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: 1129697
Sex: F
Age: 31
State: DC

Vax Date: 03/11/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Moderna COVID?19 Vaccine EUA On 3/23 I was fatigued and slept the entire day, woke at 9 am and slept 11 am to 603 pm. Today, 3/24, the injection site has developed a rash which is itchy and hot to the touch and some mild swelling. I plan to get my second dose on 4/8

Other Meds: None

Current Illness: None

ID: 1129698
Sex: F
Age: 70
State: TX

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/24/2021
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: Many food allergies , pollen . Multiple chemical sensitivity

Symptom List: Anxiety, Dyspnoea

Symptoms: 8 pm - hyper, frequent urination,chills,fever,nausea,weakness , feeling ?faint?. Symptoms lasted 4 days . Then intermittent fever & chills . After 4 days red & swollen @ site of FIRST injection (NOT the 2nd injection !) . Extreme fatigue for a week .

Other Meds: None

Current Illness: Fibromyalgia, chronic myofascial syndrome, stenosis, neuropathy, pinched nerves

ID: 1129699
Sex: F
Age: 43
State: CO

Vax Date: 03/19/2021
Onset Date: 03/22/2021
Rec V Date: 03/24/2021
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: none

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

Symptoms: 1 day of itching on face and scalp

Other Meds: Benadryl

Current Illness: none

ID: 1129700
Sex: F
Age:
State: FL

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Dizzy; Sick to the stomach; Could not eat; Sore throat; Pain in arm; Horrendous headaches; Pass out the day after; Very sick; A spontaneous report was received from consumer concerning female patient of unknown age, who experienced pass out the day after (syncope), very sick (illness), horrendous headaches (headache), dizzy (dizziness), sick to the stomach (abdominal discomfort), could not eat (decreased appetite), pain in arm (vaccination site pain), and sore throat (oropharyngeal pain). The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received first dose of two planned doses of mRNA-1273 on 11 Mar 2021 intramuscularly for prophylaxis of COVID-19 infection. On 11 Mar 2021 the patient was very sick. On 12 Mar 2021 the patient passed out. Patient stated she had horrendous headaches, was dizzy, sick to stomach and could not eat. Patient stated she had pain in arm and sore throat. Treatment for the events was not provided. Action taken with mRNA-1273 in response to the event(s) was not provided. The event, pass out the day after (syncope), was considered as recovered on 12 Mar 2021. The outcome for the events of very sick (illness), horrendous headaches (headache), dizzy (dizziness), sick to the stomach (abdominal discomfort), could not eat (decreased appetite), pain in arm (pain in extremity), and sore throat (oropharyngeal pain) 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 event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1129701
Sex: F
Age: 86
State: CA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/24/2021
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: Patient received 1st dose Pfizer then 2nd dose Moderna.

Other Meds:

Current Illness:

ID: 1129702
Sex: M
Age: 41
State: FL

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/24/2021
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: Patient stated that he started to feel itchy, dizzy, and fainted when he bent over. Fell asleep and said he was dreaming when we woke him up a few seconds later. It started happening around 5 minutes after he received the vaccine. He stated that he felt fine and back to normal after he was woken up. Had him stay until paramedics came to check him out. Was cleared to go home.

Other Meds: N/A

Current Illness: NONE

ID: 1129703
Sex: F
Age: 33
State:

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient states about an hour after Pfizer dose #1, she developed itching on back with one hive - lasted approximately 4 days. Patient estimates the size of hive was around 3cm-5cm. EE states still feels itchy on/off to this day.

Other Meds:

Current Illness:

ID: 1129704
Sex: F
Age: 57
State: NY

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, aspirin, Advil

Symptom List: Pharyngeal swelling

Symptoms: Face became numb, had mild hives, continue itchiness for 2 days

Other Meds: Multi vitamin, Metoprol, D, B, Supplements, Ubiqunal ,Triphala

Current Illness: none

ID: 1129705
Sex: M
Age: 40
State: MT

Vax Date: 03/03/2021
Onset Date: 03/21/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient had facial twitch and his tongue felt like it had a film on it around 3/17/2021. Patient had right sided facial paralysis starting 3/21/2021. Patient went to the ER that day and was diagnosed with Bells Palsy. Was Given IV steroids that day in the ER and was put on oral Valtrex and Prednisone. Patient was told that symptoms were caught early. 3/24/2021 patient reports that symptoms are starting to resolve and he is starting to get more feeling around his mouth.

Other Meds: 10mg Zyrtec 10mg Losartan

Current Illness: None

Date Died: 03/23/2021

ID: 1129706
Sex: M
Age: 78
State: MN

Vax Date: 02/25/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Patient presented to SJMC in Brainerd by private car, 3/23/21 DOA. Family with patient wanted no resuscitation. Patient pronounced deceased 2:49 pm.

Other Meds:

Current Illness:

ID: 1129707
Sex: M
Age: 61
State: IN

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Fever 99.8, nausea, tiredness, feeling unwell. Slept and rested. Symptoms gone by 3-24-2021 at 11:00 AM

Other Meds: Atorvastatin 40mg, Tadalafil 20mg, aspirin 81mg, Vitamin D3 5000iu, omeprazole 40mg, Lisinopril 10mg, Folic Acid 400MCG, Bupropn 300mg, Fish Oil 1200MG, Vitamin C 2000MG, Mirtazapine 15MG

Current Illness: None

ID: 1129708
Sex: F
Age: 48
State: IN

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Chills, nausea, headache, fatigue, fever, arm soreness with pain in armpit,

Other Meds: Multi vitamin Goli

Current Illness: None

ID: 1129709
Sex: F
Age:
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/24/2021
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: Mouth stroke; Speech affected; Tired; Little soreness at the injection site; A spontaneous report was received from a consumer concerning a 68-year old female patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced mouth stroke/dyskinesia, speech affected/dysarthria, little soreness at injection site/vaccination site pain and tired/fatigue. The patient's medical history mentions history of diabetes. Concomitant medications were not provided. On 25 Feb 2021, approximately 16 days prior to the onset of the events, the patient received the first of the two planned doses of mRNA-1273 (Batch number: 012A21A) intramuscularly for prophylaxis of COVID-19 infection. On 12 Mar 2021, reporter mentions that apart from having a little soreness at the injection site, the patient had to stay in bed all day, was tired and her speech was affected. Reports she is much better, but the doctors confirmed that she had symptoms of a mild stroke and mouth stroke. Treatment information was not provided. Lab tests were not provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the events, mouth stroke, speech affected, little soreness at injection site and tired, were considered resolved.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness: Diabetic (No reported medical history.)

ID: 1129710
Sex: F
Age: 64
State: FL

Vax Date: 03/15/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: None that I know

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

Symptoms: Swollen at injection sight red and hot to the touch

Other Meds: Blood pressure Estrogen Fish oil Water pill Vitamin E Flaxseed Elderberry

Current Illness: None

ID: 1129711
Sex: F
Age: 55
State: TX

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Bananas, melons corn & Latex

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

Symptoms: One hour after the injection the itching started in the scalp are and progressed to the face and jaw line. By the second hour the itching progressed to the chest and bra line area. I also started to experience a dull headache which did not go away. Took 2 Benadryl but this did not help. Took another round of Benadryl 6 hours later and went to bed. The next day (3-24-21) I woke with no itching, but the dull headache remains.

Other Meds: Vitamin C, Vitamin D3

Current Illness: None

ID: 1129712
Sex: F
Age: 52
State: IN

Vax Date: 03/05/2021
Onset Date: 03/10/2021
Rec V Date: 03/24/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient developed urticaria days 5-7 post vaccination. Day 7-10 developed angioedema tongue- not involving lips.

Other Meds: Tamoxifen.

Current Illness:

ID: 1129713
Sex: F
Age: 37
State: OH

Vax Date: 03/13/2021
Onset Date: 03/22/2021
Rec V Date: 03/24/2021
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: The patient contacted the pharmacy the morning of 03/24/21. She stated that this past monday (03/22/21) she began to have an adverse reaction to her vaccine. She stated that she began to develop tenderness, erythema, pain, and swelling at the injection site. She stated she had looked into her symptoms online and believed it was "COVID arm". After talking with the patient about her symptoms, I agreed. She was applying a topical corticosteroid as needed for the discomfort. I instructed her to contact her physician if her symptoms did not subside within the next few days.

Other Meds: Macrobid PRN for UTI prophylaxis

Current Illness: Used Macrobid prior to vaccine and after vaccine for UTI prophylaxis

ID: 1129714
Sex: M
Age: 22
State:

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/24/2021
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: Patient was at a shot exercise for his second dose of Pfizer COVID Vaccine, he got his second vaccine and went to the next table where he then got another dose of vaccine. Thus got 2 second doses.

Other Meds:

Current Illness:

ID: 1129715
Sex: F
Age: 23
State: CO

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies: Pineapple

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fatigue and myalgias set in about 6 hours after vaccine was administered Shortly after, tachycardia set in with pulse at 140-150 bpm resting. Fever set in at 8 pm at 103F. One OTC Benadryl brought pulse down to 130s resting. Performed Valsalva Maneuver with pulse improvement to 110s. By morning, fever was still at 103F, with headache, muscle pain, chills, fatigue, pain at injection site, and swollen lymph nodes present. Tachycardia had resolved. Within 48 hours after vaccine was administered, all side effects had resolved except fatigue and swollen lymph nodes and headache. All side effects had completely resolved 9 days after vaccine was administered.

Other Meds: Duloxetine, Gabapentin, Relafen, Vitamin D, Acetaminophen

Current Illness: None

ID: 1129716
Sex: F
Age: 43
State: FL

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Generalized myalgias, fatigue, chills, nocturnal sweats and vomiting. Tx: 1000ml Sodium Chloride IV Discharged to home

Other Meds: Deakote, Yaz, Prozac, Crestor

Current Illness: None

ID: 1129717
Sex: F
Age: 32
State: KY

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/24/2021
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: Cephalexin, IVP dye

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

Symptoms: Extreme stabbing, at times crushing bone pain that has lasted for over 2 1/2 weeks. Most prevalent in hands, feet, and elbows.

Other Meds: BioSil, Dandelion root, Hair, skin, and nail vitamin, cetirizine, Norethindrone

Current Illness:

ID: 1129718
Sex: F
Age: 37
State: MD

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/24/2021
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: I had only pain at the injection site after the first dose on February 12. I got my second dose on Friday, March 12 at 1pm and woke up at 2am Saturday with debilitating headache and severe nausea . I took tylenol and fell back asleep. I woke up again around 6am with the same severe headache and excruciating pain in my left arm at the injection site and tried to get up to get some ibuprofen. I felt extremely dizzy and could barely walk which ended up in me fainting in the kitchen. I somehow got back to bed, took ibuprofen and went back to sleep. I started feeling better after that, severe headache went away but I had low grade fever, chills, slight nausea and painful arm the whole Saturday up until Sunday morning. I had dizziness on Sunday, was very tired on Monday and still felt weak on Tuesday but after that I recovered and experienced no more symptoms.

Other Meds: Vitamin D, vitamin A, zinc, Inflavonoid intensive care, iodine, vitamin C

Current Illness: None

ID: 1129719
Sex: F
Age:
State: WA

Vax Date:
Onset Date: 03/08/2021
Rec V Date: 03/24/2021
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: wasn't making sense in conversation, starred off/Could not talk; Very groggy; could not respond, couldn't follow instructions or directions; not his normal self; shaking; Patient not his normal self; Starred off when spoke to; A spontaneous report was received from a consumer for a 79 year old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced tremor (shaking), speech disorder (wasn't making sense in conversation, starred off/could not talk), somnolence (very groggy), vaccination related malaise (not his normal self), and cognitive disorder (could not respond, couldn't follow instructions or directions). The patient's medical history was not provided. No concomitant product use was reported. On an 07 Mar 2021, the patient received the first of two planned doses of mRNA-1273 (Lot number: 029A21A) intramuscularly for prophylaxis of COVID-19 infection. On 08 Mar 2021, The patient experienced tremor (shaking), speech disorder (wasn't making sense in conversation, starred off/could not talk, feeling abnormal (not his normal self), vaccination related malaise(not his normal self), and cognitive disorder (could not respond, couldn't follow instructions or directions). On 08-Mar-2021, the patient was admitted to the hospital. On the day of hospital admission, the patient experienced somnolence (very groggy) and was known to have elevated cardiac enzymes. Treatment information was unknown. Action taken with mRNA-1273 was unknown. The outcome of the events, tremor (shaking), speech disorder (wasn't making sense in conversation, starred off/could not talk), somnolence (very groggy), vaccination related malaise (not his normal self), and cognitive disorder (could not respond, couldn't follow instructions or directions), 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 event, a causal relationship cannot be excluded.

Other Meds:

Current Illness:

ID: 1129720
Sex: F
Age: 64
State:

Vax Date: 03/10/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Covid arm (swelling, redness, itchiness, 10 days after first shot)

Other Meds: None

Current Illness: None

ID: 1129721
Sex: M
Age: 44
State: AZ

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Myalgia, low fever

Other Meds: Amlodepine, simvastatin, fenofibrate, areds2

Current Illness: none

ID: 1129722
Sex: M
Age: 52
State: NY

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/24/2021
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: lactose intolerance steroid medication for rash

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

Symptoms: My right eye felt like there was something in it and it still seems to be twitching

Other Meds: Plavix Beta blocker Atorvostatin Vitamin D Vitamin C Multi-Vitamin Zyrtec

Current Illness: None

ID: 1129723
Sex: F
Age: 53
State:

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/24/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient c/o itching all over, vitals stable. Patient given 50mg Benadryl. She felt fine after 30 minutes and discharged.

Other Meds:

Current Illness:

ID: 1129724
Sex: M
Age: 17
State: NY

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: When patient's mother attempted to complete the screening questions, she was stopped when she entered the birth date of the patient informing her that he is not eligible for the Moderna vaccine due to age. She then entered "unknown" for his birth date and was permitted by the system to continue. When she arrived at the clinic with the patient, she informed the vaccinating nurse that "His doctor gave permission for him to get the vaccine.." The vaccine was administered.

Other Meds: None

Current Illness: None

ID: 1129725
Sex: U
Age: 0
State: AZ

Vax Date: 07/16/1986
Onset Date: 02/19/2021
Rec V Date: 03/24/2021
Hospital: Y

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: N/A

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

Symptoms: Chills, Muscle ache, Fever

Other Meds: None

Current Illness: N/A

ID: 1129726
Sex: F
Age: 76
State: MD

Vax Date: 01/27/2021
Onset Date: 02/17/2021
Rec V Date: 03/24/2021
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: Nausea

Symptoms: plates went from normal to 3000; A spontaneous report was received from a consumer concerning a 76-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced having platelets went from normal to 3000 (Thrombocytopenia-unspecified). The patient's medical history, as provided by the reporter, included leukemia. No relevant concomitant medications were reported. On 27 Jan 2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: 030O20A) intramuscularly for prophylaxis of COVID-19 infection. On 07 Feb 2021, the patient had an infusion of obinutuzumab for leukemia because her platelets went from normal to 3000. She was at the hospital for three days. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event, platelets went from normal to 3000 was unknown.; Reporter's Comments: This case concerns a 76-year-old female who was hospitalized for infusion of obinutuzumab for leukemia because of a medically significant and serious unexpected event of thrombocytopenia. Event onset occurred 22 days after the first dose of mRNA-1273. Treatment not reported. Event outcome unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness: Leukemia

ID: 1129727
Sex: F
Age: 39
State: CA

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

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

Lab Data:

Allergies: Sulfa Meds

Symptom List: Injection site pain

Symptoms: Feeling tightness on the face for around 45 min. Blurred vision, very dizzy and unable to have good balance for 6 days.

Other Meds: Singular

Current Illness: none

ID: 1129728
Sex: M
Age: 38
State: VA

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Pt. experienced Syncope, has dizziness, light headed, cold-sweat, and almost fainted. Pt. did not faint had remain in chair while being observed by pharmacist, administered a cold-compress to pt. with pt. reported immediate relief and continued to observe for 30 min. Pt reported feeling better and no signs or symptoms and left with parents. Told to check back with us if any new or further problems.

Other Meds: Hydrochlorothiazide 25mg, Omeprazole 40mg

Current Illness: NA

ID: 1129729
Sex: M
Age: 69
State: MN

Vax Date: 02/24/2021
Onset Date: 03/10/2021
Rec V Date: 03/24/2021
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: Vertigo symptoms developed about 2 weeks after 1st dose. Has symptoms intermittently for last 2 weeks.

Other Meds:

Current Illness: None

ID: 1129730
Sex: M
Age: 63
State:

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 03/24/2021
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: lisinopril

Symptom List: Tremor

Symptoms: On 2/19/21 veteran had Moderna Covid-19 vaccine #1, then 2 days later developed a rash on the trunk, which spread to extremities. He also had seafood recently and so cause of rash unclear at the time. He subsequently had vaccine dose #2 in 3/2021 and developed pruritic maculopapular rash again (no recent seafood or other changes) that manifested over the same time course, symptoms appearance and pattern of spread - trunk -> extremities .

Other Meds: none

Current Illness:

ID: 1129731
Sex: F
Age: 65
State: FL

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: At 5:00am the following morning I awoke you high fever of 101 and in severe pain throughout my body. I was heavily fatigued and had a difficult time walking. I made it to the toilet and vomited. I remained nauseous and heaved for about half an hour. My fever fluctuated for the next 24 hours before it broke and I am much better today, 2 days after getting my second vaccination.

Other Meds: Oxycodone

Current Illness: None

ID: 1129732
Sex: F
Age: 52
State: OR

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 03/24/2021
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: NKDA Seasonal Allergies- tree pollen, smoke

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

Symptoms: Had vaccination shot #2 in right deltoid. Went to the observation area for the 15 minute period. After approximately 7 minutes, I felt my throat "swelling." I got up and went to the RN who administered shot. They called the RN over. Vital signs were stable, airway intact, able to speak full sentences. No shortness of breath. It took more effort to swallow. Right arm sore. They monitored me for another 15 minutes. No worsening symptoms. Swelling not improving. Recommended going to the ER (I'm an RN and this was administered at my hospital). Was escorted to ER. Hooked up to monitor. Slight redness noticed on both arms. No hives. IV started. Given IV Benadryl, famotidine, solu-medrol. No improvement. Hooked up to a monitor and given epi sub-Q. Monitored for approximately 60 minutes with improvement of throat swelling. Discharged to home with prescription for prednisone, famotidine and Benadryl x 5 days. At home, approximately 8 hours after shot, work up feeling itchy, took Benadryl PO with relief of symptoms approximately 45 minutes later. Followed up with MD on 1/21. No change in medications. Asymptomatic during the course of medications. Finished course of medications on the morning of 1/23. Later that evening started feeling tired, had chills, swollen glands. Went to bed early. On 1/24 symptoms continued including lack of appetite, increased fatigue, brain fog. Symptoms continued until 1/25 and gradually improved over the week.

Other Meds: Flovent QD Albuterol PRN Magnesium QD Fish Oil QD Vitamin D QD

Current Illness: none

ID: 1129733
Sex: M
Age: 45
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 03/24/2021
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: 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: 1129734
Sex: F
Age: 34
State: CO

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 03/24/2021
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: Labatelol, flu shot, asparagus, percocet

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Migraine, sore arm, swollen lymph node in armpit on left side.

Other Meds: Jone

Current Illness: None

ID: 1129735
Sex: M
Age: 33
State: CA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/24/2021
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: Symptoms includes: Chills Vomit Nausea Diarrhea Tiredness Headache Muscle pain Dry heaving Dehydration Shortness of breath 20 pound weight loss in 15 days Has been in the hospital two times since the vaccination. Both times on a slow drip IV to keep him hydrated urine was the same color as apple juice (Real apple juice not from concentrate or watered down whiskey if you will). Did CAT scan of lungs found 4MM nodules that weren?t there before.

Other Meds: None

Current Illness: None

ID: 1129736
Sex: F
Age: 73
State: PA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: None

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

Symptoms: About 9.5 hours after the injection, I started feeling a bit shaky. Seemed to be on left side of chest. Shakiness got stronger and stronger, spread across chest and into head. By 10 hours after injections, hands were shaking, voice, was shaking, teeth chattering. The worst lasted about 20 minutes, and then started to subside in reverse order ending on left side of chest. By 90 minutes after initiation, all shaking was gone. During the worst of it, I could sometimes control the shaking briefly with slow breathing. But then shaking would return. Fitful sleep through the night. Aches and low fever next day.

Other Meds: Meds list: Atorvastatin Levothyroxine 137 and 150 alternating Glucosamine chondroitin with MSM and hyaluronic acid Fish oil 3000 IU Daily women?s multi vitamin Aspirin 81 mg B6 B12 Vitamin D CoQ10 Zyrtec Aleve Three Advil

Current Illness: None

ID: 1129737
Sex: F
Age: 32
State: NE

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/24/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List: Pain in extremity

Symptoms: Within 10 minutes of receiving vaccine, got very lightheaded in waves. Got very shaky, felt weak. Felt heart palpitations, increased respirations, shallow breathing Recovered within 30 minutes and returned home. Symptoms have continued since receiving vaccine to include chest pain, feeling jittery/shaky and weak in the limbs

Other Meds: Naproxen 500mg tabs Centrum Women's multivitamin

Current Illness: None

ID: 1129738
Sex: F
Age: 46
State: MO

Vax Date: 03/15/2021
Onset Date: 03/22/2021
Rec V Date: 03/24/2021
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: I have ?covid arm? near my injection site. It appeared a week after my vaccine. It is red and swollen. It itches at times and it painful at times.

Other Meds: Multivitamin

Current Illness: None

ID: 1129739
Sex: F
Age: 48
State: CA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Client received 1st Pfizer Covid Vaccine (Lot # ER8732, Exp 3/24/21) approximately 1545. Client was sitting in post vaccine waiting area when she alerted EMT she was feeling lightheaded and dizzy. RN joined and began to assess client. Vitals at 1600: blood pressure 126/80 pulse 84, respirations 18. Alert and oriented. No swelling noted. Client denied shortness of breath. Per client no history of allergies or reaction to vaccines in the past. Client asked for water. PHN joined team, client instructed to take small sips of water. Client mentioned she had not ate yet and thought maybe it was related to that. Client informed she would be observed another 15 mins due to current symptoms. 1608 client stated feeling warm, anxious, and still lightheaded. PHN offered client benadryl and client accepted. Per client husband came with her and was going to drive her home. Benadryl 50mg was given orally at 1609. Vitals: blood pressure 144/90, pulse 76, respirations 18. Client informed staff she felt hands were shaky and body was warm. Client alert and oriented, no swelling noted. Vitals at 1616: 140/90, pulse 60, respirations 16. At 1622 client stated feeling better, did not want to wait rest of remaining time. Client was advised to consult primary provider prior to receiving second dose Pfizer. Client also given ER precautions. Husband was waiting in parking lot and was going to drive client home. Client left facility with a steady gait at 1630.

Other Meds: none

Current Illness: none

ID: 1129740
Sex: F
Age: 26
State: CA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/24/2021
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: Pt developed dizziness and nausea approx 30 minutes after vaccination. Denies HA, SOB, chest pain. BP 131/84 HR 88 RR 18, unlabored SpO2 98% RA

Other Meds: None

Current Illness: None

ID: 1129741
Sex: F
Age: 78
State: FL

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
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: Same as Previously submitted

Symptom List: Vomiting

Symptoms: Additional side affect on Saturday night episode where my lips became numb, my balance was unsteady, and I had difficulty walking, my head was foggy-- and additionally I felt shaky inside. Just as if you have the shivers. This is in addition to my events with the headaches. I am very worried about the second shot in the vaccine.

Other Meds: Same as previously submitted

Current Illness: Same as previously submitted

ID: 1129742
Sex: F
Age: 37
State: CA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 03/24/2021
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: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt states significant arm swelling, arm was hard to the touch, red and painful. Pt also had body aches, fatigue and fever for 3+days that required the patient to be out of work for 2 days.

Other Meds:

Current Illness:

ID: 1129743
Sex: M
Age: 60
State: MD

Vax Date: 02/04/2021
Onset Date: 02/06/2021
Rec V Date: 03/24/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: After the 2nd inj of Moderna, I?ve been experiencing a chronic pain on the injection site, now it?s forming a lump exactly where the needle was placed, the pain is increasing and sensitive to touch the area of the injection, I?m unable to sleep on the left side of my body.. What should I do?

Other Meds: None

Current Illness: None

ID: 1129744
Sex: F
Age: 66
State: IN

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/24/2021
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: Vaccine for Pneumococcal Pneumonia

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe headache, chills, sweats, tired, weakness, every muscle I have hurt.

Other Meds: Rosuvastatin 5mg, Atenolol 50mg, Citalopram 20mg, Biotin, CoQ10, Calcium Citrate Magnesium & Zinc, Daily Multi, D3, Fish Oil, Magnesium, Potassium, and Focus factor.

Current Illness: None

ID: 1129745
Sex: M
Age: 50
State: WV

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
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: high pitch ringing

Other Meds: amlodipine 10mg lisinopril 20mg atorvastatin 20mg hydralazine 10mg

Current Illness:

ID: 1129746
Sex: M
Age: 54
State: UT

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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: Within minutes of patient receiving vaccine, patient began to feel lightheaded and skin color began to turn white. Patient parked by EMS in observation parking and became unresponsive. EMS began vital signs and tried to get him to wake up. Patient stayed unresponsive and vital signs continued to decline. EMS transported patient to hospital. Upon arrival to hospital, staff conducted EKG, chest x-ray, and blood work. All tests came back normal. Patient began to become coherent, and staff began to try and feed him and get him up. After patient was able to get self up and eat food, he was sent home. Patient is now at home recovering. He states he only feels a sore arm and is fatigued.

Other Meds: Low-dose lothartin for high-blood pressure.

Current Illness: Pinched nerve in neck, was taking steroid for treatment. Not on steroid at time of vaccination.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm