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

Date Died: 02/18/2021

ID: 1156450
Sex: M
Age: 96
State: CO

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 04/01/2021
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: none reported

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received his second dose of the COVID-19 vaccine on February 17, 2021. Per family, he complained of feeling chilly and cold. He was found deceased in the early morning on February 18, 2021.

Other Meds: Gabapentin, atorvastatin, metoprolol, losartan potassium, phenazopyridine, triamcinolone, diclofenac, fluticasone propionate nasal spray USP

Current Illness:

ID: 1156451
Sex: F
Age: 60
State:

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Feels dizzy but thinks it may be anxiety. No other signs or symptoms. Informed to seek medical advice if any further problems.

Other Meds:

Current Illness:

ID: 1156452
Sex: F
Age: 66
State: OH

Vax Date: 03/28/2021
Onset Date: 03/29/2021
Rec V Date: 04/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known.

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

Symptoms: Chills that were like spasms (violent jerks of my body), fever, nausea, headache, exhaustion, shortness of breath. This was the 2nd time I had a reaction to Moderna that was so horrible I could not get out of bed. Following the first dose on Feb. 28th, I had the same reaction and my temperature got to 102.5. This time, the reaction last longer. I was still short of breath tree days after the shot. Today, April 1, I finally feel close to 100%.

Other Meds: No Prescriptions. OTC-Calcium, D3, Zinc, Fish Oil, Multi V, Osteo Bi-Flex, Melatonin

Current Illness: None.

ID: 1156453
Sex: M
Age: 29
State:

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: Pt. Got 2nd Moderna Vaccine 1 week early. His vaccine card were different and was not caught until after he got vaccine. No ill effects for pt. thus far.

Other Meds:

Current Illness:

ID: 1156454
Sex: F
Age: 56
State: NY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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 and scallops , latex

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

Symptoms: Mild Headache , tired, rash inside both forearms

Other Meds: None

Current Illness: None

ID: 1156455
Sex: F
Age: 22
State: OH

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: Patient developed nausea, dizziness, while sitting in observation at approximately11:02am. Placed legs on chair, cool compress on neck. Vitals: Baseline (11:04am) BP 129/92, pulse 71, F/U (11:11am) BP 135/98, pulse 71, (11:20) pulse 70 Patient's symptoms resolved and was able to stand on her own at 11:24am without nausea/dizziness.. Was accompanied by her mother, a nurse, who took her home.

Other Meds: unknown

Current Illness: unknown

ID: 1156456
Sex: F
Age: 69
State: CO

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/01/2021
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: Wasp stings, wool, narcotics

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Got the shot at 12:30 pm Saturday 3/27. Around 6 hours post-shot, soreness spread from the injection site across my back, into my neck, created a low headache, then went into my right arm and down both arms. Around 7 hours extreme fatigue set in. Chills hit at 9 hours. The headache became more generalized, extreme thirst, aches, shivering, and fatigue went on for exactly 24 hours. No appetite, rolling nausea (no vomiting), mental anxiety, cognitive fuzziness, sleepiness. Unable to read (short term memory and cognition), low attention for television. I never checked for fever. Around 6:30 the next evening (Sunday, 3/28), the symptoms retreated except for the fatigue and headache. Still a bit anorexic, but did eat lightly around 8 pm. Read, watched TV, and slept better. Monday, March 29: I felt very fatigued and fuzzy-brained, but otherwise normal in the morning; the afternoon brought more energy, less headache. Tuesday, March 30: Everything back to normal. Energy and clear thinking returned last.

Other Meds: None

Current Illness: None

ID: 1156457
Sex: F
Age: 42
State: MN

Vax Date: 01/19/2021
Onset Date: 02/01/2021
Rec V Date: 04/01/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Hospitalization within 6 weeks after receiving vaccine

Other Meds:

Current Illness:

ID: 1156458
Sex: F
Age: 62
State: NY

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/01/2021
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: Chills, trembling, fever for 12+ hours

Other Meds: Atorvastatin, Zoloft

Current Illness: None

ID: 1156459
Sex: F
Age: 46
State: TX

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/01/2021
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: Latex, rosephrine, novicane, penicillin, strawberries, watermelon, cantaloupe, Claritin, ketamine, all opiates, Naprosyn, flu vaccine, pneumonia vaccine, Tide soap, bounce fabric softener, coca cola, aloe juice,

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Within 20 minutes of receiving the vaccine, I started having uncontrollable itching. My tongue and lips were tingling, my body turned bright red, I could feel my heart rate go up, I was very dizzy, had a headache that was almost as bad as migraines, I got chills, my temperature went up, and my mouth became very dry. I was treated by paramedics with benadryl and a steroid and sent to emergency room. From there, they did blood work and monitored me for 3 hours. I was still very itchy going home where I was told to take benadryl every 6 hours. It didn't help much. I didn't sleep that night at all due to itching, headache, and dry mouth. I felt like something was crawling all over me. The next day I was still very itchy, my finger tips felt like they had been burned, and my lips, tongue, and face still felt swollen. I called my doctor and was prescribed a steroid because my symptoms were persistent and I couldn't deal with the itching. Today is day 4 from the vaccine and I'm still itching and my tongue still isn't normal. I also still have the headache and my fingertips still feel like they were burned.

Other Meds: Metformin, glipezide, hydroxyzine, lisinopril, singular, omeprezole, meteprolol, atrovastatin

Current Illness: None

ID: 1156460
Sex: M
Age: 46
State: HI

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: Codeine

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

Symptoms: Headache, fatigue, joint pain, low fever, severe lymph node swelling in left armpit.

Other Meds: Celebrex 200mg, Tylenol 650mg

Current Illness: None

ID: 1156461
Sex: F
Age: 69
State:

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 04/01/2021
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: Fever (99-101 degrees)?administered Ibuprofen. Three-day duration. Fatigue. Three-day duration.

Other Meds:

Current Illness:

ID: 1156462
Sex: F
Age: 64
State: OH

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: Ceclor, eggs

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

Symptoms: Patient experiencing hives on arms shortly after first dose of Pfizer covid vaccine. Patient was given 25mg Benadryl IM and the hives resolved. Patient was discharged home without incident.

Other Meds: Toprol XL, Lisinopril-hydrochlorothiazide, armour, singular, vitamin D 3, Anaprox

Current Illness: None

ID: 1156463
Sex: M
Age: 17
State: GA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 04/01/2021
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: Denies

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

Symptoms: Patient was 17 at the time of vaccination.

Other Meds: Denies

Current Illness: Denies

ID: 1156464
Sex: M
Age: 53
State: CA

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Very sore arm within 12 hours of 2nd shot on Wednesday March 24th. Woke up the next day feeling "off" and irritated. By 9pm Thursday my entire body ached severely as if I had a very bad flu. By 11pm I had very severe cold & hot shakes and felt extremely nauseous until the next morning. I checked my temp every couple hours and never was I above 98.5 but, I felt extremely sick until about 48 hours after the 2nd shot. On Friday, and for the next 2-3 days, I felt fatigued as if I was recovering from the flu. Only a flu that was without fever or any respiratory issues. By Monday I felt normal again.

Other Meds: Allopurinol, Advair, Zyrtec.

Current Illness: None

ID: 1156465
Sex: F
Age: 49
State: NY

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/01/2021
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: General malaise, chills, fever, headache, severe muscle aches

Other Meds:

Current Illness:

ID: 1156466
Sex: M
Age: 32
State: TN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: none

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

Symptoms: 9:19 Going to sit in seat for observation, seized, fell onto ground, hit head. VS: BP 108/52 HR: 57 RR: 22 O2sat: 100%; 9:20 911 was called; 9:21: BP: 132/84 HR: 72 O2: 99% RA Pupils: PERRLA; 9:27: Alert & Oriented, difficulty remembering wife's name: BP: 156/73 HR: 75 O2: 99%; 9:30 EMS arrived, transferred to ED for further treatment and eval.

Other Meds: none

Current Illness: none

ID: 1156467
Sex: F
Age: 35
State: CA

Vax Date: 03/27/2021
Onset Date: 03/28/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fever of 101F from around 10 AM to midnight; general exhaustion from 4 AM to noon the next day.

Other Meds: none

Current Illness: none

ID: 1156468
Sex: M
Age: 65
State:

Vax Date: 03/03/2021
Onset Date: 03/15/2021
Rec V Date: 04/01/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: stroke like symptoms

Other Meds:

Current Illness:

ID: 1156469
Sex: M
Age: 50
State: CA

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Low grade fever for approx 24 hours slight body ache and fatigue. Arm sore roughly 3 days

Other Meds: Tylenol, cbd oil with thc

Current Illness: Reoccurring stomach issue

ID: 1156470
Sex: F
Age: 52
State: AL

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: Flu vaccine - nausea. IV contrast - rash, Keflex- Rash, Chocolate- itching.

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

Symptoms: Member developed dizziness and metallic taste in mouth about 5-10 minutes after having the vaccine

Other Meds: ASA 81mg, Estradiol oral, Lipitor 20mg, Prilosec 40mg, Ergocalciferol 50k u weekly (took last night), Mobic 7.5mg, Hair and Nail Vitamin, Biotin, Probiotic, Singulair 10mg, Zyrtec 10mg, Advair 250 PRN (last used monday), Albuterol PRN.

Current Illness: None

ID: 1156471
Sex: F
Age: 27
State: CT

Vax Date: 03/06/2021
Onset Date: 03/25/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Rash diagnosed as Pityriasis Rosea

Other Meds: Oxcarbazepine Methylphenidate Junel

Current Illness: None

ID: 1156472
Sex: M
Age: 55
State: NJ

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/01/2021
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: Back pain several hours after receiving second dose of vaccine. The next day 103 fever, abdominal pain and joint pain.

Other Meds: lisinopril

Current Illness:

ID: 1156473
Sex: F
Age: 61
State: FL

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: penicillin, sulfa, adhesive, severe allergic reaction to cleaning solutions that contain propylene glycol or ethoxylated alchohols

Symptom List: Injection site pain, Pain

Symptoms: First day around bedtime 11:00pm sever body ache especially upper middle back, hands and feet. Heart rate high 90's. Felt better next day. 2 days later body ache again day and night, middle upper back, feet and hand, under arms. Shortness of breath especially at bedtime, heart rate has been dropping from 80's to low 60's. blood pressure a little high 130's/80's. Feel lump in throat, like choking sensation on and off. Severe weakness-tiredness. I wake up light headed and shortness of breath in the morning. Big bruise on left leg 2 inch long by 1.2 wide. My oxygen usually is between 98-100, last night dropped to 94-95. Doctor told me to report reaction. Feel a bit better today. Took today 2 Advils.

Other Meds: 4 life transfer factor plus, vegetable green juices(homemade), flax seeds milk(homemade)

Current Illness:

ID: 1156474
Sex: F
Age: 51
State: PA

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever, muscle pain, chills, extreme fatigue

Other Meds: Adderall, levothyroxine, Atacand

Current Illness: None

ID: 1156475
Sex: M
Age: 27
State: KY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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:

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

Symptoms: I experienced a very sore arm, nausea, major headache, body chills and aches. A majority of these side effects lasted about 7 hours. The sore arm and body aches lasted about 10 hours. I took ibuprofen.

Other Meds:

Current Illness:

ID: 1156476
Sex: F
Age: 46
State: OH

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 04/01/2021
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, environmental

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 3/24 - felt slight swelling in throat but subsided; 3/25 - sore arm for4 days; fever above 101 on 3/25; neck ache and head ache on 3/25; tired on 3/25

Other Meds:

Current Illness:

ID: 1156477
Sex: M
Age: 77
State: CA

Vax Date: 02/12/2021
Onset Date: 03/27/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: started with just injection spot swelling and red bumps, after 2wks its full upper body. Including arms, elbows, back, groin area, buttocks, belt line/waist, down the tops of the legs.

Other Meds: Amlopdipine, Atorvastatin Terazosin Memantine K Tab Sertaline Bayer 81mg Busiprone

Current Illness: Dementia

ID: 1156479
Sex: M
Age: 28
State: WI

Vax Date: 03/31/2021
Onset Date:
Rec V Date: 04/01/2021
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 his first dose on 3/6/21 of Moderna vaccine. He was scheduled 4/6/21 but attended another immunization clinic and marked his screening form as not having received vaccine before.

Other Meds: None

Current Illness: None

ID: 1156480
Sex: M
Age: 41
State: NM

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: Peppers

Symptom List: Nausea

Symptoms: Rash on both arms around the elbows, red, itchy bumps.

Other Meds: Gabapentin, hydroxyzine, claritin

Current Illness: None

ID: 1156481
Sex: M
Age: 47
State: WI

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/01/2021
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: Runny nose started maybe an hour or so after injection. Felt slight nausea around 6:30PM until I went to bed. Woke up at about 1:30AM with mild nausea. Within about 30 minutes I experienced chills. I hydrated and tried to go back to sleep. In the morning I had a fever of 100.3 degrees. Took 1000 mg of Tylenol and hydrated, another 500 mg 4 hours later. Chills came on and off throughout the day. Added layers of clothing to stop the chills. Ate breakfast and lunch. Drank G2 to hydrate. Temp bounced between 99.6 and 100.8 throughout the day. Experienced heartburn for several hours in the afternoon. Took a nap at 3:30 for 2 hours, ate, rehydrated and removed some layers to clothing and put on a cool towel on my forehead to try to reduce. Took 1000 mg of Tylenol and went to bed. Slept well. All symptoms were gone by morning.

Other Meds: None

Current Illness: None

ID: 1156484
Sex: F
Age: 72
State: MD

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: Sulfur, Iodine, Codeine, mushrooms, shellfish, soybeans

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

Symptoms: Severe nausea, fever, aches and pain

Other Meds: None

Current Illness: Shingles

ID: 1156485
Sex: F
Age: 21
State: NY

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: INITIALLY REPORTED AS NO ALLERGIES DURING REACTION PATIENT REPORTED SHELLFISH AND ALLERGY SHOT ANAPHYLAXIS

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

Symptoms: 2:25 PM: Patient reported facial itching at 2:25pm, coughing and chest tightness. Difficulty speaking. BP 136/100 , HR 110, RR 24, SPO2 95%. Alert and oriented, feelscold and calmy. Medications: EPI-pen administered per protocol at 2:28pm in L thigh. 911 called, ambulance dispatched. Monitored until 2:34 BP 140/98, HR 108, SPO2 99. EMS arrived 2:45pm. Transported to hospital.

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1156486
Sex: M
Age: 76
State: ID

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/01/2021
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: PCN

Symptom List: Tremor

Symptoms: Increase confusion, Altered LOC, Weakness, hypotension

Other Meds: Provera 10 mg, Depakote 750 mg, Trazodone 100 mg, Abilify 5 mg, Glimepiride 1 mg, Lasix 60 mg, Flomax 0.4mg Ipratropium-Albuterol, metformin 500mg BID, Atorvastatin 20 mg

Current Illness: Bipolar disorder, PTSD, DM2, and Repeated Falls, Muscle weakness, Difficulty in Walking, Hyperlipidema, Edema, Paraphilia

ID: 1156487
Sex: M
Age: 31
State: CA

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/01/2021
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: a 31 year old man who received the COVID-19 vaccine on March 27, 2021 in the Public Health Department parking lot. Upon arrival and check in, the patient declined any comorbidities and health history but did state that he was nervous. After administration of the vaccine by NP, the patient lowered himself to the ground, from a sitting position, and had a 60 second tonic clonic seizure. Seizure precautions such as turning the patient on his side, supporting his head, and calling EMS were taken during the seizure. After 60 seconds, the patient came to and asked what happened. PPHD staff oriented the patient to what had happened, to which he proceeded to say ?oh that is normal for me when I get anxious.? With the help of PPHD staff and his wife, the patient was brought to a sitting position and given a granola bar and water to his request. According to clinic lead RN, ?his skin was normal in appearance for race, ethnicity, and age. He was mildly diaphoretic. He verbalized feelings of anxiety and worry surrounding the vaccine.? As EMS arrived on the scene and began assessing vital signs the patients anxiety appeared to increase; he became less verbal, closed his eyes, and his breathing pattern became shallow. The patient then had a second seizure at this time lasting approximately 25 seconds. When the patient came to he immediately verbalized, ?I?m good, I?m good, I?m fine?. He was slow to respond to verbal cues, but persistently refused transport to the local acute care hospital for further evaluation. He rested on the ground in supine position for approximately 25 minutes, with his partner and EMS at his side. Upon further evaluation of the patient and his wife, it was determined that the patient has a history of seizure activities when he is nervous and that he was ?expecting? this to happen. The patient continued to decline medical care and transportation to the hospital. The patient left in medically stable condition with his wife operating the vehicle.

Other Meds:

Current Illness:

ID: 1156488
Sex: M
Age: 75
State: TX

Vax Date: 03/01/2021
Onset Date: 03/22/2021
Rec V Date: 04/01/2021
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: Levaquin

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

Symptoms: First shot 2/22/21 chills, body aches occurring 8 hours after shot. 2nd shot 3/30/21 chills, body aches after 6 hours. I recovered after day and half. I had COVID 19 December 14 and quarantined for 16 days. Both shots were Moderna. First shot left arm, Second right arm.

Other Meds: Alfuzosin 10Mg, Niacin 500Mg, Turmeric Curcumin 1500Mg, Omega 3 fish oil 1000Mg

Current Illness: First shot 2/22/2021 Moderna, chills and body aches, second shot 3/30/2021 same body symptoms, both last day and half with to be expected sore arm.

ID: 1156489
Sex: F
Age: 43
State: OH

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 04/01/2021
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: Codeine

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

Symptoms: Asthma symptoms were markedly worse on the 2nd day after injection. I needed to use my rescue inhaler throughout the day (this is not normal as my asthma is generally well-controlled)

Other Meds: Breo Ellipta inhaler, Singulair, Levalbuterol, birth control pill, Elderberry gummies with zinc and vitamin c

Current Illness:

ID: 1156490
Sex: F
Age: 77
State: MD

Vax Date: 02/20/2021
Onset Date: 03/01/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On March 1, I developed bed-shaking chills, fever to 101 and diarrhea lasting for several hours. Resolved without treatment.

Other Meds: atenolol 25 mg qd; simvastatin 25 mg qd

Current Illness: None

ID: 1156491
Sex: F
Age: 59
State: CA

Vax Date: 01/11/2021
Onset Date: 01/21/2021
Rec V Date: 04/01/2021
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: Celery Onion and Pineapple by skin test.

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

Symptoms: Ten days after the shot my arm got swollen red and hot around the injection site. It was about an inch and a half. It was a little painful but mostly hot to touch and itchy. I advised not to scratch, and it slowly went away. It stayed for four days total. I got the second dose in the other arm and I had no reaction.

Other Meds: High Blood Pressure Cholesterol Thyroid Baby Aspirin

Current Illness:

ID: 1156492
Sex: F
Age: 80
State: MA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 04/01/2021
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: non steroidal pain medscaad

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

Symptoms: fatigue, mild soreness, headache, coldness,

Other Meds:

Current Illness:

ID: 1156493
Sex: M
Age: 34
State: NH

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: Pain in extremity

Symptoms: Patient in recovery for approximately 3 minutes. Patient suddenly slumped over and unresponsive. Patient did not respond to painful stimuli immediately. After approximately 20 seconds patient inhaled deeply, opened eyes and was confused as to where he was. VSS. Rapid response called and patient transported to emergency department as per protocol.

Other Meds:

Current Illness:

ID: 1156494
Sex: M
Age: 66
State:

Vax Date: 02/28/2021
Onset Date: 03/09/2021
Rec V Date: 04/01/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Hospitalization within 6 weeks after receiving vaccine

Other Meds:

Current Illness:

ID: 1156495
Sex: F
Age: 63
State: NJ

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 04/01/2021
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: Penicillin, Sulfa, Morphine, Benadryl, Codeine Sensitive, Latex

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

Symptoms: Fever and Chills, severe dizziness, headache, appetite loss. Resolved by 8:00 p.m.

Other Meds: Pravastatin, Spironolactone, Nexium, Oxybutynin, Copaxone Injection, Dupixent Injection, Vitamin D, Biotin,

Current Illness:

ID: 1156496
Sex: F
Age: 26
State: CA

Vax Date: 03/18/2021
Onset Date: 03/27/2021
Rec V Date: 04/01/2021
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: Azithromycin, PCN

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

Symptoms: Pain and numbness left arm one week after vaccine

Other Meds: Vyvanse, Nuva Ring, Methylfolate

Current Illness: Binge Eating Disorder

ID: 1156497
Sex: F
Age: 48
State: OK

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
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: Patient indicated she had not received any COVID-19 vaccine previously; however, upon trying to log the Moderna vaccine in, it was observed that she had received 2 previous doses of Pfizer from the Department here in our town. When the patient was asked about this she indicated she didn't know what she got at the Department. Her story changed multiple times.

Other Meds:

Current Illness:

ID: 1156498
Sex: F
Age: 49
State: CO

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 04/01/2021
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: Septra, Flagyl, Yellow Dye

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt woke up 22hrs after receiving vaccine and experienced first time ever episode of vertigo, which caused her to collapse into the wall and lie on the floor. She could not lift her head without exacerbating symptoms - felt like she was falling/spinning and got nauseated. Pt had to receive treatment in ER same day for this.

Other Meds: Celebrex 200mg, Metoprolol succinate 25mg, ivabradine 5mg BID, omeprazole 40mg, cetirizine 10mg, liquid formulation magnesium OTC

Current Illness: Right sided facial paralysis and chronic headaches

ID: 1156499
Sex: F
Age: 57
State:

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 3:39 client reported being dizzy ps02 100% b/p 170/82 pulse 86 water given and monitored. Then reported that her tongue was thick and lips tingling. 3:42 b/p 218/90 pulse 120 skin pink warm and dry. Respirations even and unlabored, placed in wheel chair and at 3:52 exited the building to ER

Other Meds:

Current Illness:

ID: 1156500
Sex: M
Age: 50
State: CA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/01/2021
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: Nausea, headache, muscle ache, lethargy. For about 16 hours starting 10 hours after the vaccination. Side effects lessened and after another 24 hours were completely gone.

Other Meds: None

Current Illness: None

ID: 1156501
Sex: F
Age: 66
State: FL

Vax Date: 03/04/2021
Onset Date: 03/07/2021
Rec V Date: 04/01/2021
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 listed

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

Symptoms: VACCINE GIVEN 3/4, PATIENT STATED ON 4/1 THAT ON 3/7 SHE FELT NUMBNESS ON SIDE OF CHEEK AND NECK AND FELT IT MOVING TO THROAT, SHE TOOK A BENADRYL. ALSO WELT ON BACK OF NECK

Other Meds: none listed

Current Illness: none listed

ID: 1156502
Sex: M
Age: 43
State: NY

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 04/01/2021
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 known

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

Symptoms: I had soreness in the left arm initially. The morning after the vaccine, I woke up feeling sick. My body was achey and I felt lethargic and flu-like. I did not have fever. This largely cleared up by the evening.

Other Meds: Omeprazole, Remicade, Mercaptopurine, Oxycodone

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm