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: 1152505
Sex: F
Age: 52
State: OR

Vax Date: 02/16/2021
Onset Date: 02/16/2021
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: LA

Lab Data:

Allergies: Sulfa, EES, Cleocin, Flagyl, MS, Demerol, Hydrocodone

Symptom List: Dysphagia, Epiglottitis

Symptoms: Night of injection had very restless sleep, felt strange and had generalized discomfort. Day 1 and 2 after vaccine had severe headache, body aches, joint pain, chills, brain fog, weakness,fatigue, waves of severe weakness followed by severe pain over varying body parts/areas, SOB/chest pain w/activity, took 5 min to recover. Middle of day 2 all symptoms started to improve slowly. By the end of Day 2 the waves of severe weakness/then pain stopped. Day 3 after vaccine continued to have headaches,body/joint pain, occasional chills, weakness, fatigue,some SOB w/activity, and brain fog. Since then symptoms have slowly improved. Still have slight tiredness/fatigue, brain fog, headaches,occasional SOB, ankle/foot pain.

Other Meds: Nortriptyline, Flexeril, Sudafed, Cranberry, Vitamin C & D

Current Illness: none

ID: 1152506
Sex: F
Age: 43
State: LA

Vax Date: 01/08/2021
Onset Date: 01/20/2021
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: No

Symptom List: Anxiety, Dyspnoea

Symptoms: About 9-10 days after vaccine exp low grade fever and body aches lasted 3-4 days.

Other Meds: No

Current Illness: No

ID: 1152507
Sex: F
Age: 76
State: CA

Vax Date: 01/07/2021
Onset Date: 01/08/2021
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: Prescription for an acid reflux prescription - Omeprazole

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

Symptoms: The next day, I felt light headed and very tired. I felt that way for about three weeks. I had loose stool for those three weeks - it wasn't diarrhea but loose stool. And then 11 days after vaccine, I had a rash on my thighs and my lower torso. And that rash lasted for four days and it went away. Rash looked like measles or chicken pox - red dots. I went to the dermatologist as I have never had a rash in my life. Dermatologist did a Biopsy. The rash lasted for four days and cleared up.

Other Meds: Synthroid 100 mg; Sythastatin - 20 mg; Omisartin - 20 mg; Brio Alipta 200 mcg; Propranolol - 10 mg once a day; multi-vitamin; Vit C; Vit D3; Black Elderberry; CoQ10

Current Illness: no

ID: 1152509
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 4 seizures were documented and EMS and 911 was called, O2 given by nasal cannula

Other Meds:

Current Illness:

ID: 1152510
Sex: F
Age: 61
State: GA

Vax Date: 12/31/2020
Onset Date: 01/08/2021
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, sulfa, Darvon, Bactrim

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

Symptoms: 12/31/2020 vaccination 1/8-1/9 itching in face and swelling under L armpit, lymph nodes. Itching was from my earlobes, bottom lip, bottom chin and back of head. Visible rash on face. Symptoms lasted 2-3 days. PCM - prescribed steroids. Took care of the symptoms.

Other Meds: pravastatin 20mg; eyepromise / supplement for my eye, vitamin D

Current Illness: n/a

ID: 1152511
Sex: M
Age: 53
State: GA

Vax Date: 03/22/2021
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: Redness, rash, warm at shot site

Other Meds: None

Current Illness: None

ID: 1152512
Sex: F
Age: 68
State: PA

Vax Date: 03/03/2021
Onset Date: 03/06/2021
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: nitrofurantoin, nsaids, penicillin, tetanus toxoid

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient said a few days after receiving shot she developed a rash in the spot of injection. It was not painful or itchy. The rash has since subsided but a slight red area remains. She said she has very sensitive skin, and it could have been the result of the alcohol used to cleanse prior to administration. The area does appear to be what would have been swabbed.

Other Meds: Doxepin, Restasis, Plaquenil, Clorazepate

Current Illness: none

Date Died: 03/01/2021

ID: 1152513
Sex: F
Age: 62
State: MD

Vax Date: 01/06/2021
Onset Date: 03/15/2021
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: Unknown

Symptom List: Pharyngeal swelling

Symptoms: Employee had a heart attack and past away around 3/17/21.

Other Meds: Unknown

Current Illness: Heart blockage with heavy breathing, shortness of breath on exertion and complaints of side pain.

ID: 1152514
Sex: M
Age: 60
State: VA

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 1- On Day one few ours after the 2nd shot, I had my heart flutter and lost by breath few times, next day was gone. 2- Knee joint pain and tendons pain still ongoing was very hard to walk. Improving very slowly. 3-Felt like I had the flue the next day with a headache, flue like symptoms gone within 2 days, however I am on week 3 with a non stop headache. I usually never have a headaches, and now I have it every day and night since the 2nd shot.

Other Meds: Amlodipine 10mg daily HCTZ 5mg daily

Current Illness: no illness

ID: 1152516
Sex: F
Age: 51
State: TX

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Within 14 minutes after the vaccine injection patient started itching on face, head, arm, back ,and hand. Rash on hand and lower right side and then went away, .Sweating over body. B/P taken around 2:oopm 120/78, P- 70. Patient states she is okay now. She drank 3 bottles of water.

Other Meds: N/A

Current Illness: N/A

ID: 1152518
Sex: M
Age: 53
State: MN

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: Allergies to apples, ragweed, cat dander, crustaceans

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

Symptoms: Excessive nose bleeding, without explanation/reason.

Other Meds: Lisinopril, Tamsulosin

Current Illness: None

ID: 1152519
Sex: M
Age: 70
State: WA

Vax Date: 02/12/2021
Onset Date:
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: Generic Codones

Symptom List: Rash, Urticaria

Symptoms: Tiredness, muscle pain, chills, joint pain, fever, nausea, difficulty breathing/shortness of breath

Other Meds: Allopurinol 100mg 1x/day Atorvastatin 40mg (generic for Lipitor) 1x/day Levothyroxine Sodium 137mcg (generic for Synthroid) 1x/day Lisinopril 10mg (generic for Zestril) 1x/day Metoprolol Succinate 100mg (generic for Toprol XL)

Current Illness: N/A

ID: 1152520
Sex: M
Age: 29
State: WI

Vax Date: 03/24/2021
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: LA

Lab Data:

Allergies: None

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

Symptoms: 03/24/2021 - Mild sore throat in the evening. 03/25/2021 - Moderate sore throat, moderate fatigue and muscular pain. 03/26/2021 - Mild sore throat and mild fatigue. 03/27/2021 - Moderate sore throat, moderate fatigue and muscular pain. Low grade fever of 99.1F. 03/28/2021 - Moderate sore throat, mild ear pain, eye pain/pressure. Fever spiked to 102.4F during the night. 03/29/2021 - Severe inflammation of the right side tonsils, severe ear pain, severe eye pain/pressure, fever of 101.9F. Consulted a doctor on MD Live who felt it might still be a reaction to the vaccine and prescribed Ibuprofen 600mg to manage symptoms. 03/30/2021 - Extremely severe inflammation of the right side tonsils, severe ear pain, severe eye pain/pressure, low grade fever of 99.5F. 03/31/2021 - Symptoms same as 03/30/2021. Consulted a doctor at the local Urgent care clinic. Prescribed amoxicillin-clavulanate and predniSONE.

Other Meds: None

Current Illness: None

ID: 1152521
Sex: F
Age: 48
State: LA

Vax Date: 03/11/2021
Onset Date: 03/15/2021
Rec V Date: 03/31/2021
Hospital: Y

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: NONE

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

Symptoms: PT STARTED HAVING A FEELING OF HEAVINESS, MALAISE, FATIGUE, HEADACHES ABOUT AN HOUR OR TWO AFTER THE SHOT WAS ADMINISTERED. THE SIDE EFFECTS CONTINUED THRU THE WEEKEND AND SHE TOOK TYLENOL TO HELP WITH SYMPTOMS. ON MONDAY, 3/15/21 AROUND 720PM SHE COLLAPSED AT HOME AND WAS RUSHED TO THE HOPSITAL E.R. CT SCAN WAS ORDERED BECAUSE DR WANTED TO RULE OUT STROKE DUE TO WEAKNESS ON RIGHT SIDE,SPEECH IMPAIRMENT,HEADACHE,WEAKNESS, AND SHE HAD BITTEN HER TONGUE. SHE WAS ADMITTED INTO THE HOSPITAL. TUESDAY 3/16/21 - DR ORDERED CT SCAN AND MRI TO RULE OUT STROKE...PT WAS CONFIRMED TO HAVE HAD STROKE WEDNESDAY 3/17/21- EEG ORDERED AND PT POSITIVE FOR SEIZURES PT DISCHARGED FROM HOSPITAL 3/17/21 AND PRESCRIBED CLOPIDIGREL AND ATORVASTATIN AS TAKE HOME MEDS.

Other Meds: TYLENOL, IBUPROFEN, FOLIC ACID 1M5, FERROUS SULFATE 325MG

Current Illness: TOOTHACHE PAIN POST TOOTH EXTRACTION ON 2/10/21. HYDROCODONE WAS PRESCRIBED BUT ONLY 1 OR 2 DOSES TAKEN. PENICILLIN 250MG GIVEN BUT DUE TO CONTINUED PAIN AND INFECTION, DR PRESCRIBED IBUPROFEN 800MG AND CHANGED ANTIBIOTIC TO AUGMENTIN 875 TWICE A DAY ON 3/01/21. PT COMPLETED ANTIBIOTIC COURSE AND INFECTION RESOLVED.

ID: 1152522
Sex: M
Age: 49
State: WI

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

Lab Data:

Allergies: NKDA

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

Symptoms: Moderna Covid 19 vaccine, he had syncopal/unresponsive episode. Medical emergency called; vitals and glucose obtained. RN and Dr. to vacccine clinic. Pt brady at 40-41, diaphoretic, pale, all other vitals wnl. 911 called. Oxygen applied 2L NC. Pt talking in short sentences, complains of headache and dizziness. No resp distress or chest pain. Has had anxiety (vasovagal) episodes to needles in past.

Other Meds: None

Current Illness: None-pt did state he felt tired due to stress and did not sleep well the night prior to vaccination

ID: 1152523
Sex: M
Age: 55
State: PA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Keflax

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

Symptoms: Persistent hiccups for 3 days. Would last 3-4 hours then 1-2 hours relief. Ended 10pm on the third day.

Other Meds: levothyroxine Exetimibe Zioptin 81mg aspirin

Current Illness:

ID: 1152524
Sex: F
Age: 76
State: MA

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:

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

Symptoms: 76 yo female with c/o numbness and tingling to finger tips s/p receiving second dose of Moderna COVID vaccine in left shoulder. Fingers remained warm and well perfused, grip strength normal. Pt rested, had water, and gentle ROM exercises. Symptoms fully resolved in ~30 minutes. Pt was d/c'ed home with friend/driver.

Other Meds:

Current Illness:

ID: 1152525
Sex: M
Age: 29
State: TN

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: Latex

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The patient had a syncopal event, followed by flushing and vomitting. He received the vaccine at 9:30am and the event occurred at 9:32am and lasted 30 seconds. He then became extremely flushed and dizzy. He was given a cool compress and bottle of water. I observed him for 7 minutes and then he began to vomit. After vomiting, I observed him for 15 more minutes, personally, and then had him wait in our waiting area for 15 additional minutes.

Other Meds:

Current Illness:

ID: 1152526
Sex: M
Age: 44
State: OK

Vax Date: 12/30/2020
Onset Date: 03/31/2021
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: PENICILLIN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 03-31-2021 COVID-19 PCR POSITIVE, PT REPORTS SINUS PRESSURE, TIRED, DECREASED ENERGY AND LIGHT HEADED. PT STATES HE COMPLETED THE COVID-19 VACCINE SERIES. PRIME DOSE 12-30-2020 AND BOOSTER DOSE 01-20-2021.

Other Meds:

Current Illness:

ID: 1152527
Sex: F
Age: 38
State: CT

Vax Date: 03/06/2021
Onset Date: 03/26/2021
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: Amoxicillin

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

Symptoms: I experienced after my vaccine fatigue but did not seek any treatment for that.

Other Meds: Tamoxisin

Current Illness: None reported

ID: 1152528
Sex: M
Age: 70
State: KY

Vax Date: 02/24/2021
Onset Date: 03/07/2021
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: NKA

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

Symptoms: headaches and weakness on one side of the face Was seen in the ER and was dx with Bell's Palsy and Ramsay Hunt Auricular Sundrome treated with Famciclovir, Meloxicam, Tramadol and he is still having weakness and headaches after completing the medication. He came for 2nd vaccine today and we told him to consult with his physician about getting the 2nd dose at this time, due to his continued symptoms.

Other Meds:

Current Illness: None

ID: 1152529
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: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: Patient had initial dizziness and syncopal episode. Patient reported "vision went dark and felt heavy". Patient vomited x1. Patient given cold pack and water. After 10 minutes patient denies headache, dizziness, double vision, or ringing in ears. No report of difficulty breathing, SOB, numbness or tingling in extremities. Patient successfully discharged from observation at 4:05 pm.

Other Meds:

Current Illness:

ID: 1152530
Sex: F
Age: 73
State: MA

Vax Date: 03/11/2021
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: Latex, Naproxen, and Gluten intolerant

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

Symptoms: 2-3 days after vaccine patient experienced lightheadedness 18 days after the vaccine patient experienced muscle aches 19 days after patient experienced neuropathy of hands and feet

Other Meds: 2 Prescriptions taken 5 days a week (unsure if they were taken the day of the appointment) - Atorvastatin 20mg -Levothyroxine 175mcg

Current Illness: No

ID: 1152532
Sex: M
Age: 28
State: OH

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Patient experiecnced syncope within seconds of vaccine administration. He regained consciousness in about 30 seconds

Other Meds:

Current Illness:

ID: 1152533
Sex: F
Age: 79
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Client reported dizziness and was in bed x12 days and knees were "shaking"

Other Meds: Unable to gather prescription info

Current Illness: Hypertension

ID: 1152534
Sex: F
Age: 70
State: GA

Vax Date: 02/09/2021
Onset Date: 02/11/2021
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: Sulfa allergy

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

Symptoms: Moderna COVID-19 Vaccine EUA

Other Meds: Vitamin E Herbal Multi Vitamin

Current Illness: No illnesses

ID: 1152535
Sex: M
Age: 41
State: NV

Vax Date: 03/19/2021
Onset Date: 03/20/2021
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: Shellfish

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fatigue, chills, soreness, fever for 48 hours

Other Meds:

Current Illness: Covid positive November 2020

ID: 1152538
Sex: F
Age: 36
State: ME

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chills, aches, headache, joint pain, pain at injection site

Other Meds: None

Current Illness: None

ID: 1152539
Sex: F
Age: 24
State: OH

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

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

Symptoms: Patient had two hot bumps (bigger than a quarter size) on two sides of where the vaccine was administered in the upper left deltoid

Other Meds: abilify 15mg, lamictal 25mg,

Current Illness:

ID: 1152540
Sex: M
Age: 25
State: MD

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

Lab Data:

Allergies: None known

Symptom List: Nausea

Symptoms: High levels of unsteadiness, vertigo, and brain fog. Treatment includes vestibular exercise therapy and dramamine. Symptoms worsen over the course of the day and are triggered by movement.

Other Meds: Metroprolol, excedrin

Current Illness: None known

ID: 1152541
Sex: F
Age: 54
State: IL

Vax Date: 03/17/2021
Onset Date: 03/21/2021
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: Medicine Allergies are: Indomethacin and Allopurinol, and Colchicine and I have a shellfish allergy

Symptom List: Injection site pain

Symptoms: I am still experiencing a large rash over my upper left arm in the area of both injection sites. The rash was not present after the first injection. 4 days after my 2nd Moderna injection, I began seeing a large rash appear over my whole upper arm and it was itchy and hot to the touch. in a week time the area got darker but less hot to the touch. I was seen by my primary care physician, Dr, and she took pictures of the area and recommended I use cocoa butter on the area and to notify Police (with whom I participated with the vaccination process) and she referred me to Dermatology department and I am awaiting an appointment now.

Other Meds: Nifedipine CR 30 mg tablet once daily, Hydrochlorothiazide 75-50 mg tablet once daily, Klor -Con M20 tablet once daily, and Vitamin D 50,000 mg once weekly. Over the counter meds I take is Prilosec antacid and Allegra D for allergies and I

Current Illness: Hypertension and Anxiety.

ID: 1152542
Sex: F
Age: 34
State: CA

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

Lab Data:

Allergies: codeine, caffeine, pineapple

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

Symptoms: COVID arm - itchy, red, painful

Other Meds: Spironolactone, valtrex

Current Illness: none

ID: 1152543
Sex: M
Age: 40
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Shellfish

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

Symptoms: Tingling and itchy on his forehead

Other Meds: Losartan, Zyrtec

Current Illness:

ID: 1152544
Sex: F
Age: 41
State: TX

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:

Symptom List: Tremor

Symptoms: Patient reports feeling tingling on top of her mouth, no other symptoms. Patient was assessed by EMS, Cleared by EMS. BP; 130/80, pulse; 65, Spo2 99%

Other Meds:

Current Illness:

ID: 1152546
Sex: F
Age: 33
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Erythema, Pruritus

Symptoms: patient felt cold to the touch and pale, BP was taken and recorded at 75/49 at 1313, nurse held patient in chair to prevent her from falling off her chair

Other Meds: unknown

Current Illness: unknown

ID: 1152547
Sex: F
Age: 74
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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: Cortisone, Co-trimoxazole

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

Symptoms: Patient states rash - splotchy, then erythema around site. Rash lasted 1 week.

Other Meds: Aleve daily

Current Illness: n/a

ID: 1152548
Sex: F
Age: 59
State: IN

Vax Date: 03/17/2021
Onset Date: 03/25/2021
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: None

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

Symptoms: Started on the 8th day. Within the first 12 hours I had a fever, chills, aches, cough, and head congestion. As of today 3/31, tire and lack of energy. I do hav a history of sinus infections and spring allergies.

Other Meds: Jardiance Glipzide Januvia Metformin Atoarvastatin Losatan 81 mg aspirin

Current Illness: None

ID: 1152549
Sex: F
Age: 70
State: CT

Vax Date: 03/18/2021
Onset Date: 03/21/2021
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: Doxycycline (had a rash once)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: About three days after I received the second shot, my upper arm around the vaccination site became itchy. Over the next couple of days, there was a rectangular area (maybe 3 X 6 inches) that was slightly swollen and red, with a minor rash.

Other Meds: Levothyroxine 125 mcg Atorvastatin 10 mg Aspirin 81mg CalMagZinc Melatonin 10 mg Areds Vitamin D Multi-vitamin

Current Illness: None

ID: 1152550
Sex: F
Age: 26
State: AZ

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: SYR
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: Muscle/body aches, fatigue/tiredness, taking ibuprofen

Other Meds: Diltiazem, Desvenlafaxine, vitD3, Cetirizine, B12 Complex

Current Illness: None.

ID: 1152551
Sex: F
Age: 43
State: FL

Vax Date: 03/28/2021
Onset Date: 03/29/2021
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: Fever, muscle aches, extreme fatigue

Other Meds:

Current Illness:

ID: 1152553
Sex: M
Age: 24
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: LA

Lab Data:

Allergies: Nka

Symptom List: Pain in extremity

Symptoms: Client found on floor assisted to floor by brother. No trauma found. EM services on site . Refused transport to hospital.

Other Meds: None

Current Illness: None

ID: 1152554
Sex: F
Age: 30
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: Sulfa

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

Symptoms: Patient complained of swollen tongue, no shortness of breath, no chest tightness. Paramedics arrived on scene and gave a Benadryl shot. Patient will be sent out to a nearby hospital because symptoms are not relieved.

Other Meds: Symbalta, trazadon, multivitamin

Current Illness: No

ID: 1152555
Sex: F
Age: 66
State: FL

Vax Date: 02/04/2021
Onset Date: 02/06/2021
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: Sulfa drugs

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

Symptoms: Patient reports she felt a suddent increase in the noise in her ears. She had baseline tinnitus, but it suddenly became loud and high pitched in both ears. She also had a sensation of a tremor throughout her body and a feeling of hypersensitivity. She reports fatigue and unintentional weight loss of 3lbs since the event.

Other Meds: Calcium supplement, multivitamin, coQ10 supplement with red yeast rice, amlodipine, lisinopril, Aspirin 81mg, simvastatin

Current Illness: none

ID: 1152556
Sex: F
Age: 57
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Patient visited the vaccine clinic today which she received her first dose of Moderna vaccine lot# 020B21A to her right deltoid. While the patient sitting in the observation area , she complaining of huge to vomit. However, no vomiting noted at this time. Patient said; she has been vomiting since last night which she took medication to help stop the vomiting . As per patient and her granddaughter who currently present in the facility, the patient went to medical hospital two weeks ago where she was diagnosed with gastritis, Gallstones, she did not have any surgical procedure done. She was only prescribed medication for nausea and vomiting . Initial vital signs: Bp148/80, pulse 76, resp 18, o2 sat 99% on room air. Patient has medical history of diabetes, hypertension . As per patient, she has not been checking her blood glucose level lately nor taking her insulin. She also said that she was instructed by her doctor to be off of her medication but she still taking her metformin 500 mg twice daily, medication for vomiting and gastritis. Patient denied any known allergy. Patient was closely monitored and her condition improved. At 12:17 vs: PB 110/80, resp 18, pulse 75, o2 sa98 on room air. Patient went home accompanied her granddaughter. Patient instructed to follow up with her medical doctor or to go the nearest hospital if the condition continue. Granddaughter states" I will take her back to the hospital this evening.

Other Meds: omeprazole, metformin 500mg BID, PRN nausea meds

Current Illness: Nausea and vomitting

ID: 1152557
Sex: F
Age: 40
State: GA

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

Lab Data:

Allergies: Penicillin, Doxcycline

Symptom List: Vomiting

Symptoms: Patient was shaking and had a high blood pressure. Vitals were normal upon arrival of paramedics, but was taken to the hospital for further observation.

Other Meds: Unknown

Current Illness: None

ID: 1152558
Sex: F
Age: 26
State: IN

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

Lab Data:

Allergies: Seafood allergy (potential; undiagnosed)

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: By 10:30 of day received, slight fever. Overnight, developed high fever, aches and pains, and muscle spasms. High fever persisted through the first 24-36 hours. Then developed (and am currently experiencing) tingling in the face and headache.

Other Meds: Cymbalta; Loestrin Fe

Current Illness: N/A

ID: 1152559
Sex: F
Age: 62
State: CA

Vax Date: 03/20/2021
Onset Date: 03/20/2021
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: Pencillin, Sulfa, Contrast Iodine, all crustacean, Macrobid and Silver Nitrate.

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

Symptoms: I received the Vaccine around 11:14 a.m. At around 4:30 my lips started feeling tingling and the roof of my mounth was feeling the same. I did notice that my lips were swollen and my face was swollen slightly. I continued to drink fluids. I did take 50 mg of Benedryl hoping that the tingling and swollen lips would go away. It took almost three (3) hours for my lips to go down a little. I did not take anymore Benedryl. I alerted Pharmacy regarding my symptoms and Dr. via telephone call. I do not plan to take the second dose.

Other Meds: Losartan Potassium 62.5 mg.

Current Illness: None.

ID: 1152560
Sex: M
Age: 77
State: KY

Vax Date: 03/03/2021
Onset Date: 03/04/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 102* fever for 2 days. No other side effects.

Other Meds: Nexium, Lesinoprol (blood pressure), Statins (Tropostat), Allopurinol (uric acid)

Current Illness: no

ID: 1152562
Sex: F
Age: 43
State: IL

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: NKA

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

Symptoms: Patient reportedly had seizure after placement of the Pfizer/BioNTech COVID-19 vaccine. The patient received the vaccine at a COVID vaccination clinic. The patient had vaccination needle in her arm, and then almost immediately after, within 3 minutes, that she had a seizure event. It was for extremity shaking lasting a couple minutes which then resolved. This was witnessed by family and they kept her from having any injury sustained. Reportedly she also was very scared receiving the vaccine and "when she gets scared she has her seizures". Mother reports that the patient seizes about once a month and has had other seizures with interventions like brushing teeth. The patient has been taking her medications for seizures. Patient was postictal when medics arrived. Glucose was 79. No recent illness. No recent injury or fever. Had coronavirus over the summer.

Other Meds: Oxcarbazepine and lamotrigine

Current Illness: Developmental disability and seizure disorder

ID: 1152563
Sex: M
Age: 66
State: AL

Vax Date: 03/10/2021
Onset Date: 03/17/2021
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: anabolic steroids

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

Symptoms: Nodules on legs, arm of injection site, neck and scalp, started 1 week post vaccine and still present on 3/31 when he first saw me for this issue. Painful and itching, on exam appear to be erythema nodosum

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm