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: 1137539
Sex: F
Age: 50
State: MD

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Contrast [iodinated Contrast Media PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: 03/24/2021: Patient presented and was admitted through emergency room for CC of melena. stated that she had a BM and had bright red blood at the end. The patient does have a history of peptic ulcer disease and GI bleed. She was admitted last year with GI bleed and was found to have multiple ulcers in the duodenum. Pertinent labs on admission - Initial H&H was 8.9 and 29.6. Repeat H&H 3 hours later?was 7.8 and 24.8. Per the EUA, hospitalizations are to be reported irrespective to attribution to vaccine

Other Meds:

Current Illness:

ID: 1137540
Sex: F
Age: 17
State: MO

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
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: keppra, morphine, phenobarbital

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna vaccine administered to person <18 y/o.

Other Meds:

Current Illness:

ID: 1137541
Sex: F
Age: 17
State: MD

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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 noted

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

Symptoms: Underage to receive Moderna vaccine.

Other Meds: None noted

Current Illness: None noted

ID: 1137542
Sex: F
Age: 54
State: TX

Vax Date: 02/01/2021
Onset Date: 02/03/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: After feeling sick for 24 hours, I started urinating bright red blood. It went away about 48 hours after it started.

Other Meds: Prozac, Losartan, Clonazepam

Current Illness: none

ID: 1137543
Sex: F
Age: 27
State: PA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Azithromycin

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

Symptoms: 11:30 am called for dizziness. PR: 92. Pt stated she feels better but still dizzy. Walked to the observation area. Layed on stretcher. @ 11:46 am PR 84 , RR 18, BP 125/80, O2% 98, x1 apple juice.@ 11:55 PR 82, RR 20 , BP 131/89, O2% 98. @ 12:04 pm PR 88 , RR , 20, BP 127/84, O2% 98. @ 12:08 pm Pt expressed feeling well and had been walked out to Parking lot.

Other Meds: N/A

Current Illness: None

ID: 1137544
Sex: F
Age: 25
State: MD

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
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: NKDA

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

Symptoms: Pt C/o feeling light headed. V/S BP,112/74, Temp 98.0, RR14, HR95, Psox 99% RA . Pt was A&O x 4 and verbal. She was advised to stay for further observation lying. down on a cot. She was offered 125 mls of apple juice and she finished it. At 1:p m Pt. said she felt okay and well enough to leave. She left the site unassisted to her residence.

Other Meds: Vitamins and Birth Control med

Current Illness: None

ID: 1137545
Sex: F
Age: 63
State: CO

Vax Date: 02/03/2021
Onset Date: 02/05/2021
Rec V Date: 03/26/2021
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: Allergic to most medications, strawberries, many chemicals, air freshners, cleaning products

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I began to experience very painful nerve pain in my body, most noticeable in my feet area making it painful to walk. I had been exercising and after the Pfizer covid vaccine shot, it hurt too much to exercise.

Other Meds: Levothyroxine, Metformin, Lisinopril, chlorthalidone, simvastatin,Amlodipine, Potassium K-tab

Current Illness: none

ID: 1137546
Sex: F
Age: 44
State: ID

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: IV Compazine

Symptom List: Pharyngeal swelling

Symptoms: pt noticeably antsy, asked if she was ok. she stated that she was trying to power through but couldn't. Nurse asked her to see the injection site. When she took off her sweatshirt, stating she felt on fire, the site and her arms were extremely red. She was asked to remove her mask and we discovered her lips and area around her nose was starting to swell. At that time she stated that her tongue felt "weird". Assessing the situation, the nurse administered an Epi-pen while I dialed 911 and gave information. Epi-pen very helpful, to the point she "wished we hadn't called the ambulance" . Once the EMTs arrived, they assessed her and after some time, had her sign a release form since she declined attention. Pt was informed that she would not be allowed to finish her shift and was asked if someone could come get her. The daughter was on her way. The nurse and I sat with her, watching to make sure she didn't have a rebound reaction which she did not in the hour + we were with her. Daughter arrived, took instruction from the nurse and took her home.

Other Meds:

Current Illness:

ID: 1137547
Sex: F
Age: 51
State: MI

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: penicillin, sulfas,

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: tongue numbness/tingling, rapid heart rate, electrical or nerve zap down both arms beginning from shoulders down to fingertips that happened simultaneously (one occurence), slight swelling and tingling sensation of lips.

Other Meds: levothyroxine 125mcg, atenolol 12.5 mg, crestor 10 mg, sertraline 50 mg Vitamins: calcium, C, D, K, B12

Current Illness: none

ID: 1137548
Sex: M
Age: 51
State: NC

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: sweating and fever 12 hours after vaccine lasting through the night on vaccination day, plus chills all day the following day until bedtime. Body aches started the following day in the morning and lasted throughout the day. I did test positive for covid on January 9th, 2021 and did recover from covid before getting my first dose of vaccine.

Other Meds:

Current Illness:

ID: 1137549
Sex: F
Age: 74
State: CA

Vax Date: 03/20/2021
Onset Date: 03/22/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Iodine and shrimp and some antibiotics

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

Symptoms: Headaches everyday ranging from mild to disabling migraine.

Other Meds: Vitamins of all kinds, and extra vitamin C and acupuncture herbs and cordyceps powdered musBrooms in coffee. No pharmaceuticals.

Current Illness: I was diagnosed with rheumatoid arthritis with synovitis in my toes in 2020; peripheral neuropathy in my right foot after a bout of shingles summer 2020.

ID: 1137550
Sex: F
Age: 60
State: CA

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: penicillin/fresh garlic/Pseudoephedrine

Symptom List: Rash, Urticaria

Symptoms: Around 13 hours later 7AM didn't sleep well. Woke up with dull headache and back of neck muscle aches. This lasted all day and evening. Today 3/26/21 I woke up feeling much better, dull headache pretty much gone. That was all that I had for side affects.

Other Meds: none

Current Illness: none

ID: 1137551
Sex: M
Age: 70
State: CT

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/26/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Swelling in left knee

Other Meds: Lisinopril, bystolic, amlodopine

Current Illness: None

ID: 1137552
Sex: F
Age: 46
State: OH

Vax Date: 03/20/2021
Onset Date: 03/22/2021
Rec V Date: 03/26/2021
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: Seasonal hay fever Multiple tree and vine fruits - watermelon, cherries, cantaloupe, honeydew, bananas, kiwi, grapes,

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

Symptoms: Approximately two days after my vaccine, I started having heart palpitations about 3-4 times a day. I have never had heart palpitations previously. I continue to have the palpitations. I previously had a positive Covid-19 test on November 26, 2020. I had very minor symptoms. I went to the emergency room on 03/25/2021 to be assessed.

Other Meds: Flintstones multivitamin Calcium supplement Vitamin B-12 supplement Vitamin D-3 supplement

Current Illness: None.

ID: 1137553
Sex: F
Age: 64
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient received first injection on 3/16/21. Contacted pharmacy on 3/25/21 to report injection site swelling, redness, and hot to touch. Patient said it showed up night of injection but she did not contact us right away. Told patient to apply cool compress to the area and also to take antihistamine. Patient called back and said it was doing better. Advised patient to contact doctor in case of cellulitis if antibiotic needed.

Other Meds:

Current Illness:

ID: 1137554
Sex: F
Age: 41
State: PA

Vax Date: 03/18/2021
Onset Date: 03/21/2021
Rec V Date: 03/26/2021
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: ACE Inhibitors

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

Symptoms: I experienced left sided chest pain 2 days after the vaccination lasting 2 days. Then 4 days after the vaccine, some back/Lung pain causing difficulty and painful breathing lasting for at least 3 days. I went to the Emergency department 6 days after the vaccination. I am reporting this information on the 8th day of vaccination.

Other Meds: carvedilol, exemestane, amLODIPine, Multivitamin, calcium

Current Illness:

ID: 1137555
Sex: M
Age: 67
State: AL

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: penicillin, Gin

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

Symptoms: Vacc on Wed afternoon, woke up Thurs morning with generalized myalgia, headache, dizziness, chills, moderate tenderness (no erythema) at injection site. 24 hours later, I am much improved, but still slight headache and feel weak.

Other Meds: none

Current Illness: none

ID: 1137556
Sex: F
Age: 65
State: OH

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Hives and redness to both arms, given 25mg of Benadryl PO, after 30 minutes hives began to decrease.

Other Meds: NA

Current Illness: NA

ID: 1137557
Sex: M
Age: 66
State: RI

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: metformin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pfizer vaccine was not diluted properly- not enough diluent was used patient was called and informed, patient is not currently experiencing any side effects

Other Meds: amlodipine besylate 5 mg atorvastatin 40 mg chantix starting month box flonase glipizide 10 mg incruse ellipta lisinopril 30 mg meloxicam 15 mg proair HFA 90 mcg zyrtec 10 mg

Current Illness: na

ID: 1137558
Sex: M
Age: 37
State: NY

Vax Date: 03/07/2021
Onset Date: 03/21/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Having no prior history, developed Iritis and have vision difficulties as a result.

Other Meds: None

Current Illness: None

ID: 1137559
Sex: F
Age: 42
State: OR

Vax Date: 03/14/2021
Onset Date: 03/15/2021
Rec V Date: 03/26/2021
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: Swollen lips, red rash at the edge of the lips, itchy, burning sensation for 12 days now. Using Chapsticks for 12 days now and Abreva for 2 days now.

Other Meds: Multi vitamins, vitamin C, vitamin D, Fish oil

Current Illness:

ID: 1137560
Sex: F
Age: 50
State: OH

Vax Date: 03/17/2021
Onset Date: 03/20/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin

Symptom List: Unevaluable event

Symptoms: Viral infection in lower left gum in mouth

Other Meds: Atorvastain 20 mg Pro-biotic Multi Vitamin Airborn Immune

Current Illness:

ID: 1137561
Sex: F
Age: 71
State:

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: nuts, flax seed

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

Symptoms: Headache Numbness in jaw and lips

Other Meds: levothyroxine

Current Illness: none

ID: 1137562
Sex: M
Age: 17
State: MD

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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 reported

Symptom List: Injection site pain, Pain

Symptoms: Underage to receive Moderna vaccine.

Other Meds: None reported

Current Illness: None reported

ID: 1137563
Sex: F
Age: 43
State: OH

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 03/26/2021
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: Metallic taste in mouth

Other Meds: None

Current Illness: None

ID: 1137564
Sex: F
Age: 40
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: None known

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

Symptoms: 4 hours post-vaccine, started to shiver 6 hours post-vaccine spiked fever of 102.2 7 hours post-vaccine developed headache and began to vomit 8 hours post-vaccine, I went to the ER They found I had tachycardia for the duration of my visit (11pm - 3 am). Administered Toradol and IV fluids, discharged me with good vitals, but still tachycardia, headache, and vomiting. The next day (3/20), I still had a bad headache and could not keep liquids down. I vomited perhaps 12 times, then called the doctor. She sent me to Urgent Care to receive injections of Toradol and Phenergan. Within the hour, I could drink. Then shortly after, I could eat. I felt better for one day. The next day (3/22), my heart started pounding, and I was unable to sleep horizontally. I needed to sleep on 3 pillows due to chest discomfort. My chest still feels very uncomfortable. Abdominal breathing is helping to an extent. I have had to stay in bed and greatly reduce my activities since receiving the vaccine. Today is one week, and I am still in bed.

Other Meds: Trazodone 50 mg/night Retin-A - 3x/week

Current Illness:

ID: 1137565
Sex: F
Age: 38
State: CO

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, topamax, cashews, pistachios

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Sore/swollen arm, headaches/migraines (continuous since shot), chills, nausea, fatigue, muscle aches, swollen lymph nodes under arm and in neck, all symptoms still ongoing on 3/26/2021. Wheezing (on 3/24/2021 all evening, but not on following days)

Other Meds: Singular, zyrtec, albuterol, levothyroxine, trintellix, adderall

Current Illness: None

ID: 1137566
Sex: F
Age: 57
State: CO

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
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: Fever for 24 hours of 101.5, extreme body aches, headache, nausea, sore throat, sinus congestion, injection site very red and raised. Lasted 40 hours.

Other Meds: Lisinopryl, vitamin d, vitamin c, cholestoff, ibuprofen

Current Illness: Had positive covid on December 27, 2020. Had all known symptoms, lasted around 3 weeks stomach flu or food poisoning 3-11-21

ID: 1137567
Sex: M
Age: 16
State: ND

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: Scented oils

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

Symptoms: muscle fatigue and stiffness in both shoulders, minor runny nose, dry eyes, minor cough.

Other Meds: Escitalopram

Current Illness: N/A

ID: 1137568
Sex: F
Age: 16
State: MN

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
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: recipient is age 16 and Moderna is approved for those 18 and older. No adverse effects reported.

Other Meds:

Current Illness:

ID: 1137569
Sex: F
Age: 72
State: MN

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/26/2021
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

Symptom List: Injection site pain

Symptoms: "Pfizer-BioNT Covid-19Vaccine EUA" Because I am allergic to Hornet sings I waited 30 mins after the injection. I was fine so I walked out to my truck. I became flushed in the face and my mouth had a metallic taste so I walked back into the clinic to tell them. They took my Blood pressure which was 200/125. I felt very off so they wheeled me into Urgent Care where they gave me one benadryl and monitored my blood pressure. They then called for ambulance for ER . I was released when my blood pressure was lower. I will not get the second injection of Pfizer!

Other Meds: none

Current Illness: none

ID: 1137570
Sex: F
Age: 46
State: WI

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/26/2021
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, Augmenten

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

Symptoms: Around 10:00 a.m. the day following my first shot, I started to feel like I had the chills/a fever. I was at work so just took some tylenol to help with this and it helped a little until around 2:00 p.m. At 2:00 p.m., I started to feel much more feverish and achy. By the time I arrived home at 4:00 p.m, I had a fever of 101.7, I was achy, and very fatigued. I felt this way all night long and slept on and off from about 5 pm until 5:30 a.m. By about 10:00 a.m. the second day after my shot, I no longer had a fever and the achiness was improving but I still felt fatigued. By Day 3 after my shot, I attempted to work out. I was able to work out for about 30 minutes before feeling very fatigued. By Day 4 after my shot, I felt like normal again. FYI...I was diagnosed with Covid in October, 2020 and had tested positive for Covid Antibodies and blood donations in December 2020 and January 2021.

Other Meds: Nuvaring

Current Illness: Allergy/Sinus issues

ID: 1137571
Sex: F
Age: 40
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: None

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

Symptoms: About 4 hours after receiving the dose I started experiencing piercing, stabbing headache on the left side of my head. Sitting through my temple, eye, cheek, jaw and even my nose and top of my head. It is now 11am the next morning and still in pain only slightly more dull.

Other Meds: Occasional magnesium and l-theanine

Current Illness: None

ID: 1137572
Sex: M
Age: 55
State: MN

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/26/2021
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: Patient reported later in the evening fatigue, muscle aches, injection site soreness, and a low grade fever

Other Meds:

Current Illness:

ID: 1137573
Sex: M
Age: 19
State: TX

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: After receiving the vaccine, patient became diaphoretic, lips were turning blue and patient seemed very weak. Vital signs were taken and oxygen administered. Patient was transferred to a stretcher and taken to the ED for observation. He was given some juice and crackers and went home. Patient's mom was present throughout all of the event and desired to take the patient home.

Other Meds:

Current Illness:

ID: 1137574
Sex: F
Age: 35
State: CA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: NO KNOWN DRUG ALLERGY

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

Symptoms: On March 25, 2021, at 9:15am, patient had an appointment at 3323 to receive first Moderna COVID-19 vaccine. After PHARMACIST administered vaccine, PATIENT stayed in waiting area for 15 minutes for observation. PATIENT was conscious but called PHARMACIST over due to her feeling dizzy, sweaty, and pale. PHARMACIST called store director to assist while pharmacist monitored PATIENT. STORE MANAGER called 911. Paramedics arrived and checked/ monitored PATIENT?S symptoms and overall well-being. PATIENT was then taken to the emergency room. PHARMACIST called to follow up with PATIENT around 4:30pm and 7:40pm on March 25, 2021 when PATIENT was home. PATIENT spoke with PHARMACIST and per PATIENT reported that the Emergency Room Physician checked vital signs and symptoms, and everything was normal with PATIENT. ER physician confirmed that PATIENT?S symptoms was not related to the Moderna COVID-19 vaccine and still recommends that PATIENT still receive the second dose. PHARMACIST spoke with PATIENT and recommends that she speak with her primary care physician regarding the incident before receiving the second dose.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1137575
Sex: U
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 03/26/2021
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: I had the vaccine on 3/12/21. On Monday, 3/22/21, I broke out with severe hives all over my body. I also experienced severe itching. The next day, Tuesday 3/23/21, I went to see my primary care doctor who put me on Singular 10mg 1 tab in the evening, Hydroxyzine 25mg 1 as needed and Prednisone 50mg 1 tab everyday for 5 days. On Thursday, 3/25/21, I started to have pain a pleuritic pain when breathing. I went to the Regional ER They drew blood tests, did an EKG a chest CT. I was given Benadryl and Methylprednisolone by IV. Tests were fine and I was sent home. I still have hives.

Other Meds:

Current Illness:

ID: 1137576
Sex: F
Age: 53
State: TX

Vax Date: 03/23/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vomiting all morning. Chills then vomit, then break out in a sweat, mild headache. Low fever at 100 degrees. Haven?t been able to keep any liquids down for 7 hours.

Other Meds: Fluoxetine 20mg Vitamin D3 Lio/Levo 6/25 mcg Progesterone 200mg Methyl protect - riboflavin 25 mg, Vitamin B6 10 mcg, vitamin B12 1000 mcg, betaine anhydrous 500mg

Current Illness: None

ID: 1137577
Sex: F
Age: 66
State: IN

Vax Date: 03/23/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
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: penicillin, sulfa, tetracycle,

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

Symptoms: palpitations 24 hours after injection lasting several hours. Today is day 3 days since injection. This morning I noticed paresthesia of lips and face and tingling of lips and tongue. Beginning at 9 am and has continued through afternoon

Other Meds: daily one cap vitamin

Current Illness: no

ID: 1137578
Sex: F
Age: 42
State: MI

Vax Date: 03/19/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
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: Delayed local injection site reaction. Raised rash, hot, swollen, itching. Took Benadryl, applied cortisone cream and ice pack.

Other Meds: Fluvoxamine 50mg, Motrin 200mg

Current Illness: None

Date Died: 03/25/2021

ID: 1137579
Sex: F
Age: 62
State: MI

Vax Date: 03/16/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Sulfa (Sulfonamide Antibiotics) Angioedema, Rash and Anaphylaxis

Symptom List: Pain in extremity

Symptoms: ? Maderna vaccine #1 on 3/16 at clinic ? Provider visit 3/22 dx bronchitis due to COVID-19, z pak and steroids ? ED 3/25 syncopy, full arrest and patient expired patient states she had COVID in February

Other Meds:

Current Illness: COVID-19, diagnosed with COVID bronchitis 3/22/2021, strep pharangitis

ID: 1137580
Sex: F
Age: 48
State: IA

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: Serevent

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

Symptoms: Fever >102.4, congestion, sore arm, difficulty breathing, severe asthma, malaise, headache. Minor temp started around 10pm, woke up 3:30am with extreme cough and SOB, asthma, wheezing; fever rose throughout day greater than 102, continued shortness of breathe, coughing, congestion, wheezing, sought treatment in Emergency Room

Other Meds: Singulair, Vit D, Albuterol, Allegra, Doxycycline

Current Illness: Asthma

ID: 1137581
Sex: M
Age: 53
State: NE

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/26/2021
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: NKA

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

Symptoms: SOB while laying down x 4-5 days.

Other Meds: calcitrol, albuterol inhaler, atorvastatin, Lasix, Norvasc, olmesartan, doxazosin, bystolic, novolog

Current Illness:

ID: 1137582
Sex: F
Age: 30
State: MN

Vax Date: 02/17/2021
Onset Date: 02/26/2021
Rec V Date: 03/26/2021
Hospital: Y

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: Hospitalization within 6 weeks after receiving vaccine.

Other Meds:

Current Illness:

ID: 1137583
Sex: F
Age: 39
State: VA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/26/2021
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: Unknown

Symptom List: Vomiting

Symptoms: Client received her first dose of Pfizer vaccine and during the post-vaccination wait period, she reporting itching on her arms and upper chest. On examination, she did not have any hives, redness or swelling of the skin. Vital signs: BP=173/116, Pulse=98, regular respiration ? not labored. Client stated that she has high blood pressure, but had taken her medication in the afternoon. She was asked to wait for an additional 15 minute to see if her symptoms would improve, but it remained the same. She did not want the EMT to be called but stated that she preferred a friend to pick her up, after she was advised that it was prudent to be evaluated at the hospital. ?911? was called and Medic arrived, evaluated her and transported her away at 16:45 hours.

Other Meds: Unknown

Current Illness: Unknown

ID: 1137585
Sex: M
Age: 76
State: VT

Vax Date: 03/05/2021
Onset Date: 03/26/2021
Rec V Date: 03/26/2021
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: Allergies: BEE STINGS, SIMVASTATIN, ATORVASTATIN, PRAVASTATIN, LISINOPRIL, MELOXICAM GABAPENTIN, FLUVASTATIN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient developed chest pain at 0500 on 3/26. He took 3 doses of Nitro without relief, mildly diaphoretic, left scapula pain. Emergency responders were called. EMTs performed EKG in ambulance and reported AFib. He arrived at hospital, and symptoms resolved prior to exam. EKG, Troponin checked twice, and patient discharge to home with recommendation to return if symptoms recur and to f/u with Cardiology.

Other Meds: Active Outpatient Medications Status ========================================================================= 1) ACCU-CHEK AVIVA PLUS(GLUCOSE) TEST STRIP USE 1 TEST ACTIVE STRIP EVERY DAY TO TEST BLOOD

Current Illness: n/a

ID: 1137586
Sex: F
Age: 30
State: IN

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
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: Dog dander, novocain, C-chlore

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

Symptoms: Fatigue- started at 7am and slept most of day, continued to experience fatigue into the next day 3/26/21. Nausea- woke up at 7am on 3/25/21 with nausea that lasted until 7pm on 3/25/21. Migraine- took Tylenol every 4-6 hours from 7am on 3/25/21 until 9pm on 3/25/21.

Other Meds: Tylenol extra strength, multivitamin, vitamin C,

Current Illness: None

ID: 1137587
Sex: F
Age: 69
State: AL

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/26/2021
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: no

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever, body aches, and chills

Other Meds: Lipitor 20mg

Current Illness: no

ID: 1137588
Sex: M
Age: 60
State: FL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: RN dropped the syringe containing the vaccine on the floor, picked it up, and proceeded to administer in my left arm. After the event, I learned that the Moderna vaccine is very fragile and should not be shaken. I need guidance on what the next steps are. Should I get a replacement first dose? Is dropping the syringe considered as shaking the vial? Time is of the essence, and would appreciate a quick response. Thank you.

Other Meds: Nexium, Berberine, Ocuvite (Lutein)

Current Illness: None

ID: 1137589
Sex: F
Age: 74
State: AZ

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 03/26/2021
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: Augmenting Benzodiazepines Titanium

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

Symptoms: Head cold symptoms, stuffy head, runny nose and occasional cough.

Other Meds: Anastrozole 1mg daily Metformin ER 1500mg daily Meticore 2 capsules daily Lipozene 1500mg twice daily Zinc 50mg daily D3 2000IU daily Vit C 2000mg daily Magnesium 400mg daily Vit E 400IU daily Naproxen 220mg daily

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm