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

Incidents per State

State Total
72,296
AK1,638
AL5,339
AR3,412
AS44
AZ13,316
CA58,147
CO11,002
CT7,824
DC1,626
DE1,670
FL36,235
FM3
GA13,429
GU82
HI2,195
IA4,332
ID2,473
IL19,261
IN22,568
KS4,284
KY6,945
LA4,714
MA13,886
MD11,901
ME2,997
MH8
MI17,865
MN11,345
MO8,919
MP30
MS2,676
MT2,147
NC15,401
ND1,273
NE2,732
NH2,859
NJ17,232
NM3,702
NV4,071
NY32,763
OH18,072
OK5,940
OR7,954
PA22,457
PR2,104
QM2
RI1,911
SC6,055
SD1,133
TN8,691
TX34,122
UT4,023
VA13,944
VI49
VT1,661
WA13,811
WI10,395
WV2,220
WY805
XB5
XL1
XV2

ID: 1177220
Sex: M
Age: 69
State: KY

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Altered mental status, ? meningitis vs encephalitis, fever. Confusion back pain, not able to follow commands very agitated, had to be sedated and put in restraints

Other Meds:

Current Illness:

ID: 1177221
Sex: F
Age: 30
State: WI

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Patient did not list any allergies on immunization form.

Symptom List:

Symptoms: Patient reported that she had a red, itchy rash on her face and arms. She also reported mild tightness in her throat.

Other Meds:

Current Illness:

ID: 1177222
Sex: F
Age: 67
State: VA

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Redness, fever, itching below injection site midway down arm.

Other Meds: Losartan, Pravastatin, chlorthalidone, omerprazole, low dose aspirin

Current Illness: Bad reaction to 1st vaccine, just completed two antibiotics 3/27.

ID: 1177223
Sex: F
Age: 16
State: WI

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: This event was an administration error. The Moderna vaccine was administered to an individual under the age of 18. Patient tolerated the vaccine administration, and no adverse reactions have been reported.

Other Meds:

Current Illness:

ID: 1177224
Sex: M
Age: 20
State: MO

Vax Date: 04/03/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Red swelling spot on arm where vaccine was administered, after 2 days the size of the spot increased

Other Meds: Lexapro, Buspirone

Current Illness: N/A

ID: 1177225
Sex: F
Age: 19
State: MA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: 101.3 fever by 6 pm, 101.1 fever the next morning (6 am) intense shivering and aches in afternoon of 4-06 and intense heat evening of 4-06 and morning of 4-07. I took Tylenol and ibuprofen throughout it which definitely helped and my fever would break but then once the medicine wore off the fever would come back. Symptoms ended around noon today (4/07).

Other Meds: 150 mg Zoloft

Current Illness:

ID: 1177226
Sex: F
Age: 44
State: OH

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: I have gotten a rash before while taking Levaquin although I was out in the sun and it says it?s photo sensitive. Not sure if that counts as an allergic reaction.

Symptom List:

Symptoms: Immediately following the shot I had a metallic taste in my mouth that lasted for four days straight. The morning after I had the shot I had tinnitus. The tinnitus has progressively gotten worse over the past couple weeks. I?m not sure if I should get the second vaccine. I do not want us to get worse.

Other Meds: Diltiazem, vitamin D, elderberry juice

Current Illness: No

ID: 1177227
Sex: F
Age: 59
State:

Vax Date: 02/24/2021
Onset Date: 03/17/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient reported no significant issues after 1st dose of pfizer vaccine or any immediate issues after 2nd dose. Approximately 3 weeks after 2nd dose, patient presented to her PCP and she reports that her PCP said she had Bell's Palsy. The PCP isn't apart of our health system so we don't have any more details than that. She reached out to one of our case managers here to report the incident and that information was passed on to the pharmacy for reporting.

Other Meds:

Current Illness:

ID: 1177228
Sex: F
Age: 57
State:

Vax Date: 12/22/2020
Onset Date: 04/01/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient tested positive for COVID-19 after being fully vaccinated

Other Meds:

Current Illness:

ID: 1177229
Sex: M
Age: 53
State:

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 04/07/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Admit for progressive fever post-COVID-19 vaccination 2nd dose. Pt w/ recurrent aspiration and hx cerebral palsy, spastic quadriplegia, seizure disorder and severe mental disability. Recent discharge x1month ago for asp PNA. For multidrug resistant infection, pt was transferred to LTAC for long term abx tx.

Other Meds:

Current Illness: aspiration PNA

ID: 1177230
Sex: F
Age: 18
State: VA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NONE

Symptom List:

Symptoms: very stiff neck (day 1-2) and headache (day 2) lasting over 24 hours, extreme fatigue & sleepiness (days 2-3), swelling (day 2-present day) at the injection site longer than 5 days, low grade fever and chills (day 3), cold sore appeared on the right side corner of the mouth by April 4. She was monitored at home. Given Tylenol for the headache, stiff neck, and fever. Given plenty of water when not asleep. For the cold sore looking effect, simple OTC cold sore topical medication

Other Meds: NONE

Current Illness: NONE

ID: 1177231
Sex: M
Age: 67
State: CA

Vax Date: 02/22/2021
Onset Date: 02/24/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Yes I have allergies to wheat, dairy, and certain types of fruits. Have allergy tested and found no particular or specific cause. Have one mutation for Mediterranean Fever. Have trouble with Drug related side effects.

Symptom List:

Symptoms: Two days after shot woke up with sunburn like rash on face and back. Was short of breath and dizzy. The rash looked like little blisters on top of bumps on my face, with red rash looking spots on back, legs, and chest. The skin on my face started pealing on my face and it burned and itched. Went to see my Pulmonary Doctor first, than Infectious Disease Doctor than Primary Care. I was treated with steroids, creams and inhalers. Symptoms would get better than repeat for the first month. Still not feeling like I am ok. Have two more doctors appts. coming up.

Other Meds: 1/2 mg Klonopin 1x per day, Clobetasol .05, and multi B vitamin.

Current Illness: Have inflammation and chronic pain from past surgery.

ID: 1177232
Sex: F
Age: 73
State: MO

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: penicillins, aspirin

Symptom List:

Symptoms: Patient was unknowingly given a 3rd dose of the Covid-19 vaccination

Other Meds:

Current Illness: unknown

ID: 1177233
Sex: F
Age: 31
State:

Vax Date: 03/31/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Received the first dose of Moderna 7 days ago. This evening my arm started to itch and I noticed it was swollen at the injection site. Feels like a bump under my skin. Red circle around the area.

Other Meds: N/A

Current Illness: None

ID: 1177234
Sex: F
Age: 31
State: UT

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: One week later after vaccine I noticed I had a swollen lymph node on my clavicle on my left side. I seen my doctor he said they think it was a lymph node he said just to watch it. Until now its still the same,

Other Meds:

Current Illness:

ID: 1177235
Sex: F
Age: 45
State: PA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Was given the shot on Friday, April 2, 2021 at 4:33pm within 20mins I got mild tingling in my tongue on the left side and slight tingling in my cheek on the left side of my face--like when Novacane is wearing off. I didn't say anything since I thought it was more anxiety then the shot. It was very mild and lasted 4 hours then it moved to like a mild tooth ache by 8:45pm. The mild tooth ace would come and go for the next 3 days (April 5th last day). Woke on April 6th to a swollen top lip which went away by 12pm. No symptoms on April 7th. I didn't report this since I thought it was anxiety but I did call the next day the hospital hotline to advise about tingling then called primary care doctor on April 6th when my lip swelled.

Other Meds: Daily Liquid Iodine (1 drip), Selenium, Vit D (25 mvg 1,000 IU) & Vit C 3x a week NuAdapt (was taken day of)

Current Illness: none

ID: 1177236
Sex: M
Age: 18
State: IN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none reported

Symptom List:

Symptoms: Patient had a vasovagal response while being observed for the 15 minutes following vaccination. Rapid Response was called, vitals taken. Patient recovered with juice, crackers, and water.

Other Meds: none reported

Current Illness: none reported

ID: 1177237
Sex: F
Age: 42
State: OH

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: Five hours post vaccination generalized achiness, fatigue and very sore arm. Swollen lymph nodes to neck on Left began approx 10 days post vaccination.

Other Meds: zyrtec

Current Illness: none

ID: 1177238
Sex: F
Age: 33
State: WA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Morphine, Bacon

Symptom List:

Symptoms: Disoriented, tired, shoulder hurts, headache, can barely stand, sweating Later on, able to stand up, chills.

Other Meds: D12, B3, Spiroactone, Estradiol, Concerta

Current Illness: None

ID: 1177239
Sex: F
Age: 58
State: IL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: Pt became extremely warm all over as well as weak, Pt then began to get nausous as well as vomited. EMs was brought to the pts side where they gave her zofran. Pt was extremely anxious as well as stated she wasnt feeling better and wanted to be evaluated by the ER. EMS took her to the ER

Other Meds: unknown

Current Illness: Pt admitted to hitting her head the night before very hard

ID: 1177240
Sex: F
Age: 36
State: AK

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: MRI dye, Percaset, Vantin

Symptom List:

Symptoms: Pt approached staff and stated she felt flushed; pt has hives on chest; pt has a history of hives from an undiagnosed allergy so she took 50mg of her own Benadryl; BP and pulse were elevated most likely due to anxiety; pt went into office with Medic and EMT to rest and be observed longer.

Other Meds: Zoloft, Gavapentin, Hexaril

Current Illness: n/a

ID: 1177241
Sex: F
Age: 35
State: AZ

Vax Date: 03/15/2021
Onset Date: 04/04/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: Widespread rash on face, neck, arms, torso back and stomach, red raised itchy. Doesn?t go away with benedryl

Other Meds: Fluoxetine

Current Illness: None

ID: 1177242
Sex: F
Age: 49
State: WI

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient felt dizzy patient was placed supine , blood pressure measured. after 30minutes patient was feeling normal

Other Meds:

Current Illness:

ID: 1177243
Sex: F
Age: 82
State: CA

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: n/a

Symptom List:

Symptoms: Within a couple of hours of the first vaccine, after a long walk, my R hip/leg became weak and unreliable to the extent that I was limping and it has continued to be a problem. I'd had no problem at all with that since recovering from the surgery done in April 2019. I delayed the second vaccine until 5 weeks, and after some gradual improvement, it did get somewhat better during that fifth week -- though still not normal. Prior to the first vaccination, I was accustomed to walking 1 to 2 miles almost every day with no difficulty at all. The initial reaction to the second dose was less than with the first. (I didn't walk for two days after that one.) However, it worsened over the next couple of weeks so that again I could barely walk 1/4 mile without making things worse again. Now it's about 3 1/2 weeks since dose #2 and it does seem to be starting to improve, but slowly. (And I took ibuprofen for 5 days last week, 400 mg 2x/day, which helped.) The only other reaction I had to either dose was the usual sore arm. Neither affected the L hip which still has severe arthritis. I have kept a day-by-day journal with details.

Other Meds: one-a-day multi-vitamin (natural sources)

Current Illness: n/a

ID: 1177244
Sex: F
Age: 56
State: MA

Vax Date: 03/28/2021
Onset Date: 04/03/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Told allergic to shrimp when in college, haven?t had any reaction to small quantities since

Symptom List:

Symptoms: ?Covid arm?. Slight red rash, very warm to touch (about 4 inches diameter), slight swelling, painful to touch or when raising arm, occasional feeling of internal itching

Other Meds: None

Current Illness: None

ID: 1177245
Sex: M
Age: 16
State: WI

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Was given shot at the age of 16. This shot is currently recommended for 18 years or older.

Other Meds:

Current Illness:

ID: 1177246
Sex: F
Age: 77
State: MI

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Pfizer vaccine diluted with sterile water instead of diluent provided with Pfizer vaccine, clinical team working on follow up if revaccination needs to take place. No adverse events reported

Other Meds:

Current Illness:

ID: 1177247
Sex: F
Age: 58
State: MA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Huge lump on my arm at injection site still 10 days later.

Other Meds:

Current Illness:

Date Died: 04/06/2021

ID: 1177248
Sex: F
Age: 86
State: AL

Vax Date: 04/02/2021
Onset Date: 04/04/2021
Rec V Date: 04/07/2021
Hospital: Y

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Betadine- skin rash

Symptom List:

Symptoms: Family reports general malaise post treatment, followed by fever and chills 4/3/2021, and cardiac arrest 4/4/2021.

Other Meds: Alpahgan P 0.1% eye drops Amlodipine 5mg tablet Aspirin 81 mg tablet Delayed release Betimol 0.5% eye drops Calmoseptine 0.44%-20.6% topical ointment Carvedilol 12.5 mg tablet Hydralazine 50mg tablet lidocaine-prilocaine 2.5%-2.5% topical

Current Illness: none that I am aware of.

ID: 1177249
Sex: F
Age: 58
State: FL

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List:

Symptoms: SWOLLEN, RED, HOT SPOT. TREATMENT, ICE, AND ADVIL

Other Meds: Celexa, multivitamin

Current Illness: none

ID: 1177250
Sex: F
Age: 44
State: VA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Percocet Trans Derm Scope patch

Symptom List:

Symptoms: Severe inflammatory response in arm that has lead to Frozen Shoulder diagnosis. Limited Range of Motion. Now attending physical therapy to regain strength in arm & range of motion

Other Meds:

Current Illness:

ID: 1177251
Sex: F
Age: 50
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Patient was c/o of increased HR and shaky. HR ranging low 100s to 119. BP: 172/107, HR: 102, O2: 95% (initial assessment). EMS called, observed patient for further observation. Patient recovered and was released.

Other Meds:

Current Illness:

ID: 1177252
Sex: F
Age: 49
State: NY

Vax Date: 03/01/2021
Onset Date: 03/25/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: N/A

Symptom List:

Symptoms: Rash on the neck area Hives on the body especially under breast and neck (lymph nodes) Itchy skin

Other Meds: Metformin Ozempic Premarin Vitamin D3 Multivitamin

Current Illness: N/A

ID: 1177253
Sex: F
Age: 59
State: IN

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Terramycin & Oxycodone

Symptom List:

Symptoms: 30 min out my pointer finger and thumb became numb. It then moved to the left side of my face (corner of left eye around my cheek bone into the bridge of nose), and the left side of my tongue. It was a tingly sensation (similar to your face/lip waking up after being given Novocaine). It remained all evening on 4/5 and has continued to be intermittent in my cheek.

Other Meds: Synthroid 75mcg; Liothyronine SOD 5mcg; Vitamins D3, C, Zinc

Current Illness: None

ID: 1177254
Sex: M
Age: 30
State: NH

Vax Date: 02/15/2021
Onset Date: 03/01/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: BEES

Symptom List:

Symptoms: Just about 2 weeks after the 2nd vaccine I developed an immune response, mast cell response, dermatographic response

Other Meds: NONE

Current Illness: NONE

ID: 1177255
Sex: F
Age: 63
State: IN

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Chills for 3 hours, then fever and body aches, bad headache in morning, nausea and vomiting

Other Meds: Vytorin, Levothyroxin,r, Basaglar, Losartan, Farmiga, Trulicity,

Current Illness:

ID: 1177256
Sex: F
Age: 56
State: CO

Vax Date: 04/02/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: nkda, no known other allergies

Symptom List:

Symptoms: peeling skin of distal aspect of fingers

Other Meds: diazepam, lexapro, anusol-HC, nitroglycerin prn, aygestin, aldactone, effexor

Current Illness: none

ID: 1177257
Sex: M
Age: 57
State: NJ

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
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Allergies: NKDA

Symptom List:

Symptoms: Patient stated that he did not receive his vaccine as he did not feel it and there was no mark on his arm. RN did state that she gave vaccine but patient stated he did not. Administration and pharmacy spoke with patient to let them know they can return to receive his vaccine.

Other Meds:

Current Illness:

ID: 1177258
Sex: F
Age:
State: NC

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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Allergies: figs

Symptom List:

Symptoms: Moderna COVID?19 Vaccine EUA: chills, joint pain, difficulty breathing fatigued

Other Meds: no

Current Illness: no

ID: 1177259
Sex: F
Age: 37
State: MD

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/07/2021
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Allergies: none

Symptom List:

Symptoms: chills (6-8 hours post-vaccine), nausea (12 hours post-vaccine), headache (8-24 hours post-vaccine)

Other Meds: women's daily multi-vitamin

Current Illness: none

ID: 1177260
Sex: F
Age: 68
State: CA

Vax Date: 03/26/2021
Onset Date: 04/01/2021
Rec V Date: 04/07/2021
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Allergies: None

Symptom List:

Symptoms: 3/26/21, Covid shot in morning. By afternoon, bicep hurt moderately for about 24 hours...No biggie. 4/1/21, morning, left hip joint popped and did not support me for 24 hours. 4/5/21, morning. Left rotator cuff did not work w/o pain for 24 hours. I have osteo-arthritis on a daily basis, in different joints, mostly hands, ankles and knees. These two flare ups were particularly debilitating and unusual.

Other Meds: Flaxseed oil, Calcium, Vit?s D, B-12, C and Zinc

Current Illness: Osteo-arthritis

ID: 1177261
Sex: F
Age: 45
State: VA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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Lab Data:

Allergies: Allergies to Trileptal & Codeine (nausea & vomiting) MSG (triggers migraine) Tomatoes (triggers migraine) Red food dye (triggers migraine)

Symptom List:

Symptoms: About 18 hours after the vaccine, my vision became blurred and then doubled.

Other Meds: Verapamil Zoloft Singular Vitamin B2 Zinc Magnesium

Current Illness: None

ID: 1177262
Sex: M
Age: 17
State: PA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

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Lab Data:

Allergies: none indicated on vaccine administration record

Symptom List:

Symptoms: no adverse effects reported- the age of the patient is 17 which is currently not within the guidelines of Moderna

Other Meds: none indicated on vaccine administration record

Current Illness: none indicated on vaccine administration record

ID: 1177263
Sex: M
Age: 66
State: TX

Vax Date: 02/06/2021
Onset Date: 02/06/2021
Rec V Date: 04/07/2021
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Allergies: none

Symptom List:

Symptoms: Patient complains of rapid heart rate. Vaccine given by LPN. Patient walked up to lead nurse and complained of a rapid heart rate. Nurse lead notified LPN and myself. We both asked patient to have a seat and got patient blood pressure and heart rate. Blood pressure 162/98 and heart rate 96 BPM. Patient was taught calming techniques at 14:09. Bottle of water given to patient. Blood pressure was retaken at 14:25 and heart rate 85 BPM. Patient observed for an extra 30 minutes. Patient left building feeling perfectly fine.

Other Meds: Plavix

Current Illness: none

ID: 1177264
Sex: M
Age: 55
State: CA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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Symptoms: Patient received 2nd dose of Pfizer at 10:14 am on left deltoid, lot # ER8729, expiration date on 07/2021. Patient reports no adverse reaction to first dose of Pfizer vaccine. Patient has history of epilepsy, stroke, hemiplegia left upper extremity. Patient takes medication daily for seizure, medication was last taken this morning. At 11:37 am, patient started to have a seizure in the chair. The three EMTs, and a RN responded immediately. No fall occurred, no clusters in observation room. At 11:38 am, EMS was activated. Patient remained in chair throughout seizure and was physically stabilized by EMT . His seizure lasted approximately 1 minute. At 11:38 am, patient was non-verbal, but breathing at a rate of 20 res/min. Patient nodded to respond to neurological assessment. Vital signs were taken every 5 minutes. At 11:38 am, BP 150/77 sitting, HR 103, SpO2 97% RA, RR 20 res/min labored. Patient was transferred to anti-gravity chair with assistance from EMTs. At 11:39 am, patient was able to verbally respond to questions. Patient was alert and oriented to person, place, time and situation. Patient states "I just had a seizure". At 11:42 am, BP 152/98, HR 104, Spo2 at 95%, RR 22 res/min, labored, patient stated "I feel palpitation". Staff approached patient calmly, encouraged deep breathing, provided quiet environment. Upon assessment, patient was alert, oriented X4, clear speech, communicated in Spanish and English. At 11:45 EMS arrived. patient stated "I feel a lot better". Patient was transferred into a gurney and transported to hospital. Emergency responders left with patient at 11:57 am. Patient was accompanied by his brother .

Other Meds: Seizure medication (name unknown)

Current Illness:

ID: 1177265
Sex: F
Age: 28
State: RI

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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Allergies: Sulfa

Symptom List:

Symptoms: Numbness and tingling of middle 3 fingers on left hand

Other Meds: Spironolactone, Birth control pills, Vitamin D supplements, probiotics

Current Illness: None

ID: 1177266
Sex: M
Age: 53
State: NY

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

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Allergies: none

Symptom List:

Symptoms: no adverse events reported

Other Meds: none

Current Illness: none

ID: 1177267
Sex: F
Age: 56
State: MT

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/07/2021
Hospital: Y

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Lab Data:

Allergies: nitroglycerin, amoxicillin, asparaginase, aspirin, codeine, fentanyl, infliximab, morphine, nalbuphine, NSAIDS, ondansetron, povidone-iodine, prochlorperazine, rituximab, sulfa.

Symptom List:

Symptoms: 1010- shot given. 1020- coughing, followed by wheezing. 1025- 25ml benadryl/5mgxyzal 1037 0.3ml epi 1043- 60mg prednisone 1050-0.3ml epi 1115-0.3ml epi 1143- O2 sasts to 92% 1159- 0.3ml epi. to ED- recemic epi, glucagon, IV fluids. admitted overnight for observation.

Other Meds: azathioprine, D3, calcium, ketoconazole 2 % topical cream, losartan, hydroclorothiazide, hydrocodone-acetominophen, methylprednisolone, darisoprodol, acetaminophen, furosemide, ondansetron, famotidine, nystatin powder, apixaban, citalopram,

Current Illness: none

ID: 1177268
Sex: M
Age: 33
State: FL

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

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Allergies: none known

Symptom List:

Symptoms: patient started losing sight and hearing and starting sweating. ems was called and patient was helped to the floor because he said he was feeling faint. Before ems arrived he was feeling much better. EMS checked him out (blood pressure and blood sugar). Patient remained for another 30 minutes before saying he was ok to go home.

Other Meds: none known

Current Illness: none

ID: 1177269
Sex: M
Age: 55
State: MN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/07/2021
Hospital:

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Lab Data:

Allergies: Wellbutrin

Symptom List:

Symptoms: Patient had no reactions immediately after vaccination. Patient presented to the emergency room approximately 4 hours after vaccination with left sided chest pain that was radiating down the left arm. The pain was increased with inspiration, movement of his neck, arms, or chest. Patient woke up from a nap with extreme left-sided pain that prevented him from not putting his shoes on or taking his jacket off.

Other Meds: Setraline 100 mg PO daily Nicotine 21 mg TD daily

Current Illness: None known

Total 2021 VAERS Injuries: 599,999

Page last modified: 03 October 2021 5:28pm