o

Other Meds:

Current Illness:

ID: 1123907
Sex: M
Age: 17
State: MI

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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 Stated

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine administered outside of the recommended ages,

Other Meds: None Stated

Current Illness: None Stated

ID: 1123908
Sex: F
Age: 25
State: NY

Vax Date: 03/17/2021
Onset Date: 03/20/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Appendicitis with resulting appendectomy Appendicitis symptoms started at 6pm on 3/20/2021 Confirmed appendicitis at Emergency Room on 3/21/2021 at 12pm Laparoscopic appendectomy at 7:30pm 3/21/2021

Other Meds:

Current Illness:

ID: 1123909
Sex: F
Age: 57
State: KY

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

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

Symptoms: Throat swelling-patient reported

Other Meds: Livalo and Levothyroxine

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm