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: 1145304
Sex: F
Age: 50
State: MI

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/29/2021
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: n/a

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA Fever, chills, joint pain, muscle pain, nausea, swollen lymph nodes, feeling unwell, tired, headache

Other Meds: birth control

Current Illness: none

ID: 1145305
Sex: F
Age: 71
State: AL

Vax Date: 02/10/2021
Onset Date: 02/24/2021
Rec V Date: 03/29/2021
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: KNA

Symptom List: Anxiety, Dyspnoea

Symptoms: Numbness and tingling of hands for more than 2 weeks, weakness in legs and issues with being able to walk or stand for short periods of time, Right foot would drag when walking, unable to walk for more than 10 minutes

Other Meds: Calcium 500 +D 500 mg Amlodipine 10 mg asprin 81 mg atenolo 25 mg hydroclorothiazide 25 mg meloxicam 15 mg ramipril 10 mg

Current Illness: NA

ID: 1145306
Sex: M
Age: 40
State: OH

Vax Date: 03/25/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: lisinopril

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

Symptoms: patient was seen at primary care provider's office on 3/29/21 - diagnosis Bell's Palsy (symptoms started 2 days after Covid vaccine). Prednisone and valacyclovir ordered by primary care provider. Follow up in 2-3 weeks. Will refer to neurology if not improving.

Other Meds: amlodipine norco

Current Illness:

ID: 1145307
Sex: F
Age: 25
State: MD

Vax Date: 03/21/2021
Onset Date: 03/24/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, cefaclor

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: About 3 days after injection, there was a painful, red/purple splotch about 3 inches below the injection site on my right arm. It was only painful when touched, and it was not hard or inflamed. It had an irregular shape (not circular or with clear edges). It covered 2-3 square inches of skin. It resolved on its own after a couple of days. (The injection site itself was no longer painful at this time).

Other Meds: Modafinil, escitalopram, yaz, mirtazipine

Current Illness:

ID: 1145308
Sex: F
Age: 33
State:

Vax Date: 03/28/2021
Onset Date: 03/29/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 3/29/2021 was observed post Covid-19 immunization for 30 minutes based on complaints of chest pain . During the observation period, she experienced an adverse reaction with the following symptoms: difficulty breathing.and chest pain Assessment : Time of assessment 1500 Alert and oriented. Actions taken: Vitals sign taken at 1458. BP-128/61, P- 63, O2- 99%, chest pain 9/10, at 1502 BP- 109/63, 69, O2- 100%, 911 called at 1500, 1509- BP- 108/95, P- 67, O2- 100% pain 6/10, EMS arrives at 1517, patient walks out of building with EMS to do EKG , comes back into the building , juice is given and she is discharged with further complaint, she is advised to follow up with her PCP. Medications administered: No medication given 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 3/29/2021 2:47 PM 0.3 mL 12/11/2020 Intramuscular Manufacturer: Pfizer, Inc Lot: EP7534 NDC: 59267-1000-2 Electronically signed by RN at 3/29/2021 3:45 PM Immunization on 3/29/2021 Detailed Report Note shared with patient

Other Meds:

Current Illness:

ID: 1145309
Sex: F
Age: 33
State: CA

Vax Date: 01/20/2021
Onset Date: 01/25/2021
Rec V Date: 03/29/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: After receiving the first vaccine, started experiencing a little neck pain and swelling on and off for 2 month since first vaccination on December 30th. After second dose of Pfizer, the swelling and pain in the neck escallated and three nodules were discovered in my neck at ER visit due to pain from neck and radiating in ears and head. Extremely fatigued and headache was unbearable. ER MD discovered nodules, high white blood count, etc. Sent to follow up with Endo. Endo could not explain. Thyroid labs are all normal but the symptoms and nodules makes this suspicious. ANother ER visit with 3 days hospitalization due to pain and now elevated pulse (even while sitting in ER bed at 135-140 pulse). Low grade fever, nausea, vomiting, lethargic, elevated labs, etc. Now on propranolol for heart regulation and prednisone to monitor. Multiple CT scans and Ultrasound confirmed the nodules.

Other Meds: Ocella birth control, Spironolactone

Current Illness: None

ID: 1145310
Sex: F
Age: 63
State: KY

Vax Date: 03/27/2021
Onset Date: 03/29/2021
Rec V Date: 03/29/2021
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: Phenergan, Percocet, zofran

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient is a 63 yr/o female who presents to the emergency department complaining of dizziness since 0400 this morning. She endorses nausea, vomiting, and headache. Her symptoms are worse with position changes. She states that she has a hx of vertigo with her last episode being 11 months ago. She states that she does not normally have a headache with her episodes of vertigo, but today she developed one. Denies chest pain, sore throat, visual disturbance, or diarrhea. She reports chronic shortness of breath. She is a former smoker. Denies alcohol use. No other complaints at this time.

Other Meds: not recorded

Current Illness:

ID: 1145311
Sex: F
Age: 55
State: CA

Vax Date: 03/09/2021
Onset Date: 03/24/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: Highly sensitive to medication, NKA, possibly bee stings

Symptom List: Pharyngeal swelling

Symptoms: One week after the injection, I experienced a few days of soft bowels, and pain and then diarrhea. Then it turned into mouth sores like I?ve never had before. I had a red rash on the roof of my mouth that would get hot from time to time, was very painful, felt like maybe it went to the back of my mouth ( no sore throat), and I also had a sore on the tip of my tongue. I experienced the moth sores for 5 days seems to be getting better, not all the way gone yet. I can?t remember the last time I was sick and I felt very well prior to the injection. It?s either a coincidence or it?s the vaccine. I did read after looking things up, that their is a study going on, regarding mouth sores post Covid injection, so it may be of significance.

Other Meds: Synthroid, vitamin D,Biotin, fish oil, coQ10

Current Illness: None

ID: 1145312
Sex: M
Age: 40
State: MN

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/29/2021
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: At around 6:30 pm patient felt very dizzy, lightheaded, and nauseous. He also felt hot, had cold sweats, pale face, and blue lips. He started shaking as well. At 6:35 pm his blood pressure was 126/78, his heart rate was 69, and his oxygen saturations were 95%. We called EMS and they arrived around 6:45 pm. He was already feeling much better by the time they arrived. They checked him out and said he was good to go and he left at 6:55 pm.

Other Meds: None

Current Illness: None

ID: 1145313
Sex: F
Age: 70
State: OR

Vax Date: 03/18/2021
Onset Date: 03/20/2021
Rec V Date: 03/29/2021
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: Calcium channel blockers, epinephrine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: By Day 2 I noticed new tinnitus sounds, louder and hauntingly disturbing. Roaring in ears different than before and scary. My blood pressure dropped when I stood up and although I did not faint, I had difficulty standing up and moving about. My chest burned and I coughed a lot, shortness of breath worse than usual, and my O2sat went down to 94 when it usually was no lower than 96. These mild but disturbing symptoms persisted, and then on Day 6 I had a sudden onset of dizziness and cognitive dysfunction that made me a "bobble head" that put me to bed for 3 days. I had a headache and chest pains and dizziness that wanted to become vertigo if I moved my head. I am afraid to get the 2nd dose because I'm concerned that these symptoms will be triggered again and become permanent.

Other Meds: ? Furosemide 20mg x2 morning ? Metoprolol 25mg x1 morning & night ? Hydralazine 25mg 1x noon prn ? Telmisartan 40mg x1 night ? Prazosin 1mg x2 night ? Gabapentin 400mg/x1 morning & night ? Synthroid 75mcg 1x night ? Rosuvastatin 5mg x1 eve

Current Illness:

ID: 1145314
Sex: M
Age: 40
State: FL

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: When patient arrived at the observation area at approx. 9.32, he stated he felt slightly light headed. Had no other symptoms. Has a history of feeling light headed and MD has recommended that he take medication for this, patient can not recall the name of the medication. BP on arrival 128/84, heart rate strong , regular, 82 bpm. After 5 mins , patient stated he felt much better Advised to remain at the site for 30 mins to continue the observation. At 9.48 BP 118/72 and at 9.57 BP 120/76. Patient left the facility at 10.00. Advised to seek medical care if he should feel unwell at any time. patient verbalized understanding.

Other Meds: Buspar 30mg, Toprol 100mg, Omeprazole, Baby aspirin x 2 , Vitamin C.

Current Illness: Hypertension History of light headedness

ID: 1145315
Sex: M
Age: 53
State: IN

Vax Date: 03/27/2021
Onset Date: 03/28/2021
Rec V Date: 03/29/2021
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: Fatigue, sleepiness, pain at injection site

Other Meds: Statin, osteo bi flex,

Current Illness:

ID: 1145316
Sex: M
Age: 65
State: FL

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 03/29/2021
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: Day 2, Wednesday 3/24 at 5 am body aches, headaches, weighted down feeling. Day 3, weighted down feeling, Day 4, nausea, vomiting, diarrhea. Day 5, weak and tired, Day 6, nausea vomiting, gassy, 102 temperature., Day 7 gassy, tired/rundown but feeling better.

Other Meds: Seroquel, adivan, lisinopril, zoloft, wellbutrin, trazadone. Multivitamin, B-complex, C, D3, calcium mag zine, Omega-3 fish oil, Lutein p.r.n.

Current Illness: anemia, major depressive disorder, bipolar 1, generalized anxiety disorder. Highblood pressure. Sleeping problems.

ID: 1145317
Sex: F
Age: 15
State: CA

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/29/2021
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: NA

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

Symptoms: Vaccine was administered to 15 year old. No adverse effects. Phone follow-up in process.

Other Meds: NA

Current Illness: NA

ID: 1145318
Sex: F
Age: 60
State: IA

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 03/29/2021
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: morphine

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

Symptoms: Chills and nausea started without warning at 8 pm..............................by 6 am all symptom were done

Other Meds: 500 mg calcium 2 times per day multi vitamin 1 time per day

Current Illness: none

ID: 1145319
Sex: M
Age: 66
State: IN

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: No

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

Symptoms: During sleep, came down with chills and headache. By 9am got out of bed, took a shower and felt better.

Other Meds:

Current Illness: No

Date Died: 03/27/2021

ID: 1145320
Sex: F
Age: 74
State:

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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:

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

Symptoms: Patient reviewed vaccination at 1:20pm. She was observed for one hour per MD. At 5:18, she became unresponsive in her wheelchair and became blue with no palpable pulse. Patient had a DNR status and was not revived.

Other Meds: Vantin, trazadone, aricept, senna, ertapenem, vitamin D, heparin, risperidone,

Current Illness: Urosepsis with metabolic encephalopathy

ID: 1145321
Sex: F
Age: 25
State: MT

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fever & Joint Pain.

Other Meds:

Current Illness:

ID: 1145322
Sex: F
Age: 68
State: MN

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 03/29/2021
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: Got the vaccine and within 3 minutes her left little finger went completely numb. Then a couple minutes after that had a really severe stiff neck on the left side, painfully stiff neck. Then 5 minutes later felt like a knife was being jabbed into her left ear. She did not inform them of the reaction, and went home. The symptoms stayed the same and lasted for about an hour and a half and then all were completely gone. Her arm was a little sore, but mothing severe.

Other Meds: Multivitamin.

Current Illness: None.

ID: 1145323
Sex: F
Age: 43
State: MT

Vax Date: 03/18/2021
Onset Date: 03/26/2021
Rec V Date: 03/29/2021
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: Sore arm the following day. Noticed lump in armpit 7 days after shot. Large red itchy mark on left arm at shot site. Swollen and itchy. Enlarged lymph node in armpit is size of marble. Armpit area is swollen compared to right arm pit.

Other Meds: Women?s multi vitamin Vitamin D Sertraline 50 mg

Current Illness: None

ID: 1145324
Sex: F
Age: 52
State: PA

Vax Date: 03/29/2012
Onset Date: 03/29/2021
Rec V Date: 03/29/2021
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: none

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

Symptoms: Pt felt her heart was racing. Taken to medical observation. Preferred to stay seated in wheelchair. BP 162/80 HR 65 Pulse oximeter 100. Heart beat auscultated to be regular in rhythm. Lungs clear 3:36 PM BP 165/78 HR 64 Pulse ox 100 3:40 PM BP 172/91 standing HR 65 Pulse ox 100 3:47 PM Patient discharged via wheelchair to exit in stable condition

Other Meds: metoprolol, aciphex, rabeprazole

Current Illness: none

ID: 1145325
Sex: F
Age: 73
State: KY

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

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

Lab Data:

Allergies: PCN

Symptom List: Unevaluable event

Symptoms: PT INSTRUCTED TO WAIT 30 MINUTES DUE TO SHE STATED AFTER THE FIRST DOSE, SHE HAD HEART RACING AFTER SHE GOT HOME, BUT QUIT AND HAD NO OTHER PROBLEMS. CHECKED ON PT AFTER 20 MIN(11:05AM), SHE WAS C/O ITCHY THROAT, THROAT TIGHTNESS WITH SWALLOWING, TONGUE NUMB, LIPS NUMB. PT WAS AWAKE, A&OX4, NO DISTRESS, RESPIRATIONS RATE NORMAL AND REGULAR, PULSE RATE NORMAL AND REGULAR. AT 11:05AM BEGAN MONITORING V/S, EVERY 5-15 MIN, SYMPTOMS PERSISTED, STAFF CALLED 911 AT 11:30AM, 11:32AM DOSE OF EPINEPHRINE INJECTABLE PEN 0.3MG GIVEN IM RVL, 11:40AM EMS ARRIVED. PT WALKED TO AMBULANCE AND TAKEN TO LOCAL HOSPITAL

Other Meds: NONE, TOOK BP MED LAST NIGHT

Current Illness: NONE

ID: 1145326
Sex: F
Age: 77
State: AK

Vax Date: 01/21/2021
Onset Date: 01/29/2021
Rec V Date: 03/29/2021
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: augmentin, bactrim

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

Symptoms: redness, swelling, itching in left arm.

Other Meds:

Current Illness:

ID: 1145327
Sex: M
Age: 91
State: FL

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/29/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Left arm are red, sore, itchy, and swollen.

Other Meds:

Current Illness:

ID: 1145328
Sex: F
Age: 64
State: WA

Vax Date: 03/20/2021
Onset Date: 03/28/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: SOME ANTIOBIOTICS

Symptom List: Injection site pain, Menorrhagia

Symptoms: rash on arm around injection site. Itchy, but otherwise not troubling.

Other Meds: THYROID MEDICINE, SYNTHROID AND LYTHYRONINE

Current Illness: NONE

ID: 1145329
Sex: F
Age: 31
State: LA

Vax Date: 03/27/2021
Onset Date: 03/28/2021
Rec V Date: 03/29/2021
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

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

Symptoms: Skin rash (hives) all over the top of my back; also experienced other typical side effects such as fever, nausea, fatigue, and muscle aches.

Other Meds:

Current Illness:

ID: 1145330
Sex: M
Age: 28
State: AZ

Vax Date: 03/26/2021
Onset Date: 03/28/2021
Rec V Date: 03/29/2021
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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tinnitus and jaw pain. Some fatigue

Other Meds:

Current Illness:

ID: 1145331
Sex: F
Age: 63
State: CA

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: Insect stings

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Temperature 100 - One day 3/28/2021 Nerve headache - grabbing pain from back of head to left side; grabbing pain from left side only - 3/28 & 3/29/21 Left arm - terrible pain in arm Body aches - particularly in both arms Extremely tired - slept all day and night from 3/27 afternoon thru Monday morning, 3/29

Other Meds: Topamax, Estradiol, Progesterone caps, Sertraline,, Calcium Citrate, Super B Complex, Flaxseed Oil

Current Illness: N/A

ID: 1145332
Sex: F
Age: 68
State: PA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/29/2021
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: penicilin, zolaf

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

Symptoms: Dizziness and weakness. Total including weakness around 24 hours.

Other Meds: low dose aspirin, omeprazole, amLODIPine Besylate, lamoTRIigine, Sertraline, TerraZyme

Current Illness: high blood pressure

ID: 1145333
Sex: F
Age: 66
State: CA

Vax Date: 03/25/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: no known drug allergies

Symptom List: Nausea

Symptoms: Patient experienced trunk rash with headaches, fever, fatigue and diziness.

Other Meds: n/a

Current Illness: n/a

ID: 1145334
Sex: M
Age: 58
State: IL

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: Injection site pain

Symptoms: Covid Arm, left elbow swollen and red

Other Meds: pantoprazole 40mg,dicyclomine 10mg

Current Illness: none

ID: 1145335
Sex: F
Age: 59
State: ME

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: Antibiotics Bee Venom

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

Symptoms: Released from observation at 10:20am. Walking towards exit my throat felt strange. Employee asked how was my day and I said great but my throat feels funny. Employee immediately escorted me to front of facility and asked me to wait to see how I was feeling however moments later paramedic walked up to me and escorted me to screened medical area. My face and neck were flushed, throat and swallowing were changing. Paramedic gave me Benadryl and antacid tablet with water however Pharmascist arrived at same time and instructed paramedic to administer Benadryl shot as well. BP elevation, itch.

Other Meds: Losartan Buspirone

Current Illness: None

ID: 1145336
Sex: F
Age: 74
State: MI

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: Bactrim, Carta XL, wheat/gluten, lactose, rubber, petroleum products, chlorhexidine topical, various antibacterial soaps & perfumes (topical]

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

Symptoms: Injection site painful w/itching, redness and swelling, headache & congestion, muscle & joint aches, chills & sweating, fever to 101.0, fatigues, malaise

Other Meds: Levothyroxin, pravastatin, lamotrigine, carvedilol, vit. D, magnesium, potassium, prebiotic, multivtamin. Aspirin 81 mg, Anoro Ellipta inhaler

Current Illness: None

ID: 1145337
Sex: F
Age: 47
State: IL

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 03/29/2021
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: No

Symptom List: Tremor

Symptoms: At around 3 am, the day after getting the vaccine, I woke up having severe chills, running a fever and achy all over especially my back. At around 7 am I could not move the arm I got the vaccine in without major pain and my entire body was very sore especially my back. I was extremely fatigued with a headache and had virago. This lasted all day Friday, then on Saturday I still had a mild temperature and still sore but not as severe except for my back and still I had a headache. I noticed a little swelling under my arm. On Sunday, I felt a lot better but still a little fatigued and my back is still hurting. It was just like having Covid 19 again but a shorter version.

Other Meds: Vitamins, Levothyroxine

Current Illness: No

ID: 1145338
Sex: M
Age: 60
State: WV

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 03/29/2021
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: Red spots on side of head down the neck and red swollen eye. Seen at Med urgent care

Other Meds: Lisinopril Metformin ASA Zoloft Nexium

Current Illness: Diabetes Heart Disease

ID: 1145339
Sex: F
Age: 58
State: NC

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/29/2021
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: Flu Vaccine

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

Symptoms: Pt. informed nurse of anaphylaxis to flu vaccine approximately ten years ago. Her personal MD, advised her to have COVID-19 vaccine and to have Benadryl and EPI-Pen in purse. Pt. monitored for 30 minutes instead of usual 15 minutes. Twenty-five minutes post-vaccination, pt. developed rash on wrists and shortness of breath. Five minutes later O2 Sat. 97% on RA and rash spread up arms and around lips. Reported feeling clammy. Pt. took 25 mg of personal Benadryl by mouth and declined further Benadryl as it would "make me too sleepy to drive". Six minutes later O2 Sat. 85% on RA and rash on trunk, lips and face. EMS was dispatched, and pt. transferred to ER via EMS.

Other Meds:

Current Illness:

ID: 1145341
Sex: M
Age: 70
State: GA

Vax Date: 03/15/2021
Onset Date: 03/17/2021
Rec V Date: 03/29/2021
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: Hay Fever

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

Symptoms: Severe skin rash and 'sunburn' with peeling on inner thighs. Later redness and small blisters on arms and hands.

Other Meds: Atorvastatin 20mg, Aspirin 81mg, Multivitamin,CO-q10

Current Illness: None

ID: 1145342
Sex: F
Age: 66
State: NJ

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: Albuterol - headache Cats, Dogs, Dust Mite, Mold - Nasal Congestion Fosamax - muscle aches

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient developed a Shingles outbreak on the right side of her abdomen on 3/27, one day after receiving her second dose of the Pfizer/BioNTech vaccine.

Other Meds: Lisinopril, Metoprolol Succinate, Singulair, Brimonidine eye drop, Calcium Carbonate, Cetirizine, Hydroxyzine, Olopatadine, Omeprazole, Rosuvastatin, Vesicare, Trazodone, Tumeric caps, Venlafaxine ER

Current Illness: N/A

ID: 1145343
Sex: F
Age: 35
State: GA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/29/2021
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: doxycycline

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

Symptoms: Chills, mild fever, muscle aches, left arm pain and swelling at injection sight. I felt better 28 hours after shot was administered.

Other Meds: Lo Loestrin Fe

Current Illness: Asthma

ID: 1145344
Sex: M
Age: 27
State: PA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 03/29/2021
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: No known allergies.

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

Symptoms: Immediately after administration of the vaccine, the patient fell onto the ground and experienced tonic clinic seizure activity for approximately one minute and 30 seconds, including eyes rolling to the back of head and jerking motions of all extremities. Patient was taken to hospital via EMS.

Other Meds: None.

Current Illness: None.

ID: 1145345
Sex: F
Age: 59
State: GA

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: ASPIRIN,IBUPROFEN,CODEINE,ETODOLAC,LISINOPRIL,MAXZINE,PENICILLIN,GEODON,CLINDAMYCIN,DULOXETINE,

Symptom List: Pain in extremity

Symptoms: SWELLING,SHORTNESS OF BREATH,TENDNESS,PAIN,LYMPH NODES SWELLING,HARDNESS,FAST HEARTBEAT

Other Meds:

Current Illness: SHORTNESS OF BREATH,RASH,FAST HEARTBEAT,SWELLING,LYMPH NODES SWELLING,PAIN,TENDERNESS,HARDNESS,REDNESS DIAHREA,BLOOD PRESSURE HIGH 195/106

ID: 1145346
Sex: F
Age: 65
State:

Vax Date: 03/27/2021
Onset Date: 03/28/2021
Rec V Date: 03/29/2021
Hospital:

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

Lab Data:

Allergies: Acetaminophen, oats, nutmeg - yes, these foods cause allergies, resulting in hives, etc.

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

Symptoms: Hard, red, hot, itchy lumps under the skin at the injection site, about three inches both directions - occurred about 17 hours after the injection. This was accompanied by about 10 hours of chills (no cycling to heat, just chills all day) and nausea. I take the regular flu vaccines every year and never had any reactions to them, so this came as a surprise to me. The first COVID19 (Moderna) injection caused no symptoms of any sort, not even a sore arm. This one caused this weird under-the-skin hot rash-like thing, which may have started in the night when I was asleep, but was clearly annoying by morning. Later that evening I took an antihistamine, which relieved all symptoms, including the nausea. And the following day I seemed to have an abundance of more energy, taking another long hike. I do want to note that I took an 11.4 mile climbing hike the day after my first vaccine, and again, a long hike today, just a day and a half after the second. Knowing my own body well, I would say this was a mild allergic reaction to some component in this vaccine, since it was ended with one single does of antihistamine.

Other Meds: none

Current Illness: none

ID: 1145347
Sex: F
Age: 59
State: MT

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: Diarrhea, Body aches, Nausea, Headache, Injection site pain

Other Meds:

Current Illness:

ID: 1145348
Sex: M
Age: 17
State: CO

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/29/2021
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: Unknown

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

Symptoms: Vaccine was administered to a 17 year old patient.

Other Meds: Unknown

Current Illness: Unknown

ID: 1145349
Sex: F
Age: 30
State: DE

Vax Date: 03/19/2021
Onset Date: 03/27/2021
Rec V Date: 03/29/2021
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: Delay allergic reaction- welt on arm and severe itching at injection site. hot to the touch, tender.

Other Meds:

Current Illness:

ID: 1145350
Sex: F
Age: 67
State: MS

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/29/2021
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: Arm very big and swollen and bruised. Still bruised.

Other Meds:

Current Illness:

ID: 1145351
Sex: M
Age: 17
State: CA

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/29/2021
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: unknown

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

Symptoms: Patient was not of correct age to be vaccinated with Moderna vaccine - incorrect administration

Other Meds: none

Current Illness: unknown

ID: 1145352
Sex: F
Age: 32
State: IL

Vax Date: 03/05/2021
Onset Date: 03/23/2021
Rec V Date: 03/29/2021
Hospital: Y

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: Acute Splenic Artery Thrombosis

Other Meds:

Current Illness:

ID: 1145353
Sex: F
Age: 46
State: IL

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/29/2021
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: flush, throat closing, stingingin lips and face, dizzy

Other Meds:

Current Illness:

ID: 1145354
Sex: F
Age: 53
State: SC

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 03/29/2021
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: Penicillin

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

Symptoms: 20 minutes after the vaccine was given to me I developed a rash on my arms, chest, neck and face. The pharmacist gave me 25mg of Benadryl and waited to see if that would stop the reaction. Ten minutes later the rash was all ver my legs, I started having heart palpitations, my lips started to swell, my tongue started tingling and my chest was getting tight. The pharmacist gave me an epicenter injection in my left thigh and called paramedics. Paramedics came and administered 130mg of solumedrol after listening to my breathing and my chest sound still tight along with 50 mg of Benadryl thru my IV. They took me to a Hospital, my rash was gone and my breathing was back to normal. I stayed in the ER for observation for 2 hours with no further reactions so I was discharged with a prescription of prednisone for five days.

Other Meds: Omeprazole

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm