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: 1152271
Sex: M
Age: 53
State: IN

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 03/31/2021
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: penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: dizziness, sweat passed out, seizures

Other Meds:

Current Illness:

ID: 1152272
Sex: F
Age: 61
State: KY

Vax Date: 03/25/2021
Onset Date: 03/27/2021
Rec V Date: 03/31/2021
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: Codeine & morphine -hallucinations, nausea & vomit & Nalex-A (anaphylaxis reaction)

Symptom List: Anxiety, Dyspnoea

Symptoms: 3/25/21 sore arm, tired achiness, headache, lite headedness-throughout day & night. 3/26/2021 same as previous day. 3/27/2021 at 6:30 am awaken unable to breath.- Both ears felt closed, throat felt closed. Immediately took a Benadryl, put Vicks on neck-throat area, used steamer for moist air through nose. Lasted close to one hour. 3/27/21 most of afternoon & evening extreme tiredness. 3/28/21 morning ok, by afternoon extreme achy tiredness again. 3/29 to present headaches.

Other Meds: Moexpril 7.5mg (2- twice a day) for blood pressure; Hydrochlorot 25mg : Nexium OTC 20 mg; & Miralax

Current Illness: none known

ID: 1152274
Sex: F
Age: 61
State: IN

Vax Date: 03/23/2021
Onset Date: 03/25/2021
Rec V Date: 03/31/2021
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:

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

Symptoms: This is in addition to side effects I reported earlier. Day 7 woke up dizzy and bad headache. This lasted whole day. Woke up day 8 lymph nodes in chest and back on left side only hurt. From earlier notes shot in right arm all lymph nodes effected were on left side . Headache and dizziness gone.

Other Meds: Lisinopril 5 mg

Current Illness:

ID: 1152275
Sex: F
Age: 59
State: IN

Vax Date: 01/01/2021
Onset Date: 01/25/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: Versed, penicillins, Ibuprofen and zofran

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Had period of syncope after first dose. After second dose I again suffered from syncope that is still present. I get dizzy when I lay down that last for 5 to 10 seconds. After the second dose I also became ill and missed a week of work . Respiratory difficulties, coughing, HA, etc. Seen my my MD and tested for COVID which was negative.

Other Meds: N/A

Current Illness: None

ID: 1152277
Sex: M
Age: 71
State: MI

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/31/2021
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, tetracycline, clindamycin, erythromycin

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

Symptoms: Approximately an hour and a half after receiving the vaccine I developed start of a canker on the side and slightly under my tongue it lasted about 24 hours. I also awoke in the middle of the night with drenching sweats. The following day I was feeling okay. My concern is that the developing canker type sore would be considered anaphylactic

Other Meds: Simvastatin, levothyroxine, Prevacid, vitamin C, multivitamin, Ocuvite, Co Q10 enzyme, Omega-3

Current Illness:

ID: 1152278
Sex: F
Age: 47
State: IN

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: none

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

Symptoms: after about 12 hours i woke experiencing the worst bone and joint pain i have ever had in my life. I have had several kidney stones, I had sepsis in 2011 from a botched surgery and I've had kidney surgery. This pain was at the same level. I also had burning of my skin all over and then headaches and fatigue which I expected. But the bone and joint pain were at a level that felt unsafe and I was unable to walk without assistance. This went on for at least 10 hours. It subsided shortly after. I will not be taking a second dose of this vaccine. There is no way I will succumb my body to this kind of reaction a second time. This was not normal. Not normal at all.

Other Meds: none

Current Illness: none

ID: 1152279
Sex: F
Age: 28
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was sitting on chair for 15 minutes after vaccination to be observed for adverse reaction. Patient stood up from chair to pick her for phone on ground, and reported sudden dizziness. I asked patient to lay her back on ground. Patient reported she had fainted at blood exam before due to orthostatic hypotension.

Other Meds: unknown

Current Illness: patient stated she had orthostatic hypotension before

ID: 1152280
Sex: F
Age: 23
State: VA

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: Tramadol Amaxosillon Ondansetron

Symptom List: Pharyngeal swelling

Symptoms: The symptoms were headache, sever body pain, vomiting, diarrhea, dizziness, and fatigue. These symptoms lasted two weeks.

Other Meds: Yaz- birth control pills

Current Illness: None

ID: 1152281
Sex: M
Age: 61
State: IN

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/31/2021
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: Symptoms appeared roughly 12hrs after the second dose. Chills, slight fever, body aches. Symptoms lasted for less than 24hrs.

Other Meds: Losarten, 50mg/daily

Current Illness: None

ID: 1152282
Sex: M
Age: 29
State: OH

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Tree nut allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Headache, march 30 at 5pm Feverish, march 31 at 4am Lightheaded and fatigued, march 31 at 4am

Other Meds: Lexapro 25mg Losartan 25mg

Current Illness:

ID: 1152284
Sex: F
Age: 58
State:

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: About 5 minutes after patient got vaccinated. Pt states feeling not able to control of of walking, dizzy, feels faint, feels palpitations and major headache. Has chronic history of migraines and headaches. Had headache before getting the vaccine. Patient laid down and still did not feel better, pt able to talk in normal sentences without respiratory distress. Paramedics arrived. Vitals normal. Blood sugar normal (108 mg/dL). No known allergies. Pt takes BP meds, synthesis for thyroid, bupropion for depression and fibromyalgia. Pt stable and was wheel-chaired to car where her husband was at.

Other Meds:

Current Illness:

ID: 1152285
Sex: F
Age: 47
State: OK

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Benadryl

Symptom List: Rash, Urticaria

Symptoms: Oral swelling , itching ,right side facial drooping. Taken to ER by staff in wheelchair

Other Meds:

Current Illness: Neurological disorder

ID: 1152286
Sex: F
Age: 17
State: CO

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/31/2021
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: Patient was given the moderna vaccination at the age of 17

Other Meds:

Current Illness:

ID: 1152287
Sex: F
Age: 91
State: PA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/31/2021
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: not known

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

Symptoms: Denied having received a Covid vaccine prior, after giving Moderna 1st dose, indicated had received Pfizer 1st dose on 2/27/2021

Other Meds: not known

Current Illness: not known

Date Died: 03/30/2021

ID: 1152288
Sex: M
Age: 91
State: AK

Vax Date: 01/07/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: lisinopril, penicillin, maxitrol, lemon

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

Symptoms: Death

Other Meds: Odanestron, KCl, Levothyroxine, Duloxetine, Atorvastatin, amlodipine, aspirin, losartan, prednisone, azithromycin, omeprazole, metoprolol, finasteride, budesonide, ipratropium-albuterol

Current Illness: neuropathy, uti, anemia, BPH, depression, hypothyroid, COPD, HTN, CAD

ID: 1152289
Sex: F
Age: 21
State: NC

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Post Covid vaccine while in observation area patient complained of heart beating fast, some difficulty breathing, feeling anxious. Skin was warm and clammy, vital signs taken, O2 sat 100% and she developed hives on her upper chest and neck area. Benadryl 12.5 mg given x 2 , 5 minutes apart. EMS was called and patient transported to Hospital for further evaluation.

Other Meds:

Current Illness:

ID: 1152290
Sex: F
Age: 70
State: VA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: advil, aspirin, diuretics

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

Symptoms: Became "flushed felt unwell chills", blood pressure elevated, Lasted 30 minutes. Resolved on it's own.

Other Meds: verapamil 100mg telmisartan 80mg xanax 0.5mg flonase

Current Illness: none

ID: 1152291
Sex: F
Age: 30
State: KY

Vax Date: 01/07/2021
Onset Date: 01/14/2021
Rec V Date: 03/31/2021
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: It was a rash that started small and grew to about two /two and a half inches in diameter over the course of the day. My arm was very hot, warm to the touch and noticably swollen. I went to UC and received an antibiotic and a topical cream. The visable rash faded after about two days.

Other Meds: I was taking prescription medications.

Current Illness: No

ID: 1152293
Sex: F
Age: 60
State: TX

Vax Date: 03/22/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: Cortizone

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: On the eight day from vaccine given, my right arm has developed a red rash around the injection site. I didn't have any symptoms for the first seven days.

Other Meds: Daily Multivitamin, Flaxseed Oil, Probiotic, Magnesium

Current Illness: None

ID: 1152294
Sex: F
Age: 64
State: IL

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: aspirin, NSAIDs, codeine, Norco, Dulera, Singulair, Ventolin, Zantac, Tetanus

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

Symptoms: Patient required to stay 30 minutes for monitoring due to previous reactions: tetanus (reported dizziness, no anaphylaxis or treatment needed) and Norco in which anaphylaxis was reported. Patient stated she has had flu shots and pneumonia vaccinations in past. Approximately 15 - 20 minutes into monitoring patient reported headache and feelings of throat spasm. She took diphenhydramine that she had with her because of her past experience with anaphylaxis. At the end of the 30 minute monitoring period she said the throat spasm was not any worse and did not report any new symptoms, but an ambulance was contacted to take her to the local ER as a precaution. According to patient, she was monitored in the ER and given iv medications and sent home later in the afternoon. The patient stated she believes she was given a steroid medication and anti-nausea medication to fill at an outpatient pharmacy (unknown, uses other pharmacy).

Other Meds: unknown

Current Illness: unknown

ID: 1152295
Sex: M
Age: 56
State: TX

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 03/31/2021
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: Ibreprofuen

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

Symptoms: Body is sore have chills and can?t taste anything

Other Meds: Vitamin C and men?s multi vitamins

Current Illness: No

ID: 1152296
Sex: M
Age: 55
State: IN

Vax Date: 03/08/2021
Onset Date: 03/13/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: Bananas

Symptom List: Unevaluable event

Symptoms: Loss of taste and smell

Other Meds: Dexilant

Current Illness: None

ID: 1152297
Sex: M
Age: 27
State: ID

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 03/31/2021
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: None

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

Symptoms: Lightedness, tightness in neck, anterior and posterior aspects without chest pain, without SOB Vital Signs: BP 140/82 HR 67 Resp 20 O2sat 96 Skin Signs: Warm and dry Circulation: Cap refill <2sec Respiratory: Breath sound clear bilaterally Initial treatment: nsg vs, assessment - resp, neurological Physician assessment performed by Dr. at 13:48 PM 13:50 PM Vital Signs: BP 122/82 HR 72 Resp 70 O2sat 97 Skin Signs: Warm and dry Circulation: Cap refill <2sec Wait an additional 15 minutes in observation in addition to 30 min wait observ time Did not have lunch, only breakfast this am - gave him apple jc and nuts as a snack Disposition: Home by Self

Other Meds: Supplements

Current Illness: None

ID: 1152298
Sex: F
Age: 55
State: NY

Vax Date: 03/28/2021
Onset Date: 03/29/2021
Rec V Date: 03/31/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Chills, fatigue, nausea and vomiting, headaches, non sleep

Other Meds: None

Current Illness: None

ID: 1152299
Sex: F
Age: 36
State: WA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: clindamycin/nifedipine/hydrocodone/purple dye

Symptom List: Injection site pain, Menorrhagia

Symptoms: scratchy throat/rash/itching/sweating - given epi pen/Zyrtec/Benadryl - sent to ER

Other Meds: venlafaxine/albuterol/levothyroxine/atenolol/nortriptyline

Current Illness: 0

ID: 1152300
Sex: F
Age: 63
State: OR

Vax Date: 03/21/2021
Onset Date: 03/28/2021
Rec V Date: 03/31/2021
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: My right arm was sore fit about 3 days following vaccine and on March 28 my right under arm feels a sore and when I looked to see my lymph glands are extremely swollen and painful but not red. It is now March 31 and it is a little less swollen but still tender.

Other Meds: Lexapro 40 mg Trazadone 50 mg

Current Illness: None

ID: 1152301
Sex: F
Age: 17
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: No Known Drug Allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The Moderna COVID-19 Vaccine is only FDA authorized by EUA for patients 18 years of age or older; however, this vaccine was given to a 17 year old in mistake. The patient was contacted and notified. She had no adverse reactions. The prescriber was also notified and said it was acceptable. Patient will still receive second dose of Moderna per protocol.

Other Meds:

Current Illness:

ID: 1152303
Sex: F
Age: 55
State: TN

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: sulpha drugs - hives (have an epi-pen for it) Oxy Cordon - can't take Cordon Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: First night, I was okay until about 10 pm - chills - my teeth was chattering I had never experienced , hot, threw up all night and I had to miss work. I was really sick for the next few days. I was tired, too. The reflux made me go to the doctor - a couple weeks after vaccine. Increased symptoms of it real bad. They increased my Omeprazole dose from 20-40 mg. I have loose stools. They added a nose spray as well. I had had my allergy shots the same week as I had my vaccine.

Other Meds: Spiriva Inhaler - use every day ; Loratadine; Vitamins - Centrum one a day; Omeprazole

Current Illness: no

ID: 1152305
Sex: M
Age: 47
State: KY

Vax Date: 01/25/2021
Onset Date: 02/01/2021
Rec V Date: 03/31/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Pt called to report that approximately one week after second dose of Moderna, he developed a rash on his abdomen, that progressed to his arms and legs. Described rash as red, raised and sandpaper texture. Has not improved. Severe itching associated with rash. Has also experienced low grade temps (100.1) and headaches on and off since that time. Has been seen by PCP who has administered 2 injections of steroids and steroid dose pack. Did not experience any issues immediately following the administration of either dose or any problems after first dose of vaccine.

Other Meds: unknown

Current Illness: no

ID: 1152306
Sex: F
Age: 86
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Patient experiencing nausea anxiety SOB. On-site emergency response performed assessment. Vital signs all within normal limits; patient and husband advised to continue monitoring for life-threatening signs and symptoms; further medical transportation and treatment not advised; patient advised to hydrate and wait additional time. no transportation utilized RN

Other Meds:

Current Illness:

ID: 1152307
Sex: M
Age: 62
State: CO

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Injection site pain

Symptoms: Fever hallucination took nyquil to get to sleep. Still not great next morning. OK within 24 hours

Other Meds: Losartan 25mg once a day

Current Illness: none

ID: 1152308
Sex: F
Age: 60
State: FL

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pain at injection site - w/i 2 hours and lasting 5 days Fatigue - w/i 4 hours and lasting 4 days headache - w/i 4 hours and lasting 3 days nausea - w/i 4 hours and lasting 3 days dizziness - w/i 4 hours and lasting 4 days joint pain - w/i 5 hours and lasting 2 days swelling of lymph nodes in throat leading to not being able to swallow saliva leading to panic - w/i 8 hours and lasting about 40 minutes then gradually reducing in size over the next couple of days

Other Meds: Vitamin B12 Vitamin D3

Current Illness:

ID: 1152310
Sex: M
Age: 89
State: MD

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/31/2021
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: Penicillin - swelling Sulfa - interstical nephritis All ACE Inhibitors-reaction unknown

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

Symptoms: Patient reports that he lose the use of his legs about 18 hours after receiving the vaccine. He was unable to move them but had feeling in them. He also reports having a fever of 102F. Patient also reports that this happened when he had COVID, but no records from the hospital note this.

Other Meds: Lantus 26 units, Ziaprim 200 qd, Sorbic Acid 500 qd, Baby ASA qd, Atenalol 25 bid, Lipator 80 mg qd, B complex qd, Dulcolax 2 tabs qd, Pepcid 20mg tabs- 2 at night, Proscal 5mg qd, Folic Acid 1mg qd, Lasix 20 qd, Neuroton 300 qd, Magnesiu

Current Illness: Hospital admission 1/8/21-1/12/21 for generalized weakness and dx with UTI and gout flare up.

ID: 1152311
Sex: F
Age: 34
State: WI

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 03/31/2021
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: Codine Amoxycillan Metal, all Gluten Dairy

Symptom List: Tremor

Symptoms: Raised hives on chest and neck; lasting one hour Swollen hands color white and purple; lasting 20 min Swollen throat still able to breath; lasting 20 minutes Extreme fatigue; lasting through the end of 3/30 Migraine sensitive to all light and sound; lasting through the end of 3/30

Other Meds: Bupropion XL 150mg - am Buspirone 30mg - am/pm Chlorthalidone 25mg - pm Duloxetine 30mg - am/pm Hydroxychloroquine 400mg - pm Potassium CL 10meq ER - am/pm Xyzal 10mg - am Zyrtec 20mg - pm

Current Illness: N/a

ID: 1152312
Sex: F
Age: 20
State: GA

Vax Date: 03/23/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: Patient reports NKDFA

Symptom List: Erythema, Pruritus

Symptoms: Pt c/o fatigue, malaise, left arm/injection site soreness, sweats, and dizziness. Decadron 8 mg IM administered. Rx given for Medrol pack. Rests. Ice and gentle massage to left deltoid recommended. OTC Benadryl and Ibuprofen prn symptoms recommended.

Other Meds: Rx Sprintec OCP, OTC Women's daily multi vitamins. Rx Fluconazole on 3/29/21.

Current Illness: Patient denied

ID: 1152313
Sex: F
Age: 40
State: AZ

Vax Date: 03/27/2021
Onset Date: 03/29/2021
Rec V Date: 03/31/2021
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: Latex

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

Symptoms: herpes labialis

Other Meds: none

Current Illness: none

ID: 1152314
Sex: F
Age: 56
State: IN

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: Dupixent

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

Symptoms: Headache, tiredness, feeling sick, unbalance 25 hours later they started. Headache and tiredness continued 3rd day. Just I am getting rest.

Other Meds: None

Current Illness: None

ID: 1152315
Sex: F
Age: 56
State: FL

Vax Date: 03/23/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Codeine allergy

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Covid arm. Rash 4 inches by 4 inches at injection site.

Other Meds: Supplements

Current Illness: None

ID: 1152316
Sex: F
Age: 62
State: IN

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Chills, body ache, pain in my joints and spine, nausea, fatigue.

Other Meds: ATOMOXETINE HCL 40 MG CAPSULE ATORVASTATIN 20 MG TABLET BUPROPION HCL XL 150 MG TABLET Tablet Extended Release 24 hr ESTRADIOL 0.01% CREAM LEVOTHYROXINE 88 MCG TABLET LIOTHYRONINE SOD 5 MCG TAB TABLET METFORMIN HCL ER 750 MG TABLET T

Current Illness: NONE. Have not even had a cold.

ID: 1152318
Sex: F
Age: 53
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: Dizziness BP:108/64 P: 66 O2: 99% #21 Went home

Other Meds:

Current Illness:

ID: 1152319
Sex: F
Age: 24
State: RI

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 03/31/2021
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: Pain in extremity

Symptoms: excruciating stomach pains for several hours, fatigue, body aches, headache.

Other Meds: topiramate, bupropion, nexplanon, nutrafol

Current Illness: none

ID: 1152320
Sex: F
Age: 59
State: VA

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/31/2021
Hospital:

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

Lab Data:

Allergies: States numerous allergies

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

Symptoms: History of allergic reactions. c/o numbness and tingling. 167/75, 75, 16 Given 10ml children's liquid benadryl. Symptoms improved. Released.

Other Meds:

Current Illness:

ID: 1152321
Sex: M
Age: 21
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: PT COLLAPSED AND FELL ON THE FLOOR FACE DOWN ABOUT 5 MINUTES, AROUND 9:35AM AFTER GETTING 1ST DOSE OF COVID VACCINE. PT WAS TURNED OVER WITH THE HELP OF A SAMARITAN WHILE WE CALLED 911. PT HAD SEVERAL SEIZURE EPISODES. PT REGAINED CONSCIOUSNESS AND BECAME RESPONSIVE AFTER ABOUT 2 MINUTES. PARAMEDICS CAME AND TOOK OVER. PER PT, NO PRIOR HISTORY OF SEIZURE OR MEDICAL CONDITION. PT CAME FROM 10 HRS NIGHT SHIFT (2 DAYS IN A ROW) TO GET HIS VACCINE. DAD WAS INFORMED PER PT'S AUTHORIZATION ABOUT INCIDENT AND HE SAID HE WILL BE ON HIS WAY. PT TO BE TRANSPORTED TO A NEARBY HOSPITAL PER ONE OF THE PARAMEDICS.

Other Meds: none that we know of

Current Illness: none

ID: 1152322
Sex: F
Age: 62
State: MN

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 03/31/2021
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: sulfa

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

Symptoms: Chills, fever began at 10:30 pm, 3/24/2021. On 3/25/2021, fever over 102.2, nausea, extreme headache, chills, inability to eat or drink, aches, weak, tired. Fever dropped to 100.2 later in day, headache lessoned ~6 pm after taking one prescription migraine tablet (rizatriptan 5 mg) plus one OTC migraine formula tablet (acetaminophen-250 mg) + (aspirin-250 mg) + (caffeine-65 mg). Continued with chills, fever, headache, nasea into next day. Gradually subsided. I have had a headache every day since the vaccination. I wake up with a very bad headache and have taken both my prescription and/or OTC migraine tablets to help reduce the headache. Still weak and tired. I had COVID-19 in Nov. 2020.

Other Meds: tolterodine tartrate 4mg/day, cranberry 500 mg/day

Current Illness: none

ID: 1152323
Sex: F
Age: 33
State:

Vax Date: 03/11/2021
Onset Date: 03/20/2021
Rec V Date: 03/31/2021
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: Starting having hives/itching rashes all over body 1 week after vaccine

Other Meds:

Current Illness:

ID: 1152325
Sex: F
Age: 49
State:

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: latex, tape, citrus

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Developed rash on contralateral arms @ 20 minutes then spread to rest of body. Then developed SOB/facial swelling. Received Epi pen x1 with some response, and brought to ED. VS remained stable 150-160/100-110. Exam notable for diaphoresis, RRR, CTAB no wheezes.

Other Meds:

Current Illness: breast cancer

ID: 1152326
Sex: F
Age: 72
State: MA

Vax Date: 03/04/2021
Onset Date: 03/11/2021
Rec V Date: 03/31/2021
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: tetinus vaccine aspirin sulfa drugs clindamycin

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

Symptoms: I had several episodes of Meniere's Disease with severe vertigo. I had not had any such episodes since 2013

Other Meds: Alavert

Current Illness: none

ID: 1152327
Sex: M
Age: 49
State: OK

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: Naproxen Sodium

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Spontaneous, and heavy nosebleed.

Other Meds: Amlodopine Besolate, Cymbalta, Baby Aspirin, Hydroxyzine, Bupropion, Montelukast, Levothyroxine, Atorvastatin, Clopidogrel

Current Illness: None.

ID: 1152328
Sex: M
Age: 61
State: CA

Vax Date: 03/27/2021
Onset Date: 03/28/2021
Rec V Date: 03/31/2021
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

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

Symptoms: Rash / hives developed on the inner left thigh. Itchy, red skin discoloration, small bumps with dime sized hives. Covers about a 9 inch by 3 inch area of skin.

Other Meds: None

Current Illness: No

ID: 1152329
Sex: M
Age: 67
State: AL

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 03/31/2021
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: none

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

Symptoms: 90% loss of smell/taste next day. Also feel irritable and nervous but manageable

Other Meds: Levothyroxin 100 mcg Zocor synthetic 40 mg

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm