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: 1126801
Sex: F
Age: 78
State: MI

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/23/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Recipient was given Janssen Covid 19 Vaccine. Nurse was not aware that recipient had already received first dose of Moderna vaccine on 2/25/21 as client was not able to relay this information.

Other Meds: Unknown

Current Illness:

ID: 1126802
Sex: M
Age: 49
State: NV

Vax Date: 03/16/2021
Onset Date: 03/23/2021
Rec V Date: 03/23/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Itching, rash and redness at injection site 1 week after injection received.

Other Meds:

Current Illness:

ID: 1126803
Sex: F
Age: 76
State: NV

Vax Date: 02/01/2021
Onset Date: 03/18/2021
Rec V Date: 03/23/2021
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: ER VISIT X 2 diagnosed with Shingles

Other Meds: Daily centrum multi vitamin Norvasc Atorvastin

Current Illness: NA

ID: 1126805
Sex: F
Age: 48
State: DE

Vax Date: 03/18/2021
Onset Date: 03/22/2021
Rec V Date: 03/23/2021
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: noticed rash on entire body 3/22/2021 around 6pm , non pruritic, called pharmacist he recommend taking Benadryl 50mg every 6 hours as needed , rash has improved some , not completely gone away

Other Meds: norethindrone 5mg, Prilosec otc, zyrtec

Current Illness: none

ID: 1126806
Sex: M
Age: 78
State: MN

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 03/23/2021
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: Very bad muscle and joint pain in my hips, groins, and knees. My shoulders were much sorer than normal as well as I have had soreness in both shoulders which has been ongoing. My symptoms continue. My walking, sitting, and standing up, all are affected.

Other Meds: atorvastatin-cholecaliferol-clopidogrel-coenzime Q1 glucos-chrondroit-melatonin-metoprol tartrate-warfarin

Current Illness:

ID: 1126807
Sex: F
Age: 46
State: NE

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/23/2021
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: Amoxicillin

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

Symptoms: I have not had a period for over 6 months, I overlap my birth control to not have a period. Since the vaccine I have started bleeding and the bleeding has gotten worse each day. Along with the period I am now getting cramps that I have never had in the past. Also feel very foggy in the head.

Other Meds: Zyrtec, Montelukast, Fluticasone

Current Illness: none

ID: 1126808
Sex: M
Age: 70
State: NH

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 03/23/2021
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 allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Well he got the shot at 9 in the morning and by 4 in the a.m he had a stoke and it took him 5 hrs to get to his phone for help and called my mother

Other Meds: He doesn't take any medication. To my knowledge

Current Illness: He was very healthy worked out daily, still worked a job 40 hrs a week and was very active and on the go

ID: 1126809
Sex: F
Age: 58
State: NH

Vax Date: 03/07/2021
Onset Date: 03/16/2021
Rec V Date: 03/23/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: I noticed nerve pain(left side back to front), pain on my back right below scapula. On 3/17 I was diagnosed with Shingles prescribed Antiviral, Lidocaine patches and Ibuprofen.

Other Meds: Metformin 2 day,Lipitor 80 once daily, Zetia 10 mg, Vit D 2000 units daily

Current Illness: No

Date Died: 03/20/2021

ID: 1126810
Sex: M
Age: 89
State: AZ

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 03/23/2021
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: Codiene

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient suffered AMI within 24 hours after dose was administered.

Other Meds: Acetaminophen 325mg tab, 1 tab 4x per day as needed for leg pain Artificial tears PVA 1.4%/Povidone, 1 drop in both eyes 4x per day as needed for dry eyes Brimonidine 0.2T ophthal. solution, 1 drop in both eyes 3x per day for glaucoma Diclo

Current Illness: RIGHT inguinal hernia with small bowel entrapment/reducible Dementia Anemia Impaired glucose tolerance Cholelithiasis RIGHT ankle pain Glaucoma Dry eye syndrome COPD hyperlipidemia asbestosis

ID: 1126811
Sex: F
Age: 63
State: NJ

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/23/2021
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: NONE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Wednesday night I felt tired and cold. Woke up Thursday morning and couldn't lift up my head. Migraine was in all of top teeth, ears, behind eyes, all over head. Pain was so extreme I fainted in bed. Came to and pain was a bit better but quickly came back full force. Woke up at 1am Friday morning drenched from sweat through to the mattress but migraine was better. Ran fever up to 102 and down and up all day Friday. Saturday fever was only 100 but came back after each sweat. Sunday I had almost no fever and just a regular head ache. Monday exhausted but okay.

Other Meds: VITAMIN C, MULTI, BIOTIN, CALCIUM

Current Illness: Possible exposure to COVID

ID: 1126812
Sex: F
Age: 54
State: FL

Vax Date: 03/15/2021
Onset Date: 03/21/2021
Rec V Date: 03/23/2021
Hospital:

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

Lab Data:

Allergies: Percocet

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

Symptoms: A week after vaccine started dizziness, lightheadedness, vertigo. This is day 3 of symptoms

Other Meds: Lantus Victoza Lipitor Tylenol Advil

Current Illness: None

ID: 1126813
Sex: F
Age: 55
State: SC

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/23/2021
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: No

Symptom List: Rash, Urticaria

Symptoms: Nausea and vomiting continuously for three hours that afternoon of receiving the vaccine. Felt bad the next day but nothing horrible. A week later experienced what they call Covid arm. So far that has lasted about four days but it is better.

Other Meds: Levemir Glipizide Januvia Metformin Olmesartan Amlopodine Xanax Elations Dexilant Vitamin b12 Vitamin d Cranberry extract Potassium gluconate

Current Illness: DCIS in situ

ID: 1126814
Sex: F
Age: 59
State: IN

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/23/2021
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, Iodine and Codine

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

Symptoms: Low grade fever, cold chills, sever headache and body ache. Flu like symptoms.

Other Meds: Aspirin 81 mg, Carvedilol 6.25 mg, Losartan 25 mg, Metformin HCL 500 mg, Atorvastatin 80 mg and Tylenol 500 mg

Current Illness:

ID: 1126815
Sex: M
Age: 49
State: VA

Vax Date: 03/02/2021
Onset Date: 03/04/2021
Rec V Date: 03/23/2021
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: Allergic to sulfa medication

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

Symptoms: Peripheral neuropathy and/or paresthesia in hands, feet and (occasionally) face.

Other Meds: Losartan-HCTZ 100-25 Protonix

Current Illness:

ID: 1126816
Sex: F
Age: 61
State: VA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/23/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Patient received COVID19 vaccine @ 1411. Pt was waiting in biosafety area when she began complaining of discomfort. Pt. felt "nervous, dizzy, and shaky". Pt. could neither confirm nor deny difficulty breathing, but expressed a tightness in the throat. Epinephrine IM was administered at 1433. 911 was called. Pt remained responsive. BP 186/98, 99% on RA, RR increased, EMS assumed care of pt who remained conversational and was transported w/ family (sister) present.

Other Meds:

Current Illness:

ID: 1126817
Sex: F
Age: 34
State: VA

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 03/23/2021
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: Patient fainted shortly after vaccination (within 15 minutes) and had low BP. Patient refused transport to ER and was released to home.

Other Meds:

Current Illness:

ID: 1126818
Sex: M
Age: 69
State: CA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/23/2021
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: NKA

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

Symptoms: admitted to the ICU with acute respiratory failure. h/o DM and HL, prior h/o smoking and EtOH and opium abuse (none x 28 yrs, per family). Received second dose of the Pfizer COVID vaccine in AM of 3/16, having had severe adverse reactions (fever up to 104, n/v) to the first dose three weeks earlier. Experienced recurrent fevers (up to 103) beginning by the evening of 3/16, for which he took acetaminophen. Awoke at 3 AM w/ recurrent fevers, for which he took ibuprofen. Felt better in AM, had breakfast, and retired back to bed. Awoke shortly after noon w/ severe n/v and AMS. Was brought to the ED by the EMS. Febrile (T 39.6) w/ rigors, tachycardic, tachypneic, and poorly responsive on arrival. Continued to experience episodes of emesis, and was felt to have possibly had a seizure episode ("looked to the side and was shaking"; no clear tonic-clonic movements noted). Was thus intubated for airway protection. Initial laboratory w/u revealed presence of mild leukocytosis (WBC 12.6, 47p49L0Eo), lactic acidosis (LA 5.2), hyperglycemia (glu 297), elevated lipase level (161) renal insufficiency (Cr 1.23). extubated on 3/19. received antibiotics for positive blood culture (streptococcus parasanguinis). diagnosis: ADVERSE EFFECT OF CORONAVIRUS COVID-19 VACCINE

Other Meds:

Current Illness:

ID: 1126819
Sex: F
Age: 71
State: OH

Vax Date: 02/23/2021
Onset Date: 02/27/2021
Rec V Date: 03/23/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: sulfa macrobid norco

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe headache, earaches, tinnitus, jaw pain, eye pain started 2/27/2021. Started taking 300 ml of ibuprofen & 500 ml acetaminophen 3 times daily. Went to PC doctor, on 3/3/2021 who prescribed antibiotics and later a CT sinus scan. Went to ER on 3/22/2021 where was given CT brain scan, injection of ketorolac and 60 mg prednisone for 6 days. Finished prednisone and symptoms returned. Again taking ibuprofen and acetaminophen for pain. Symptoms are still on a daily basis and did not go to receive the next vaccination. Have follow up with ENT doctor on 3/25/2021 and neurologist on 4/23/2021.

Other Meds: none

Current Illness: none

ID: 1126820
Sex: F
Age: 87
State: AZ

Vax Date: 02/06/2021
Onset Date: 02/09/2021
Rec V Date: 03/23/2021
Hospital: Y

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After vaccination my right arm went numb, then my leg, face and speech. I was taken by ambulance to hospital where they ran test and gave me magnesium and potassium and kept me overnight, they sent me home with a heart monitor and I still have it.

Other Meds: Ropinirole, daily vitamin, fish oil, calcium, Vitamins B,C,D

Current Illness: no

ID: 1126821
Sex: F
Age: 56
State: GA

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

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

Lab Data:

Allergies: penicillin, sulfa drugs, erythromycin, codeine

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

Symptoms: Just a very sore arm, and itchiness at the injection site on March 23. I hope within a few days it will go away.

Other Meds: losartan, sertaline, amlodpine

Current Illness:

ID: 1126822
Sex: F
Age: 41
State: VA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/23/2021
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: quinoa

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

Symptoms: 5 min after vaccine administration the entire right arm tingled. That faded within 2 min, at which point the tongue started tingling on both sides. At 18 min post-vaccine, patient spoke to pharmacist and was advised the tongue tingling was not an expected or documented side effect; the pharmacist requested that the patient stay an additional 5 min for monitoring. During that 5 min, a mild rash appeared on both forearms and tops of both hands. Pharmacist advised patient to take bendaryl and monitor for any further adverse symptoms. When patient reached vehicle, she noticed that her face was bright red and rash had appeared on part of neck and chest. Benadryl was taken at roughly 55 min post-vaccine. 1.5 hrs post vaccine, patient noted some of the rash had disappeared, the face tingling had stopped, and the tongue was less tingly.

Other Meds: Celebrex, vitamin D3, vitamin B12, folic acid

Current Illness: none

ID: 1126823
Sex: F
Age: 32
State: NY

Vax Date: 12/27/2020
Onset Date: 02/14/2021
Rec V Date: 03/23/2021
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: Persistent Left arm pain

Other Meds: Iron, Colace, Multivitamins, Vit C

Current Illness: None

ID: 1126824
Sex: M
Age: 65
State:

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/23/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient fell a day prior to receiving the vaccine on 3/18/21. Patient takes Eliquis daily. About one or two days after receiving the vaccination, the patient's skin became a blotchy red all over. His legs had a "honeycomb" like appearance. His mental status was altered slightly. Patient was admitted to the hospital 3/23/21.

Other Meds:

Current Illness:

ID: 1126825
Sex: F
Age: 65
State: NC

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient received first dose of covid vaccine on 2/26/21 with Pfizer manufacturer. At visit for second dose on 3/22/2021 patient received Moderna manufacturer as her second dose in error. No adverse reaction was reported from the vaccine, only reporting incorrect manufacturer received.

Other Meds:

Current Illness:

ID: 1126826
Sex: F
Age: 49
State: OH

Vax Date: 03/13/2021
Onset Date: 03/19/2021
Rec V Date: 03/23/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Eight days after receiving my first Moderna vaccine, my right arm developed a red, circular rash. It is slightly warm to the touch, sore but not painful, red and itchy. As of today, the redness has slightly faded and the other symptoms are improving..

Other Meds: Daily multivitamin Vitamin D Azelastine HCI Fluticasone Propionate

Current Illness: none

ID: 1126827
Sex: F
Age: 37
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 03/23/2021
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: Employee received .2 cc of Pfizer instead of .3 cc which was inadvertently administrated by vaccine nurse. NO ADVERSE REACTION, just reporting medication error. Our Vaccine Task Force, after speaking with CDC and PA DOH, decided to offer the employee an additional COVID-19 vaccine dose. Thanks.

Other Meds:

Current Illness:

ID: 1126828
Sex: F
Age: 41
State: ME

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/23/2021
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: Sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient has had continuous pain in her injected arm. She states that she can not lift her arm above her head. She spoke with a Tele Doc and then made an appointment with a provider

Other Meds: Lamotrigine 150mg, Vyvanse 70mg, Fluvoxamine 50mg, D-Amphetamine Salt Combo 20mg

Current Illness:

ID: 1126829
Sex: F
Age: 65
State: MO

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

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

Lab Data:

Allergies: Inhalants, dust, mold, and pollens

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 1. Two hour naps needed for 10 days after shot, now down to an hour. 2. Extremely out of breath - from day of shot and continues.

Other Meds: Armor thyroid, buproprion, amlodipine, probiotics, xeljanz, sodium diclofenac,

Current Illness: allergies, ear infection

ID: 1126830
Sex: F
Age: 72
State:

Vax Date: 02/01/2021
Onset Date: 02/02/2021
Rec V Date: 03/23/2021
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: When patient came to get her 2nd dose on 3/17/21, she reported that after getting the first dose, she had a reaction to it. The night of vaccination and the following day, she apparently had a swelling in the left side of her face including her lips and ears all the way including her head. She took Tylenol and was ok later the next day. She did not seek medical care for this. Discussed these with the MD who determined that she is not a candidate for the 2nd dose due to the allergic reaction. Explained to her and no 2nd dose given on 3/17/21.

Other Meds:

Current Illness:

ID: 1126831
Sex: M
Age: 23
State: VA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 03/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: 3 to 5 minutes after vaccination patient had nausea and then had a seizure that lasted about 30 seconds. Patient was transported to ER via EMS.

Other Meds:

Current Illness:

ID: 1126832
Sex: F
Age: 66
State: NJ

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/23/2021
Hospital:

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

Lab Data:

Allergies: Medications: Lipitor (leg muscle cramping), Tetracyclin (dry heaves), Avalox (hives), Niaspan (hives), Lazek (gout) Pruritis from short-stapled wool (scratchy) Increasingly becoming more lactose intolerant.

Symptom List: Injection site pain

Symptoms: Triggered atrial fibrillation within 4 hours after receiving 2nd dose. Double-loading Amiodarone for one week after speaking with doctor's office on 3/10/21 (3/10/21 - 3/16/21) and for another week (3/16/21 - 3/22/21) did not convert my heart back to normal sinus rhythm. During Kardia readings (taken 2-3 times per day), heart beat jumps back and forth repeatedly in the range of 92 to 110+.

Other Meds: Prescriptions: Metformin, Glipizide; Rosuvastatin, Levothyroxine, Carvedilol (Coreg), Torsemide, Lisiniprol, Fenofibrate; Xarelto, Amiodarone

Current Illness: None

ID: 1126833
Sex: F
Age: 61
State: NM

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/23/2021
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: 1130: Patient c/o dizziness approximately 15 minutes post vaccine. Patient stood up dizziness increased. PMHx: Epstien Barr, Bradycardia, Tachycardia Stage II Renal Disease Patient A & O x4, skin pink, warm and dry, PERRLA ~3mm Speech clear and appropriate. EMS and Physician on duty at bedside assessing patient. VS:1127:156/106-b/p, 60-hr, SaO2 96% on RA, 1141 VS: 154/104, Repeat 146/98 58-HR, SaO2 98% on RA EKG, VS as above. Patient advised to be evaluated in ED. Patient refused ambulance transport. Symptoms subsided, minimal at the time of departure ~1210. Patient taken to care via wheelchair. Daughter to transport to ED by Patient's own vehicle.

Other Meds: unknown

Current Illness: unknown

Date Died: 02/25/2021

ID: 1126834
Sex: F
Age: 78
State:

Vax Date: 01/13/2021
Onset Date: 01/16/2021
Rec V Date: 03/23/2021
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: NKDA

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

Symptoms: vaccinated 1/13. presented for COVID screening on 1/14 due to a + exposure. Test was +. Patient came to ED on 1/16 with weakness, congestion, poor appetite, coughing. Previous headache and sweating had resolved by the time she presented. Discharged with isolation instructions. Returned to ED late on 1/22 with " right-sided chest pain described as sharp constant 6/10 nonradiating pain localized to the right side of upper chest, shortness of breath with exertion since this afternoon. She does endorse subjective fevers, with associated increased coughing which is productive in nature, shortness of breath." Admitted to ICU early 1/23, transferred to Medical Center on 2/4/21.

Other Meds: unknown

Current Illness: unknown

ID: 1126835
Sex: M
Age: 52
State: TX

Vax Date: 03/12/2021
Onset Date: 03/21/2021
Rec V Date: 03/23/2021
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: None

Symptom List: Tremor

Symptoms: Redness and mild swelling around injection site - approx 2 inches in diameter. Noticed approximately 8 days after injection.

Other Meds: CBD supplements

Current Illness: None

ID: 1126836
Sex: F
Age: 55
State:

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/23/2021
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: Erythema, Pruritus

Symptoms: Headache same day (Tylenol). Next day headache, fever and chills, dizziness, sore arm (Tylenol)

Other Meds:

Current Illness: kidney stone

ID: 1126837
Sex: F
Age: 37
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 03/23/2021
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: Employee received .2 cc of Pfizer instead of .3 cc which was inadvertently administrated by vaccine nurse. NO ADVERSE REACTION, just reporting medication error. Our Vaccine Task Force, after speaking with CDC, decided to offer the employee an additional COVID-19 vaccine dose. Thanks.

Other Meds:

Current Illness:

ID: 1126838
Sex: F
Age: 41
State: IN

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/23/2021
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: Severe itching throughout body and mild rash throughout.

Other Meds: Sertaline, Xyretk

Current Illness: None

ID: 1126840
Sex: F
Age: 39
State: MD

Vax Date: 03/21/2021
Onset Date: 03/23/2021
Rec V Date: 03/23/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Day 2 after the vaccine i continued to experience body aches; in the morning i woke up with shortness of breath and headache

Other Meds: None

Current Illness: None

ID: 1126841
Sex: F
Age: 79
State: CO

Vax Date: 03/01/2021
Onset Date: 03/12/2021
Rec V Date: 03/23/2021
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: Percocet [Oxycodone-acetaminophen]- Anaphylaxis ALPHAGAN P [BRIMONIDINE] Niacin Some detergents

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

Symptoms: Adverse effect of vaccine, initial encounter The left elbow skin lesion which appeared immediately after her vaccination has suspicious timing, and we discussed with her that we will report this to the vaccine reporting system. The lesion almost appears to resemble psoriasis. In any case it is improving, and she can use the over-the-counter ointment that she has had on an as-needed basis. No further treatment needed.

Other Meds: calcium acetate (PHOSLO) 667 mg capsule cephalexin (KEFLEX) 500 mg capsule cetirizine (ZYRTEC) 10 mg tablet cholecalciferol (VITAMIN D3) 1,000 unit tablet citalopram (CELEXA) 20 mg tablet DOCOSAHEXANOIC ACID/EPA (FISH OIL PO) latanoprost (X

Current Illness: Lumbar pain Anxiety Palpitations Open-angle glaucoma, unspecified glaucoma stage, unspecified laterality, unspecified open-angle glaucoma type Pain of right hand Stiffness of right hand joint

ID: 1126842
Sex: U
Age: 69
State: VA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/23/2021
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: LATEX

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

Symptoms: PT WITH PREVIOUS KNOWN REACTION FROM 1ST DOSE COVID-19 VACCINE. PT CONSULTED WITH HER PHYSICAIN WHO ADVISED TO RECIEVE 2ND DOSE. STAFF AND EMS AWARE OF PT'S HISTORY. PT PRE-MEDICATED WITH 1/2 TABLET OF 25MG OF BENADRYL. PT VACCINATED 20 MINUTES POST ADMINISTRATION OF BENADRYL. DIZZINESS/SOB REPORTED BY PT 30 MINUTES POST VACCINE. EMS EVALUATED PATIENT. VITALS TAKEN. PATIENT OFFERED SUPPLEMENTAL OXYGEN FOR EASE OF BREATHING. 2L NC GIVEN. PT COMPLAINTS OF CHILLS, HEADACHE, CONTINUED SOB, SORE THROAT. OXYGEN INCREASED UP TO 6L NC. DISCUSSED PT BEING TRANSPORTED FOR EVALUATION. LUNGS CLEAR. PT STATED FEELING BETTER. OXYGEN DECREASED DOWN TO 4L NC. PT OBSERVED FOR 2 HOURS POST VACCINATION.

Other Meds: GABAPENTIN, LASIX, AMITRIPTYLINE, ASA, VICTOZA

Current Illness: NONE

ID: 1126843
Sex: F
Age: 37
State: NJ

Vax Date: 02/05/2021
Onset Date: 02/23/2021
Rec V Date: 03/23/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to pencillin.

Symptom List: Pain in extremity

Symptoms: I had typical vaccine side effects. I went in for a regular check up and had an ultrasound on 02/07/2021 that showed a low heart beat at 107 which is slightly low for 7 weeks gestation. On 03/05/2021 we repeated the ultrasound and had no heart beat.

Other Meds: I was taking prenatal vitamins and a baby asprin.

Current Illness: No

ID: 1126844
Sex: M
Age: 65
State: NY

Vax Date: 12/27/2020
Onset Date: 01/10/2021
Rec V Date: 03/23/2021
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: 12-27-2020 Injection; Volunteered for automated test for nasopharyngeal swab for Covid-19 Antigen on 1-7-2021. No symptoms. Nasal swab had some blood on it because of friable nasal mucosa. The Test (SCV2-SPX-EP molecular test by the lab) was reported positive on 1-10-21. Symptoms then were mild to moderate fatigue, occasional partially productive cough without respiratory distress (SpO2's on room air always > 94%), headache - mild and episodic, dulled sensorium (clouded thinking at times)

Other Meds: Pantoprazole, Vitamin D, Vit B-12, B-Complex Vit's, Vit C. Calcium, Fish Oil tablets, Baby Aspirin, Lutein, Cinnamon tablets, Biotin tablets, Probiotic capsules, Bromelain supplements, Mushroom tabs,

Current Illness: None

ID: 1126845
Sex: F
Age: 61
State:

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/23/2021
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: codeine, omeprazole

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

Symptoms: After waiting 20 minutes, noted some back pain, tightness; on oxygen at home; cannister almost empty. VSS ; uncertain after called about whether to be evaluated/go home; refused ED at that time. Decided if could get in car comfortably would go home, if not, to ED for evaluation. More chest tightness as tried to get in car, decided to go to ED for evaluation; again called.

Other Meds:

Current Illness:

ID: 1126846
Sex: M
Age: 34
State: NJ

Vax Date: 03/19/2021
Onset Date: 03/21/2021
Rec V Date: 03/23/2021
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: Tamiflu, Ciprofloxacin , activated charcol

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

Symptoms: I got vaccine on Friday3/19/21. Everything was good on Saturday but when I wake up on Sunday morning I realized that my neck is very stiff and I was not able move my neck. The pain was very severe and was predominantly in the area of upper back and right shoulder area. I was on bed whole Sunday. On Monday i had the same issue. On Tuesday I got little improved. On Tuesday I can move my neck left and right with some pain but still I can?t move my neck downward. I call my doctor?s office and they told me to use over the counter pain medication and if I still have pain until Thursday then schedule office visit.

Other Meds: Vitamin D, Lisinopril 5mg

Current Illness:

ID: 1126847
Sex: M
Age: 48
State: CO

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Fever of 100.7 with joint pain and body aches. Took Ibuprofen 2 200mg at onset and approximately 12 hours later

Other Meds: Methylphenidate ER 36gm, Metformin HCL 2000gm x2, Insulin Glargine injection 30units x2

Current Illness:

ID: 1126848
Sex: M
Age: 33
State:

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Employee received .2 cc of Pfizer instead of .3 cc which was inadvertently administrated by vaccine nurse. NO ADVERSE REACTION, just reporting medication error. Our Vaccine Task Force, after speaking with CDC and, decided to offer the employee an additional COVID-19 vaccine dose. Thanks.

Other Meds:

Current Illness:

ID: 1126849
Sex: F
Age: 71
State: UT

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

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

Lab Data:

Allergies: Sulfa, B-12, Chili

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

Symptoms: As of this morning- 5 days after receiving my second dose. My left arm was tender and red about 2 inches below the injection site. The red and warm area measured about 1.5 inches high by about 4 inches around my arm. I also have slight chills. About 18 hours after receiving the shot I got a headache up the back of my head. Tylenol was taken and it took care of the problem.

Other Meds: Aller-Flo, AllerClear--neither of these were taken today.

Current Illness: none

ID: 1126850
Sex: F
Age: 43
State: AK

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 03/23/2021
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: metrogel, statin drugs

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Left arm pain, swelling and swollen glands day of immunization. Left arm pain and limited mobility ongoing . (3 months now.)

Other Meds: Prozac, multi vitamin, mini pill

Current Illness: none

ID: 1126851
Sex: M
Age: 55
State: TX

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/23/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Coughing up phlegm, head congestion, fever, headache, fatigue I have been coughing up phlegm, had head congestion, headache and been very fatigued for 12 days. Only my fever has gone away.

Other Meds: multivitamin, vitamin c, glucosamine, Tumeric, fish oil, cardia xt 180

Current Illness: None

ID: 1126852
Sex: F
Age: 45
State: DC

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/23/2021
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: ACE inhibitors, Angiotensin Reuptake Blockers, Xanax, SSRIs, SNRIs, Bactrim

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

Symptoms: Extreme dizziness and nausea immediately following injection, lasted for over an hour. After 10 minutes following injection a strong wave of nausea started in pit of stomach and moved up through abdomen to chest, then felt moderate chest pressure and warmth, lasting about 3-5minutes. Blood pressure was 177/110 and pulse was 138 approximately 15minutes following injection and sustained this high for another 20minutes. After an hour of observation, went home and experienced significant exhaustion and drowsiness.

Other Meds: Spirinalactone, vitamin D, zinc, collagen

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm