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: 1137724
Sex: F
Age: 61
State: NY

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

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Dry heaves, high fever of 103, headache, sore throat for 2 1/2 days

Other Meds: Aspirin (baby), valtrex ,prednisone - 4mg; lexapro 5mg, bystolic 10 mg; telemasartin 80 mg,

Current Illness:

ID: 1137726
Sex: F
Age: 40
State: KS

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: tree nuts, peanuts, codeine, hydrocodone, penicillin, nickel, gold, quaternium-15, neomycin

Symptom List: Anxiety, Dyspnoea

Symptoms: Janssen COVID-19 Vaccine EUA headache (8/10), chills, muscle pain, fever, nausea, dizziness, weakness, fatigue

Other Meds: levothyroxine, albuterol, lutein, iron, prenatal vitamin

Current Illness:

ID: 1137727
Sex: F
Age: 66
State: IL

Vax Date: 03/21/2021
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: aspirin , latex

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

Symptoms: itching arm, cluster of little bumps, pain in arm

Other Meds: glipizide 10mg, farxiga 10mg, diclosenac 75mg, estradiol 2mg

Current Illness:

ID: 1137728
Sex: F
Age: 33
State: AZ

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I felt some numbness and tingling in the cheeks and nose of my face. I had quick jabby/stabby type pains in my brain (nothing too intense). And light tremors in my legs that made them feel a little weak and hard to walk on. All of my symptoms subsided in about an hour.

Other Meds: Excedrin sinus headache, acetaminophen 325 mg and phenylephrine HCI 5 mg, aspirin free, pain reliever and nasal decongestant...I only took one pill in the morning

Current Illness: Migraine

ID: 1137729
Sex: U
Age: 18
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: strawberries, amoxicillin, hot sauce

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

Symptoms: Hive like rash appeared on forehead after vaccination. No SOB, wheezing or throat tightness. VS taken and stable. Zyrtec 10mg given PO.

Other Meds: loratadine, escitalopram

Current Illness: None

ID: 1137730
Sex: F
Age: 53
State: OR

Vax Date: 01/25/2021
Onset Date: 01/28/2021
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: Codeine

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

Symptoms: Easy bruising, petechiae, gum bleeding, aches and joint pains

Other Meds:

Current Illness:

ID: 1137731
Sex: F
Age: 55
State: PA

Vax Date: 03/19/2021
Onset Date: 03/21/2021
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 penicillin, Lisinopril, bee stings, and Tetanus vaccine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I woke up with extreme pain and swelling at the base of my left big toe and the ball of my left foot. I suspect it was a gout attack. I've had attacks like this before, followed by bloodwork which did NOT show elevated uric acid levels, so I've been told it's arthritis, not gout. I still think it's arthritis. The swelling/pain has made it difficult to walk, but it's decreasing in intensity as the days pass. I've been taking ibuprofen regularly since the onset of symptoms and discontinued use of HCTZ and potassium supplements..

Other Meds: Synthroid, Losartan Potassium, Hydrochlorothiazide, Potassium Chloride, Loratadine, Omeprazole, Vitamin D3

Current Illness: experienced edema in lower legs after first Pfizer civid-19 vaccine shot

ID: 1137732
Sex: M
Age: 30
State: UT

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: LA

Lab Data:

Allergies: Honey Bee

Symptom List: Pharyngeal swelling

Symptoms: Received vaccin on 3/24 3:00pm, started experiencing severe fever and chills on 3/24 from 10:00pm to 2:00am. Fever broke around 2:30am. Had fatigue, headache, and extreme body ache through 8:30 pm on 3/25. Residual full body muscle soreness and headache through 3/26 at 12pm.

Other Meds: None

Current Illness: None

ID: 1137733
Sex: F
Age: 61
State: CA

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Agmentin, DTAP, Dairy, Pollen

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: At 20 minutes from vacination my face became in flamed below the ear on both sides. Face became bright red. Heart rate was taken. Blood pressure was taken (said to be 182 over 95 - nomal runs 82). Was given one benydrl. which makes me drozy. After approximately 30 minutes heart rate lowered. I wasn't given the full information. Representatives identified themselves as CDC documented information. PCP was notified. I need to get a second vaccine, I need to be advised on how to proceed.

Other Meds: HDTZ 12.5mg, 81mg Asprin, Metoprolol Succinate ER 50mg

Current Illness: None

ID: 1137734
Sex: F
Age: 38
State: NJ

Vax Date: 01/12/2021
Onset Date: 03/22/2021
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: Patient presented to the ER on 3/20/21 with complaints of cough and nasal congestion since Thursday 3/18/21. Patient received both doses of the COVID-19 vaccine on 12/22/20 and 1/12/21. Patient tested COVID-19 positive on 3/22/21. SARS COV2 tested using PCR Cepheid.

Other Meds:

Current Illness:

ID: 1137735
Sex: F
Age: 27
State: OH

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Blood in stool 03/25/21

Other Meds:

Current Illness:

ID: 1137736
Sex: F
Age: 94
State: MA

Vax Date: 03/16/2021
Onset Date: 03/19/2021
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: vitamin D

Symptom List: Rash, Urticaria

Symptoms: Severe left leg pain on 3/19

Other Meds: lisinopril, atenolol

Current Illness: no

ID: 1137737
Sex: F
Age: 39
State: WA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
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:

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

Symptoms: Pt received Covid-1 vaccine. About 15 minutes after shot was given pt waved down parking attendant and asked for a nurse. 2 nurses arrived at pt's car. Pt reported that she first started feeling itchy on a bug bite on her arm which was red. She then stated it went from her bug bite to feeling tingly/burning on her lips. Pt reported she hadn't eaten much today and had drank hardly any water today. Pt's vitals were 152/92 to which pt stated she takes BP meds and her BP is at times higher than that. Her HR was 64, resp 22, SpO2 98%. Pt stayed for an extra 15 minutes then stated she was feeling better and wanted to go home.

Other Meds:

Current Illness:

ID: 1137738
Sex: F
Age: 44
State: OH

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: Patient reported hives and difficulty breathing with "all contrast dyes". Patient said she "burned from inside out" with barium sulfate and had anaphylaxis with Gadolinium. (She also reports stomach bleed with methadone and confusion with Lyrica.)

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

Symptoms: Patient said a headache started 40 minutes after first dose, then flushing began 8 to 9 hours after first dose. The headache and flushing lasted four days. (Fatigue also started that afternoon but stopped 24-48 hr later. Sore arm started the same day and lasted three days.)

Other Meds:

Current Illness:

ID: 1137739
Sex: M
Age: 39
State: OH

Vax Date: 03/18/2021
Onset Date: 03/20/2021
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: NONE

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

Symptoms: 2 DAYS AFTER SM RECIEVED HIS MODERNA VACCINE IN HIS LEFT ARM HIS RIGHT ARM TURNED BLUE. HE WENT TO THE EMERGENCY ROOM TO FIND OUT HE RECIEVED A BLOOD CLOT WHICH THEY THINK WAS CAUSED BY THE VACCINE. HE WAS PUT ON BLOOD THINNERS THAT DAY AND SENT HOME 6 HOURS LATER. HE WILL BE ON BLOOD THINNERS FOR UP TO 6 MONTHS.

Other Meds: INJECTABLE TESTOSTERONE

Current Illness: NONE

ID: 1137740
Sex: F
Age: 30
State: IL

Vax Date: 03/20/2021
Onset Date: 03/20/2021
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: None

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

Symptoms: 8 hours after the vaccine felt fatigue, had 103 fever, body chills and aches, sweats, head pressure. Took Tylenol and fever went down. Woke up Sunday with 101 fever, aches, took Tylenol again and sweat it out. Fever went away completely but had nausea and diarrhea. That lasted 2 days. Tuesday morning started feeling congested, sinus pressure ringing in ears when laying down, Thursday noticed mild smell and taste. Tested positive for Covid via a rapid test. Friend who had vaccine same day same exact symptoms also tested positive, were never near each other and no one else around me is sick.

Other Meds: Claritin

Current Illness: None

ID: 1137742
Sex: F
Age:
State: WA

Vax Date: 03/22/2021
Onset Date: 03/24/2021
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: Large scale local reaction to bee stings.

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

Symptoms: facial rash, mild swelling and itching beginning 2 days after 1st dose Moderna. Also used new face lotion the two days prior to onset

Other Meds: New face lotion, non-rx

Current Illness: N/A

ID: 1137743
Sex: F
Age: 78
State: NY

Vax Date: 03/23/2021
Onset Date: 03/25/2021
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: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The arm was sore for 2 days. I have diverticulitis and it flared up a few days letter. my legs feel a little heavy. I don't think that a vaccine should be attacking my weaknesses or current health conditions. I eat very bland and I don't have issues but now I have terrible issues since the vaccine.

Other Meds: atenolol, lisinopril, essential vitamins, coQ10, Eye vitamins

Current Illness: No

ID: 1137744
Sex: F
Age: 76
State: PA

Vax Date: 02/24/2021
Onset Date: 03/06/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: On approx. March 6th I noticed I was having a ringing in my ears. It has persisted since then, no better no worse. It does not keep me up at night but it is annoying. I don't know if it is related to the vaccine shot but I kept thinking that it could be a delayed reaction. Maybe it started before but at a lower level and took until the 6th for me to notice. This week (week of March 22) I read a news article about someone who committed suicide because he was having severe bouts of tinitis since having had a case of covid. That made me think that my tinitis could be related to the vaccine. I tried to red up on tinitis and it seems that there is no treatment for this. Am I correct in that information?

Other Meds: Triamterene-HCTZ37.5/25 mg; Levothyroxine Sodium 75 mcg; Vitamin D-3 50 mcg; Chelated Zinc 50mg, Tumeric 500mg; Calcium supplement; Multi-vitamin

Current Illness: none

ID: 1137745
Sex: M
Age: 39
State:

Vax Date: 03/11/2021
Onset Date: 03/11/2021
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: CT iodine contrast

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

Symptoms: Within an hour of the shot, started feeling dizzy. Intense fatigue and full body aches set in within 3 hours. Facial numbness and left-side facial drooping began within 8 hours. Low fever, chills, heavy heart beat, and intermittent cramps of the abdomen and on the left side (between hip and rib cage) began within 18 hours. Swollen lymph nodes in the neck and constipation began within 48 hours. At ~4 days since the first shot, the facial numbness, heavy heart beat, and fatigue persisted, though the drooping became less prominent and the other symptoms have largely resolved. At ~2 weeks since the first shot, the facial numbness has been constant, but varying in intensity, and the left-side facial drooping has returned multiple times.

Other Meds: Fish Oil, Turmeric, Lutein

Current Illness: None

ID: 1137746
Sex: F
Age: 42
State: OH

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: Unknown

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

Symptoms: Tight throat and chest tightness, 12.5mg Benadryl PO provided

Other Meds: NA

Current Illness: NA

ID: 1137747
Sex: M
Age: 65
State: MA

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Unevaluable event

Symptoms: AE: pt reported chest pain and tingling/ numbness of lips approximately 30 minutes post vaccination Tx: EMS eval and vitals Outcome: pt refused further treatment and transport

Other Meds: none

Current Illness: none

ID: 1137748
Sex: F
Age: 46
State: CT

Vax Date: 03/04/2021
Onset Date: 03/06/2021
Rec V Date: 03/26/2021
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: NO

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

Symptoms: I had a Covid vaccine from my job on 3/4/2021. I started feeling symptoms 2 days after my vaccination and everyday I am experiencing new symptoms. I was in the ER one week after the vaccine with numnes on the entire left side of my body, when I was admitted to the hospital I had many tests done, I tested positive for Covid , i had MRIs , everyday I would lose feeling in different parts of my body. After staying in the hospital 5 days I was diagnosed with GBS and sent home. Three days after I came home I had new symptoms I couldn?t walk my legs w re paralyzed. I had to go back to the hospital. I stayed in the hospital 5 days.I was diagnosed one more time with Post-Vaccination Guillain-Barr? Syndrome (GBS) .My symptoms are still coming back to my spine and head. I am not able to keep my head up for long. They did all the test again and the neurologists confirmed one more time that I have GBS syndrome after receiving the vaccine.

Other Meds: NO

Current Illness: NO

ID: 1137749
Sex: F
Age: 28
State: NC

Vax Date: 03/09/2021
Onset Date: 03/09/2021
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: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: Syncopal episode - monitored for a few minutes, patient improved and went home.

Other Meds:

Current Illness:

ID: 1137750
Sex: F
Age: 28
State: IN

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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin, sulfates, adhesives

Symptom List: Injection site pain, Menorrhagia

Symptoms: Rash at injection site, painful arm, body aches, chills, fever

Other Meds: Lisinopril, metformin, propranolol, gemfibrozil, Paxil, vraylar, omeprazole, delta 8 thc

Current Illness: None

ID: 1137751
Sex: F
Age: 42
State: VA

Vax Date: 03/24/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Hard lump behind left ear (same side as injection site)

Other Meds: Birth Control

Current Illness: None

ID: 1137752
Sex: F
Age: 50
State: FL

Vax Date: 03/20/2021
Onset Date: 03/21/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I got the normal muscle aches, pain, fatigue, fever (103),and headache. I had on Sunday, the day after I had pain under my left rib toward my side, leg and groin. I had developed red spots on my legs. I contacted my PCP and they sent my platelet test and it can back ok. I went in to see my PCP and he checked me and only thing he came up with due to my auto immune disease it triggered inflammation. I'm still in pain everywhere and can't touch certain parts of my body, my Dr. can't figure out where it's from and believes it's from the shot. If it's not better in a week he wants me to go back.

Other Meds: Excedrin Tylenol

Current Illness: UTI ( March 09, 2021)

ID: 1137753
Sex: F
Age: 44
State: MA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
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: penicillan

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Sore arm, chills, slight fever, headache, brain fog. Headache and brain fog lasted until Monday. Then 8 days later I woke up with very sore arm again and a big red circle around the injection site. My arm was also swollen. Same day, I also woke up with painful upper shoulder pain across both shoulders and upper back. I have been more tired over these past 2 weeks and napping frequenlty.

Other Meds: Birth control pill daily vitamins

Current Illness: no

ID: 1137754
Sex: F
Age: 34
State: NY

Vax Date: 03/05/2021
Onset Date: 03/05/2021
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: Not allergies, but intolerance to animal products (dairy, eggs, fish, poultry, and meat). Allergies to dust, cats, dogs, and pollen.

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

Symptoms: Extreme fatigue starting 6 hours after injection, continuing for ~36 hours. Mental fog starting morning after. Words sound like word salad; couldn't remember words for common things, couldn't understand things said to me. "Tip of the tongue" syndrome has continued to persist. Depression worsened. Suicide ideation.

Other Meds: Adderall, wellbutrin, vyvance, beyaz, b-12, vitamin D, xanax

Current Illness: Bipolar depression, anxiety, adhd

ID: 1137755
Sex: M
Age: 28
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Environmental Sulfur

Symptom List: Nausea

Symptoms: 1257 as patient drove off from vaccine bay, mom reports he?s started fainting and she pulled over so he would not crash. As we arrived to the vehicleA patient was Faint and lethargic but responsive. Patient mom reports patient always faints whenever he gets a shot. 1:01 911 called 1:02 Dr. arrived, blood pressure 121 systolic 1:06 fire Dept. arrived blood pressure 126/78 , 99% on room air 12 lead normal sinus rhythm. Patient and his parents feel going to the hospital will cause more anxiety. 1:28 patient went home wiener his parents. Mom driving his car 1:26

Other Meds: Allegra d Rexapril Fenisteride

Current Illness:

ID: 1137756
Sex: F
Age: 69
State: GA

Vax Date: 03/02/2021
Onset Date: 03/25/2021
Rec V Date: 03/26/2021
Hospital: Y

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: Injection site pain

Symptoms: Vaccine 3/2/2021.Presented to ER 3/25/2021 with chest pain and found to have acute MI with completely occluded left main coronary artery with clot causing cardiac arrest, cardiogenic shock. Currently Critically ill, intubated, high risk mortality.

Other Meds: Acyclovir, Lipitor, Coreg, Pepcid, Levothyroxine, Prograf, CellCept

Current Illness: Kidney transplant, hypertension, diabetes

ID: 1137757
Sex: F
Age: 73
State: AZ

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/26/2021
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: Shellfish and Iodine

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

Symptoms: Felt a bit dizzy and tired. These continued with inability to securely grasp things with my left hand until Saturday March 20th when I was taken to the ER.

Other Meds: Eliquis, Atorvastatin, Valsartin

Current Illness: None within the last 1 year and 3 months

ID: 1137758
Sex: M
Age: 43
State: OH

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Nausea Dizzyness

Other Meds: None

Current Illness: None

ID: 1137759
Sex: F
Age: 71
State: IN

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Tetracycline, Tucks, Percocet, Fentanyl patch, Lovenox, nickel (metal)

Symptom List: Tremor

Symptoms: Sore arm, 3:00 pm date of vaccine, mild soreness remains 2 days later; chills and fever began approx. 11:00 pm date of vaccine (T 99.8), fever 101.2 and 101.3, down to 99.5 with 2 Tylenol day after vaccine; chills lasted an hour; fever broke about 1:30 am 2nd day after vaccine. Temp normal 2nd day after vaccine. Mild fatigue 2nd day after vaccine.

Other Meds: multi-vitamin-mineral, CoQ10, fish oil, calcium-magnesium-zinc, Lutein,apple cider vinegar, Kyolic, Lisinopril, vitamin C, Montelukast,Turmeric, 81 mg. aspirin,Cetirizine, Advair discus, Niacin time release

Current Illness: none

ID: 1137760
Sex: F
Age: 31
State:

Vax Date: 01/13/2021
Onset Date: 02/04/2021
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: Erythema, Pruritus

Symptoms: Hospitalization within 6 weeks after receiving vaccine

Other Meds:

Current Illness:

ID: 1137761
Sex: F
Age: 45
State:

Vax Date: 03/26/2021
Onset Date: 03/26/2021
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:

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

Symptoms: 3/26/2021 Patient was observed post Covid-19 immunization for 30 minutes based on pre-vaccination screening . During the observation period, she experienced an adverse reaction with the following symptoms: Numbness to left fingers,left arm aches, . Assessment : Time of assessment 1040am Alert and oriented. No redness or swelling, able to move fingers, reports pain 3?10. Actions taken: VS @1040am BP- 149/100, P- 81, O2- 99%, recheck at 1049 BP- 152/87, recheck @ 1131- 147/79, P- 77, O2-100%. Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 30 minutes. Discharged home. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 3/26/2021 10:46 AM 0.3 mL 12/11/2020 Intramuscular Manufacturer: Pfizer, Inc

Other Meds:

Current Illness:

ID: 1137762
Sex: M
Age: 83
State: FL

Vax Date: 02/11/2021
Onset Date: 02/17/2021
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: NKA

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: CLIENT DEVELOPED RED RAISED RASH WITH ULCERATION WAS SEEN BY PRIMARY CARE MD X2 VISITS. RECEIVED PRESCRIPTIONS FOR CEPHLAHEXIN 500MG AT FIRST VISIT AND BACTRIM DS AT FOLLOW UP

Other Meds: NKA

Current Illness: NKA

ID: 1137763
Sex: F
Age: 66
State: OH

Vax Date: 02/26/2021
Onset Date: 02/26/2021
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: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient said diarrhea started 3 to 4 hours after first dose and lasted 3 to 4 hours off and on. (She said the same thing happens after a flu shot for her.)

Other Meds:

Current Illness:

ID: 1137764
Sex: M
Age: 38
State: NY

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: antibiotics and shellfish

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

Symptoms: pt states he got a couple of hives after taking the vax. He was given Benadryl which helped with the hives. Later that night after going to bed he woke up w/ his muscles and nerves twitching and tingling. He says you can sometimes see the muscles spasms and then other times he feels it tingling under the skin. Pt is still having these symptoms. He had a sore arm for about 48 hours. For about 3 to 4 days he had a faster heart rate and higher blood pressure than normal. He developed a headache that lasted about 2 days. Currently he is having some brain fog and his shoulder and biceps still have a heavy feeling like they are detached from his body along with the muscle twitching and tingling. He does not feel like these symptoms are improving and will see his PCP on 3/29/2021.

Other Meds: pantoprazole 40mg, Xanax 0.5mg, multivitamin, elderberry, tums

Current Illness: no

ID: 1137765
Sex: F
Age: 63
State: AZ

Vax Date: 03/20/2021
Onset Date: 03/20/2021
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:

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

Symptoms: chills, extreme muscle & joint ache espectialy arthritic and nerve damage low back & leg rt foot. violent vomititng with severe headache 2nd day, Nausea, low fever 100, extreme fatigue lasting more than 4 days

Other Meds: cymbalta, trazodone, estrodal, progestrone, pantoprazole

Current Illness: two day stomache virus 2 weeks prior

ID: 1137766
Sex: M
Age: 66
State: SC

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: IM
Vax Site: LA

Lab Data:

Allergies: Sulfur and Penicillin

Symptom List: Pain in extremity

Symptoms: Developed severe chills with swelling. right arm is erythematous and warm to touch.

Other Meds: Ramipril 10 mg once daily, Metoprolol Succinate 50 mg qhs, ASA 81 mg po daily, Centrum Siler Multivitamin, Rosuvastatin 40 mg, Vitamin E 400 iu, Pantoprazole 40 mg, Larginine 2000 IU

Current Illness: Hyperlipidemia, Essential Hypertension, GERD, Anxiety, Glucose Intolerance, Fatty Liver, CAD, Colon Polyps

ID: 1137767
Sex: F
Age: 16
State: MN

Vax Date: 03/15/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Client put an incorrect birthdate on her client record so it appeared she was 18. When the record was sent to the state they recognized the patient record had a different date of birth (age 16). Parent confirmed she was 16 and client appointment for 2nd dose was cancelled as she is not eligible for Moderna vaccine at this time.

Other Meds:

Current Illness:

ID: 1137768
Sex: F
Age: 45
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Very Mild allergy to fungus (mushrooms), seasonal allergies.

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

Symptoms: Itchy reaction on arms face and head.

Other Meds: OTC - allergy 20mg (cetirizine hydrochloride), Culturalle Probiotics (ultimate strength), One-a-Day Women?s complete Multivitamin

Current Illness: None

ID: 1137769
Sex: M
Age: 61
State: MN

Vax Date: 03/17/2021
Onset Date: 03/25/2021
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:

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

Symptoms: Large red blotch at site of injection (several inches)

Other Meds:

Current Illness:

ID: 1137770
Sex: M
Age: 48
State: IL

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: nka

Symptom List: Vomiting

Symptoms: Patient reports 2/10 headache following vaccination. Took patient vitals to find him hypertensive. patient refused transport to ED

Other Meds: n/a

Current Illness: n/a

ID: 1137771
Sex: F
Age: 59
State: VT

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Less than 10 minutes after injection, patient verbalized she did not feel well, then became unresponsive to verbal cues, eyes glazed over, pale face. Clinic was being held outdoors, clinic staff could not get accurate vital signs. Call EMS. Meanwhile, patient began to respond to verbal cues, was able to walk inside, said her stomach hurt. EMS arrived and also had difficulty obtaining vital signs, transported to the local ER. Patient was treated and released from the ER with a diagnosis of dehydration.

Other Meds: Unknown

Current Illness: None

ID: 1137772
Sex: F
Age: 85
State: WA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
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:

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

Symptoms: Patient monitored for reaction as recommended per ACIP guidelines after vaccine administration. Pt reported dizziness, flushing, numbness in both hands to patient monitor. This RN assessed pt, who also reported chest pain, described as "angina" but said she had not had this type of chest pain before. Said she takes nitro for other chest pain but that pain is sharp and stabbing. Pain today described as "dull" and on left side of chest. Also reported nausea. VS: BP 130/82, HR 86, SpO2 98%. EMS called due to chest pain. While waiting for EMS, patient reported that pain started radiating from chest around to left back. No SOB, talking in full sentences with RN and son. EMS arrived and brought patient to ambulance. Pt was not transported to ED, returned to car to go home (son driving). Electronically Signed by RN on 02/10/21, 1707

Other Meds:

Current Illness:

ID: 1137773
Sex: F
Age: 41
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: At approx. 1050 pt reported dry mouth, nausea, and feeling need to puke. Pt given emesis bag. Pt dry heaved and reported not eating breakfast. Pt given water and stated she felt better after drinking water. Pt reported no hx of reaction to prior vaccinations. Pt denied throat irritation, itchiness, and rashes. Vital signs assessed at approx. 1056. BP 110/70 mmHg, PR 75 bpm, spO2 99% RA. Pt advised to wait 30 minutes for further observation. Vitals reassessed at approx. 1115. BP 120/80 mmHg, PR 75 bpm, spO2 99% RA. Pt reported no throat irritation and stated she felt fine. Pt advised to sign up on CDC V-safe. Pt left facility with steady gait and unlabored breathing at approx. 1120.

Other Meds:

Current Illness:

ID: 1137774
Sex: F
Age: 52
State: NJ

Vax Date: 01/08/2021
Onset Date: 03/01/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Patient received both doses of COVID19 Pfizer vaccine. Second dose was given on 1/8/21. Patient reportedly tested positive for COVID19.

Other Meds:

Current Illness:

ID: 1137776
Sex: F
Age: 68
State: KY

Vax Date: 03/18/2021
Onset Date: 03/24/2021
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: Allergic to antibiotics: penicillin, streptomycin, terramycin, Levaquin, Sulfa drugs, Mysteclin, Codeine, Benadryl Food: Eggs and Wheat grains Feathers and Wool

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

Symptoms: The delayed reaction began on March 24, 2021 in the early evening. My right arm (bicep and injection site area) began to itch and break out in a rash. I applied over the counter hydrocortisone and took a Chlorpheniramine Maleate 4 mg allergy tablet. The site continued to itch throughout the night and woke me up several times. Upon rising on March 25, 2021 I looked at my arm and the top of my shoulder and the rash had spread and there were large red hives that were hot to the touch, itching, swelling, and painful. I decided it was time to call my Dr. and make an appointment. I was not able to see him and was referred to his colleague. I went to see her at 11:30 a.m. She diagnosed the rash as a Moderna Delayed Reaction. She prescribed a prescription strength Hydrocortisone Cream to be applied3 times daily and Chlorpheniramine Maleate 4 mgs. since I am allergic to Benadryl every four hours. As of today, March 26, 2021 the rash has improved but still has the intense itch that travels down my arm and up.

Other Meds: Premarin 1.25 1 daily; Singulair 10mg 1 daily.; Synthroid 50mcg 1 daily; Montelukast Sodium Tablets 10 mg; Hydrochlorothiazide 25 mg 1/2tablet daily; Rosuvastatin Tabs 10mg. 1 daily; Allegra 180 mg 1 daily; Juice Plus Berry Blend, Fruit ble

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm