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: 1136262
Sex: M
Age: 41
State: GA

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/25/2021
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: -caine family products (mild rash at young age, no symptoms since)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Arm soreness at site of injection appeared within 15 minutes, and has not subsided in 4 days.

Other Meds: Lexapro (20mg/day); Adderall (10 mg 2x/day); Fluconazole (400 mg/week); Men's multivitamin (1 daily); Iron (65 mg/ 2x daily) D3 (50mcg/daily)

Current Illness:

ID: 1136263
Sex: F
Age: 24
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: Mixed series. First vaccine in series was Moderna.

Other Meds:

Current Illness:

ID: 1136264
Sex: F
Age: 70
State: NY

Vax Date: 02/27/2021
Onset Date: 02/28/2021
Rec V Date: 03/25/2021
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: Sulfa antibiotics, shellfish and fish, mushrooms, iodine(?), animals (cats, dogs, horses, etc.)

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

Symptoms: Extreme fatigue, afternoon of 2/27 -- had to lie down; fatigue for the next two weeks -- often took an afternoon nap (which otherwise never do). Fatigue is better now. Right breast -- vague discomfort (also reported breast symptoms that started 3 days after first shot, VAERS report #380584). The breast discomfort (slight nipple tenderness; feeling of breast fullness, and sometimes warmth; slight fullness under arm) is off and on and continues even now, 03/24/2021.

Other Meds: Triamterene/HCTZ 37.5/25, Travatan (eyedrops), Betimol (eyedrops), zyrtec 10 mg; vit. B, magnesium, vit. D

Current Illness:

ID: 1136265
Sex: F
Age: 64
State: VA

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 03/25/2021
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: Injection site started to itch two days after injection. Developed small hives under injection site. Went away for a day or two. Came back on 8th day after injection itched a little more and there were more hives.

Other Meds: Synthroid, zinc, vitamin c , vitamin D3

Current Illness: None

ID: 1136266
Sex: F
Age: 67
State: LA

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Approximately 10pm I started getting diarrhea. I had 5 bouts of it during the first night. I took pepto bismal and it stopped for one day , which was the 21st. On the 22 I woke up with more diarrhea and took Imodium. It stopped the rest of the day until evening when my stomach started to feel like Ibwss going to get nauseated. I took an Imodium. 23 I felt a little nauseous and took pepto bismal. 24 and 25th I feel fine but I still have soft stools and some water excrement. A little ache in left arm for a little bit of time today.)

Other Meds: Atorvastatin. Singular, fish oil, one a day multi-vitamin and a B complex vitamin. Zicam with elderberry.

Current Illness: None

ID: 1136267
Sex: F
Age: 47
State: KY

Vax Date: 03/16/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: Silicon

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

Symptoms: Hard knot and red streaks at injection site. 3 inches from injection site 2 puss filled bumps.

Other Meds: Flovent, Albuterol,Wellbutrin

Current Illness: None

ID: 1136268
Sex: F
Age: 62
State: PA

Vax Date: 03/17/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: Downy Fabric Softener

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: On the 8th day developed 2 enlarged, hardened red bumps that became very itchy at the injection site on left arm. Also developed hives on back and backside. Unsure if it was related to vaccine.

Other Meds: Escitalopram 10mg Saxenda

Current Illness: None

ID: 1136269
Sex: M
Age: 29
State: MT

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: After leaving the vaccination clinic following the 15 minute waiting period, I felt normal and ran a quick errand before returning to work. After completing the errand (roughly 15 minutes), I began driving back to my office (roughly 10 minute drive). As I was roughly 1/2 mile from the office, I started to feel slightly lightheaded/woozy. I continued to drive toward the office, and within a matter of a couple minutes or less, I was overcome with extreme disorientation and faintness. Before I could manage to return to the office or pull over to collect myself, I completely lost consciousness and crashed into another vehicle. Even after the crash, I was unconscious for roughly a minute or so until I finally came to and realized what had happened. It then took me another couple of minutes to collect myself and exit the vehicle to assess the situation and ensure all parties were alright. Police/Emergency services were contacted and a police report was filed. After the event, I remained slightly nauseated for approximately 3 hours and had intermittent chill episodes, but the adverse events have since subsided.

Other Meds: None

Current Illness: None

ID: 1136270
Sex: F
Age: 37
State: CA

Vax Date: 03/14/2021
Onset Date: 03/24/2021
Rec V Date: 03/25/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: The next day the lymph node underarm is swollen. On 10th day, my left boob is swollen, and tender and painful. left Shoulder blade, underarm l,left chest very painful

Other Meds: None

Current Illness: UTI

ID: 1136271
Sex: F
Age: 25
State: AK

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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 experienced syncope after Moderna Covid-19 immunization. She never lost consciousness but was lowered from her chair to lie down on the floor by administering pharmacist and technician. Store management brought her cushioned chair to be seated more comfortably. Eventually was able to walk and was driven home by roommate.

Other Meds:

Current Illness:

ID: 1136272
Sex: F
Age: 46
State: NJ

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Fatigue started a few hours after shot and was moderate intensity for that day, low intensity starting day 2, but low intensity fatigue continues to be present 2 weeks later. Napping almost daily; was not a regular nap-taker previously.

Other Meds: None

Current Illness: None

ID: 1136273
Sex: M
Age: 27
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Second dose administered too early (13 days).

Other Meds:

Current Illness:

ID: 1136274
Sex: F
Age: 79
State: AZ

Vax Date: 02/11/2021
Onset Date: 03/22/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: Cephalexin,Percocet,cipro

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

Symptoms: Headache, chills, fatigue - lasted one day

Other Meds: Warfarin, lisinopril, progesterone, estradiol, fish oil, multi-vitamin, caltrate

Current Illness: None

ID: 1136275
Sex: F
Age: 76
State: CT

Vax Date: 03/23/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: demerol morphine

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

Symptoms: 2nd vaccine caused red raised non itchy or painful rash in 2days vs #1 was 7 days raised red itchy painful disappeared in several days

Other Meds: Folic acid creator Vit B12 C D3 Ocycodone Lorazepam

Current Illness: One

ID: 1136276
Sex: M
Age: 24
State: TN

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: A few minutes after the shot, the patient said he was not feeling well, and told the pharmacist he was about to pass out and felt very dizzy. He was extremely pale and sweating profusely all over. We took his blood pressure and it was about 94/50. His heart rate was 50. We got the patient water and continued to monitor him and he improved.

Other Meds:

Current Illness:

ID: 1136277
Sex: M
Age: 69
State: TX

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/25/2021
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: Penicillin and sulfa drugs & Levaquin.

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

Symptoms: After first dose my existing tinnitus in both ears was lowder.

Other Meds: Crestor & Vitamin D2

Current Illness: None

ID: 1136278
Sex: M
Age: 66
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: Flomax

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

Symptoms: Patient requested to receive Covid 19 vaccine; completed screening per protocol, As provider talked to him about vaccine and what to expect per Morderna vaccine guidelines. Patient was given Moderna covid 19 vaccine; without any complication he was discharged home after being observed for 15 minutes. As protocol we started entering vaccine in the health features and find out that patient had already received both 2 series of Covid 19 vaccines; also noted on the needle injection sign that he was given in the past after he had already left the clinic. I called patient on the phone to check how he was doing, state to be safe, felt well, Also confirm that he had received vaccine at health department, he state that he was confused about 2 series of shingle vaccine and covid 19 vaccine, and state that he was fine. Advised patient to call us or seek urgent care in case of any reaction. Planning to call patient again in the next day to check on him.

Other Meds: Atovastastin, vitamin D, Metoprolol succinate, ferrousul, linzess, miralax & lactulose

Current Illness: Constipation Prostate cancer Fatigue

ID: 1136279
Sex: F
Age: 58
State: CA

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: Lidocaine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Rash all over body, body aches, teeth hurting Right leg numbness tingling swelling pain From day one

Other Meds: None

Current Illness: None

ID: 1136280
Sex: F
Age: 57
State: CA

Vax Date: 02/19/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: contrast dye

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Beginning four hours after injection, began developing rashes: initially left middle finger became itchy, raised erythematous, weeping, progressed to eventual desquamation down to dermal layer. Over several days to week developed facial rash appearing atopic, weeping. Bilateral nipple rashes: pruritic, lichenified, weeping. Bilateral thighs with annular erythematous pruritic, now lichenified lesions. Initially thought to be herpetic whitlow when just affecting finger--HSV culture sent, rxd antiviral. Ultimately was rx'd prednisone course (5d 40 mg) today, 5 weeks out.

Other Meds: none

Current Illness: none

ID: 1136281
Sex: F
Age: 38
State: TX

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/25/2021
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: Muscle aches, severe chills, shaking/teeth chattering. Head felt ?off? all day. 10 days later diarrhea for several days.

Other Meds: Adderall XR, Wellbutrin XR, Xanax and Tylenol

Current Illness: None

ID: 1136282
Sex: F
Age: 84
State: CA

Vax Date: 03/04/2021
Onset Date: 03/08/2021
Rec V Date: 03/25/2021
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: Penicillin

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

Symptoms: Swelling of lymph nodes and of both breasts

Other Meds: Diovan, prilosec, atorvastatin, vit. D, ambien, aleve

Current Illness: None

ID: 1272741
Sex: M
Age: 71
State:

Vax Date: 03/17/2021
Onset Date: 03/21/2021
Rec V Date: 03/25/2021
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:

Symptom List: Unevaluable event

Symptoms: Shortness of breath

Other Meds:

Current Illness:

ID: 1300736
Sex: M
Age: 58
State:

Vax Date: 02/26/2021
Onset Date: 01/28/2021
Rec V Date: 03/25/2021
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 did not have any symptoms at the time of covid vaccination or during the observation period. Patient started having left arm and foot numbness the day after moderna covid vaccination. He developed left facial droop 2 days after vaccination and went to local ER on 02/28/2021. CT/MRI revealed acute right occipital and right thalamic infarct and old left occipital infarct. Carotid US showed fully occluded left carotid. Patient smoked for 40 years and quit March 2021 and previously used crack cocaine and quit 1 year ago. He was discharged from hospital on amlodipine, clopidogrel, atorvastatin, and aspirin, which were new medications. Patient has returned to work for over 2 weeks.

Other Meds:

Current Illness:

ID: 1381498
Sex: F
Age: 25
State: VA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/25/2021
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: Patient reported sweating, coldness of hands, dizziness, blurred vision, nausea, paleness similar to symptoms of syncope but when she complained of mild pain in the left side of chest, called 911. Helped her to safety without any injury and observed until symptoms resolved in a few minutes. By the time 911 crew arrived, she was doing good and feeling much better. She did not lose consciousness at any time during the adverse event and after 911 crew arrived. she informed she does not have any chest pain and she was doing well and does not need to be referred to a hospital or her PCP. 911 crew left without any treatment. I called the patient today again at 07:45 PM and she stated she is perfectly fine.

Other Meds: None

Current Illness: None

ID: 1381499
Sex: F
Age: 61
State: GA

Vax Date: 03/16/2021
Onset Date: 03/24/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt developed redness, arm tightness and warm to touch in arm she received vaccine starting yesterday. She stated it has progressively become worse over the last 24 hours

Other Meds: herbal remedies being taken at the time of vaccination

Current Illness:

ID: 1406314
Sex: U
Age: 71
State: AZ

Vax Date: 06/30/2020
Onset Date: 06/30/2020
Rec V Date: 03/25/2021
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: Penicillin, Sulfa, Laytex

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

Symptoms: RETURNED TO MEDICAL OFFICE, SAID SAME DOCTOR TOLD TO GIVE IT TIME AND SEE PRIMARY. SITE WAS SWOLLEN, RED AND HOT. COULDN'T MOVE OR LIFT ARM- GREW WORSE DAILY. WAS INFECTED- GIVEN DOXYCYCLINE HYCLATE 100 MG. ON 7-10-20 BY MEDICAL OFFICE DOCTOR

Other Meds:

Current Illness: n/a

ID: 1406317
Sex: F
Age: 1
State: MA

Vax Date: 12/11/2020
Onset Date: 12/17/2020
Rec V Date: 03/25/2021
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: erythematous maculopapular rash on trunk/neck non pruritic. Blanches. Received MMR 7 days prior,

Other Meds: none

Current Illness: none

ID: 1406319
Sex: F
Age: 25
State: RI

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt states "<48 hours after the vaccine I was so sick I should have gone to the ER but didn't have anyone to watch my kids." Pt states <48 hours s/p vaccination she woke up @ 3 am with "extreme nausea, vomiting, a 103 degree fever, and difficulty breathing. Pt stated that "It felt like I had a straw for lungs." Pt took her SO's inhaler and this helped w/breathing. Pt also states that he was "sweating profusely." Pt also states that she had an "extremely sore and painful arm even at the injection site. "Pt state that "it still hurts me to touch it to this day, one month later." Pt declined an appointment with her provider. Pt also wanted to make known that she is declining all further HPV vaccine

Other Meds: Melatonin 1 mg PO QHS PRN (sleep)

Current Illness: N/A

ID: 1406355
Sex: F
Age: 18
State: MA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/25/2021
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: After IM injection pt had some discomfort in arm and site which progressed as day went on with decreased ROM due to pain where was more at shoulder to deltoid pain with movement and at rest. Used heat/ice ibuprofen and pain continued, no redness or swelling at site. Over 1 week decreased symptoms but still 3/10 office visit has decreased symptoms time of visit

Other Meds:

Current Illness: none

ID: 1416729
Sex: M
Age: 58
State:

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/25/2021
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: Headache headache x2 days Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1416774
Sex: F
Age: 41
State:

Vax Date: 03/19/2021
Onset Date: 03/24/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Myalgia, Arthralgia, Fever, NauseaVomiting, photophobia/ "red, tender, chapped lips" Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1416775
Sex: F
Age: 37
State:

Vax Date: 01/28/2021
Onset Date: 01/29/2021
Rec V Date: 03/25/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Headache, Myalgia, Fatigue, Injection site pain.

Other Meds:

Current Illness:

ID: 1416786
Sex: F
Age: 48
State:

Vax Date: 03/20/2021
Onset Date: 03/21/2021
Rec V Date: 03/25/2021
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: FATIGUE

Other Meds:

Current Illness:

ID: 1416793
Sex: M
Age: 33
State:

Vax Date: 03/24/2021
Onset Date: 03/01/2021
Rec V Date: 03/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Dizziness & Palpitations Narrative: Employee reported 3/1 to 3/7/2021 "mild/moderate palpitations, fast heart rate, light headed". Obtained medical attention "possible vaccination side effect; EKG done 3/5/2021; placed off work 3/1/-3/5, monitor". Resulted in 4 days work missed.

Other Meds:

Current Illness:

ID: 1416797
Sex: M
Age: 61
State:

Vax Date: 03/24/2021
Onset Date: 03/19/2021
Rec V Date: 03/25/2021
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, Myalgia & NauseaVomiting Narrative:

Other Meds:

Current Illness:

ID: 1416798
Sex: F
Age: 48
State:

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/25/2021
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: Dizziness, Headache, Myalgia, Arthralgia, chills Narrative: Symptoms have resolved although Emp fatigue today due to event.

Other Meds:

Current Illness:

ID: 1416834
Sex: F
Age: 22
State:

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/25/2021
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: Dizziness, NauseaVomiting, Palpitations, near syncope/tingling in extremities Narrative: Employee presented to the ER for evaluation within 15 minutes of vaccine with dizziness, palpitations and feeling nauseated. She reported tingling in her legs as well. She was monitored-required IVF, pepcid and benadryl in the ER. Other Relevant History:

Other Meds:

Current Illness:

ID: 1416835
Sex: F
Age: 43
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Headache, Myalgia, felt flushed and body felt heavy. Narrative: Patient VS were checked and WNL. Patient was furthered monitored in vaccine clinic and given water. No further actions required and no further complaints from patient.

Other Meds:

Current Illness:

ID: 1416836
Sex: F
Age: 49
State:

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/25/2021
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:

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

Symptoms: Headache, Fever, NauseaVomiting, fatigue and chills Narrative: Employee reported fever, headache, fatigue, nausea and chills. Resulted in unable to work 3/15/2021.

Other Meds:

Current Illness:

ID: 1416837
Sex: M
Age: 37
State:

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Fatigue, Hand numbness. Narrative:

Other Meds:

Current Illness:

ID: 1416838
Sex: M
Age: 52
State:

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 03/25/2021
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: Pain in extremity

Symptoms: Myalgia Injection site pain. Narrative:

Other Meds:

Current Illness:

ID: 1416840
Sex: F
Age: 65
State:

Vax Date: 03/24/2021
Onset Date: 03/19/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Myalgia, Rash, Chills Narrative:

Other Meds:

Current Illness:

ID: 1416842
Sex: F
Age: 47
State:

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/25/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Fever, SkinRash, Diarrhea, "I had a very sore Left arm, considerable pain in the Left Axilla, chills, fatigue, headache, light headedness, body ache and a fever Tuesday night onwards that lasted a few days. Friday evening I developed itching which had increased considerably and Narrative: Employee emails: **************** "Dear Wonderful Members of the COVID Team, Hope that all of you are fabulous as we are at our end and staying healthy and happy. I was asked to reach out to you and notify you regarding my allergic reaction to my second dose of the Pfizer vaccine. I had my first dose on Tuesday, February 16, 2021 in the morning and experienced soreness in the left arm and pain with moving it for a day or two starting Tuesday night. I also had chills Tuesday night, chills, body ache and diarrhea Wednesday night and chills and fever, Sunday evening onwards for a few days. All was good and then I had my second dose on Tuesday, March 9, 2020 in the afternoon. I had a very sore Left arm, considerable pain in the Left Axilla, chills, fatigue, headache, light headedness, body ache and a fever Tuesday night onwards that lasted a few days. Friday evening I developed itching which had increased considerably and I got some hives and a rash Saturday onwards with throat restrictions, left greater than right. Benadryl, Claritin, Zyrtec did not provide any relief and I was unable to have clothes on due to the increased itching. I went to the Urgent Care on Sunday and they put me on Famotidine along with Cetrizine and emollients, and Benadryl at night, to no avail. On Monday I saw my PCP who examined me and started me on 5 mg Prednisone which did not help and after consulting with an Allergist, I was put on a course of 20 mg a day for 2 days, 10 mg a day for 2 days and then 5 mg a day for 2 days. The itching decreased and finally subsided by this past Saturday. The body aches are there (some) but I can handle all of that. The itching was crazy. I know that I will do Great!! Thank You for your kind time and for all you do. Have a great week. Happy Spring!! Kindest Regards, patient" Other Relevant History:

Other Meds:

Current Illness:

ID: 1416843
Sex: F
Age: 46
State:

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: CHILLS

Other Meds:

Current Illness:

ID: 1416844
Sex: F
Age: 47
State:

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 03/25/2021
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: Injection site pain

Other Meds:

Current Illness:

ID: 1417014
Sex: F
Age: 87
State:

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 03/25/2021
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: SEVERE SHORTNESS OF BREATH Narrative:

Other Meds:

Current Illness:

ID: 1417015
Sex: F
Age: 55
State:

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 03/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: injection site pain and shoulder pain Narrative:

Other Meds:

Current Illness:

ID: 1417018
Sex: M
Age: 56
State:

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/25/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: chills Narrative: Patient is a 56-year-old male with history of paranoid schizophrenia, COPD/ emphysema, alcoholic hepatitis and alcohol use remission who presents for ED evaluation of 1 day of pressure-like frontal headache with light sensitivity, myalgias, chills and fatigue, the symptoms are following the first Covid vaccine yesterday. Patient has not tried anything for the headache at this time, describes that is not different from his previous headaches. Does report some nausea without vomiting.

Other Meds:

Current Illness:

ID: 1417025
Sex: M
Age: 87
State:

Vax Date: 01/29/2021
Onset Date: 01/20/2021
Rec V Date: 03/25/2021
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: injectio site pain Narrative

Other Meds:

Current Illness:

ID: 1417026
Sex: F
Age: 61
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/25/2021
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:

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

Symptoms: itching/numb lips Narrative:

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm