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: 1160877
Sex: M
Age: 72
State: CO

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: almost immediate reaction in larynx. Irritated larynx/vocal cords.

Other Meds: N/A

Current Illness: N/A

ID: 1160878
Sex: M
Age: 55
State: MO

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/02/2021
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: PCN, Cipro

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient c/o itching, burning, headache and increased phlem in throat. 1257 BP 160/72 Pulse 70 1258 IM 50 mg Benadryl Right Arm Lot 030008 Ex 03/22 1303 BP 178/72 Pulse 62 Lungs clear no wheezing Patient stated he ate a snack at breakfast nothing since, water and banana given to patient. 1318 Bp 150/68 Lungs clear no wheezing Patient stated phlem feeling was gone, and that itching and burning had dramatically decreased Continued monitoring for another 20 minutes to make sure no changes. Patient declined any higher medical assistance. Patient declined the offer of calling family to come drive him home. Staff offered to keep patient to monitor longer, patient declined. Patient educated about following up with physician and what to monitor after leaving facility. Follow up call made to patient 04/01 and 4/2 no answer VM. Patient called back 4/3 stated he was fine with no further issues that day.

Other Meds: unknown

Current Illness: unknown

ID: 1160879
Sex: M
Age: 77
State: AZ

Vax Date: 02/05/2021
Onset Date: 02/19/2021
Rec V Date: 04/02/2021
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: Chocolate, Glutin

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

Symptoms: Shingles approximately 2 weeks after first moderna vaccination. And Shingles again after second moderna vaccination. A friend also developed Shingles approximately 2 weeks after receiving the first Pfizer vaccination. A co-worker of my real estate also developed shingles after receiving the covid19 vaccination.

Other Meds: Generic Mirapex

Current Illness: None

ID: 1160880
Sex: F
Age: 55
State: TX

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Date: 3/23/2021 Problem: feeling "woozy" Notes: Patient started feeling "woozy" after vaccine administration. Patient noted with blank stare, pale, & sweaty. BP 95/68 P:60 R:18, O2: 97.1 T: 9.0 Patients legs elevated to elevated BP. Patient came to and is awake, alert, & oriented x3. Small sips of water offered. BP: 117/77 P:61 R: 18 O2: 9& T: 96.4 Blood glucose. 128mg/dl. Patient states that she had-breakfast. Patient states that she had- breakfast. Patient able to stand up without feeling dizzy. patient walked to observation with observation nurses. Client observed for a additional 30 mins. After the 30 mins she states feel fine. T 98.8 P 64 R18 BP 120/74 O2 97% RA. AAOx3. Client left facility via personal vehicle.

Other Meds: N/A

Current Illness: N/A

ID: 1160881
Sex: F
Age: 34
State: NY

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: lightheaded, tingly, tongue felt swollen

Other Meds:

Current Illness:

ID: 1160882
Sex: M
Age: 60
State: NY

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/02/2021
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: Sulfa Drugs - Severe Systemic Itching.

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

Symptoms: 1st vaccination on March, 4, 2021 - Right arm, soreness at injection site for 2-3 days. No swelling. After that I was fine. 2nd vaccination on April 1, 2021 - Right arm, Slight bodily flushing within 15 minutes of injection. About 4:00 PM started to develop mild aches and chills.. As the day progressed, aches and chills became substantial with a 2:00 AM temperature of around 102 degrees F headache and mild nausea. now 5:00 PM the following day ,i.e., now, with a temperature of 100.5. F. Injection site slightly diminished in pain. No swelling. Monitoring my condition.

Other Meds: Yes, Prescription drugs for chronic illnesses. Call me to inquire.

Current Illness: Nothing acute.

ID: 1160883
Sex: F
Age: 60
State: MN

Vax Date: 03/30/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: motion sickness/dizziness with accompanying nausea (feels like on a boat).

Other Meds: possibly flexeril, unisom, Benicar (patient states has not taken for awhile)

Current Illness: n/a

ID: 1160884
Sex: F
Age: 45
State: WI

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Severe muscle and joint pain leading to lowback spasm and inability to walk

Other Meds: Verapmil Cymbalta

Current Illness:

ID: 1160885
Sex: F
Age: 51
State: SC

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 04/02/2021
Hospital: Y

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

Lab Data:

Allergies: Tree Nuts

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Slurred speech at 3am on 20Jan2021. Emergency room doctor diagnosed TIA at 7am. Discharged but symptoms returned at 10am. HCP transferred me to hospital for possible Stroke. I was admitted to the hospital on 1/20/2021 at 2pm. MRI indicated that I had a stroke.

Other Meds: Atorvastatin 10mg

Current Illness: None

ID: 1160886
Sex: F
Age: 64
State: UT

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extreme nausea and diarrhea. Took some pepto bismo. This has been going on for about 4 hours

Other Meds: Lisinopril

Current Illness: None

ID: 1160888
Sex: F
Age: 47
State: GA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, Erythromycin, Doxycycline

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

Symptoms: I got dizzy at 4:00 pm the day of the injection and have remained dizzy ever since (currently about 10 day). My blood pressure is very elevated from normal too. Currently, 147/97. Normal for me is somewhere in the 120s/80s. I have noticed the dizzy gets better if I lie down. Also, the dizzy can vary from hour to hour on intensity. Only 1 day since the injection did I have a day with minimal dizziness.

Other Meds: Levothyroxine

Current Illness: None

ID: 1160889
Sex: M
Age: 66
State: NY

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: The patient reported L leg swelling leading to weakness. This was interpreted as a possible stroke, so he was admitted as a stroke code. However, MRI did not show a lesion. This could have been a TIA. For the leg swelling, lower extremity dopplers were negative for DVT.

Other Meds: asprin 81 lipitor 40 olmesartan 40

Current Illness:

ID: 1160890
Sex: F
Age: 48
State: MI

Vax Date: 03/17/2021
Onset Date: 03/28/2021
Rec V Date: 04/02/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient diagnosed with COVID-19 after COVID-19 vaccine

Other Meds:

Current Illness:

ID: 1160891
Sex: M
Age: 32
State: WI

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/02/2021
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:

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA 32-year-old male with history of anxiety and hypertension presents with possible reaction to the COVID vaccine. He was in his usual state of health and doing well until he received his first dose of the Pfizer vaccine around 0740 this morning. Around 10 minutes following the vaccine, patient became short of breath, lightheaded and had his vision gray out before losing consciousness for few seconds. Patient was sitting in a chair at that time and did not fall or hit his head. He was then given juice and was able to ambulate and felt better. Patient was directed to the emergency department for evaluation. He states that he now feels back to his baseline with no lightheadedness or difficulty breathing. Patient states that he has passed out following blood draws in the past and usually lies down afterward. Patient's presentation is overall most consistent with vasovagal syncope, especially given his history of similar events following blood draws. Patient was observed in the emergency department for nearly an hour and remained asymptomatic so he was discharged home with return precautions

Other Meds:

Current Illness:

ID: 1160892
Sex: M
Age: 61
State: NH

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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:

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

Symptoms: Tachyacarida/anxiety Pulse Ox: 95 @ 4:23pm Pulse/Heart Rate: 95 @ 4:23, 73 @ 4:26pm Transfered to EMS @ 4:29pm for evaluation, evaluated in back of ambulance, left in personal vehicle

Other Meds:

Current Illness:

ID: 1160893
Sex: F
Age: 37
State: OH

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: Passed out in shower

Other Meds:

Current Illness:

ID: 1160894
Sex: M
Age: 33
State: IL

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Patient fainted after receiving vaccine.

Other Meds:

Current Illness:

ID: 1160895
Sex: F
Age: 63
State: NY

Vax Date: 03/06/2021
Onset Date: 03/07/2021
Rec V Date: 04/02/2021
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: Itchy rash on face and neck for almost 3 weeks now.

Other Meds: Clopidogrel bisulfate 75mg Atorvastatin cal 20mg Amlodipine B 10mg Methimazole 5mg Ezetimbe 10mg Losarant potassium 100mg Metoprolol suc. 25mg Potassium chloride 20mg

Current Illness: None

ID: 1160896
Sex: F
Age: 61
State: MN

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies: eggs, "anything green outside", mirtazapine, penicillin, influenza virus vaccine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient alerted pharmacy that she had experienced swelling and itching from influenza shots in the past, and has asthma and allergies, however has never had to use an Epi-pen in the past. Patient seemed very nervous, but insisted she was OK to receive the shot. Pharmacist on duty administered Moderna to patient, and waited next to her for several minutes to observe for possible reaction. Patient felt fine after several minutes of talking, so pharmacist advised patient and her husband to let her know if patient started feeling SOB, or itchy, or swelling of face, and went back to pharmacy to complete rxs in que. At that time a different patient who had just received the Moderna vaccine passed out, and pt witnessed this, further increasing her anxiety. 911 was called for the patient who passed out. During the next half hour, pharmacist kept checking on pt. She indicated her tongue seemed to be swelling. So pharmacist on duty asked EMT to check out pt after they had finished taking care of patient who had passed out. EMT checked pt throat, and assured her there was no swelling, however suggested diphenhydramine 25-50mg to be proactive. Pharmacist on duty asked pt if she would like diphenhydramine, and she said, "Yes, Please." So pharmacist provided the diphenhydramine to pt, and she took 50mg. After that she seemed to be fine, and her husband took her home.

Other Meds: none noted

Current Illness: none noted

ID: 1160897
Sex: F
Age: 54
State: VA

Vax Date: 03/22/2021
Onset Date: 03/31/2021
Rec V Date: 04/02/2021
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: Shingles diagnosed on Wednesday March 31, 2021

Other Meds:

Current Illness:

ID: 1160898
Sex: F
Age: 74
State: TX

Vax Date: 01/09/2021
Onset Date: 01/20/2021
Rec V Date: 04/02/2021
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:

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

Symptoms: I felt an unusual feeling in my chest like a bubbling feeling and I went to the doctor. I sometimes have gastric issues and this felt different than normal. I went to the doctor and they took blood work. I was told that my Pancreatic enzymes were very high and I was told to go the emergency room. After testing there was no problem with my Pancreas, and I did not feel really sick. I got the second dose of the vaccine and I had fever and chills the next day. I didn't have any more of the chest feeling like the first time.

Other Meds: Synstatin Vitamins

Current Illness:

ID: 1160899
Sex: F
Age: 24
State:

Vax Date: 02/24/2021
Onset Date: 03/11/2021
Rec V Date: 04/02/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Hospitalization within 6 weeks after receiving vaccine

Other Meds:

Current Illness:

ID: 1160900
Sex: M
Age: 52
State: NC

Vax Date: 03/19/2021
Onset Date: 03/21/2021
Rec V Date: 04/02/2021
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: Penicillin

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

Symptoms: Cloudy/Foggy vision in right eye started on 3/21/21, two days after receiving 1st dose of Moderna vaccine on 3/19/21. Went to See Ophthalmologist on 3/25/21. Diagnosed w/ Optic Disc Edema. Given referral to Neuro Ophthalmologist. Vision got worse so I went to ER on 3/26/21. Opthamologists in ER conducted in depth eye tests. MRI, Lumbar Puncture, and blood work were performed. Diagnosed with Optic Nerve Edema. Discharged with a prescription for Prednisone. Follow up appointment w/ Neuro Ophthalmologist, Dr on 4/9/21.

Other Meds: CBD Oil - 20 mg per day, Claritin

Current Illness: none

ID: 1160901
Sex: F
Age: 76
State:

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/02/2021
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: lip, tongue swelling, facial tingling

Other Meds: omeprazole, denusomab

Current Illness:

ID: 1160902
Sex: F
Age: 72
State:

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: Injection site pain, Menorrhagia

Symptoms: Pt received COVID vaccine 1 st dose on 3/4. 2nd dose vaccine given on 4/2/21- received VACCINE. Disclosed to pt. Voiced no concerns. She was informed that she has completed her vaccine series at this time.

Other Meds:

Current Illness:

ID: 1160903
Sex: F
Age: 74
State: WA

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/02/2021
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: codeine statins prednisone nasal steroids demerol

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

Symptoms: Severe: fatigue headache diarrhea muscle pain joint pain chills nausea lasting 48 hours Had problems staying hydrated due to nausea

Other Meds: amlodipine famotidine calcium magnesium

Current Illness: none

ID: 1160904
Sex: F
Age: 63
State: NJ

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 04/02/2021
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: Skin tape Neomycin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Red rash on arm. Started at injection site and moved out to about the size of a lemon. Some itching. Using ice and an antihistamine.

Other Meds: Metropolol Vivelle Dot - Estradiol Prometrium

Current Illness: None

ID: 1160905
Sex: F
Age: 52
State: NY

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 04/02/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Environmental Allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Tinnitus right ear-moderately to severe - still going on sometimes very loud and unbearable. No treatment for it. Swollen, aching joints in knees and back- moderate at first lasting 7 days- mild as of today but still there. Tylenol. Covid arm- Moderate for 7 days, redness, pain, swelling, itching. Today it is mild red and itchy day 8. Benadryl, Tylenol Fatigue- Moderate for 7 days. Mild as of today. Most concerning is the Tinnitus.

Other Meds: Synthroid, Prevacid, Metformin, Vitamin D3, B-Complex, Lutein, Vitamin K2

Current Illness: Had first Covid shot- Moderna 2/24/2021

ID: 1160906
Sex: F
Age: 78
State: OR

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 04/02/2021
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: About March 30th I had very large bruise on my left foot. Don't remember bumping it but it is possible I forgot. April1, 2021 I had another large hard red bruise on my left front forearm. Felt like a hematoma underneath bruise Don't remember ever having such large bruises even when I did bruise. The one on my left foot on top front of foot was very large black and blue about 4 inches wide. The one on arm was red about 2 inches circle.

Other Meds: Lisinopril 40 mgm. in am 10 mgm pm Atorvastatin 20 mgm. evening, Aspirin 80 mgm. daily, coq10 Pep10 mgm. daily Prevacid q other day. Pepcid 20 mgm. other day Glucasamine glucanate 2 tabs. daily

Current Illness: none

ID: 1160907
Sex: F
Age: 32
State: MD

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: Extreme pain throughout entire body such that I can?t eat or sleep. Even lying down is painful.

Other Meds:

Current Illness:

ID: 1160908
Sex: F
Age: 49
State: TX

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

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

Lab Data:

Allergies: lisinopril

Symptom List: Injection site pain

Symptoms: swollen left eye, red puffy face

Other Meds: unknown

Current Illness: none known

ID: 1160909
Sex: F
Age: 48
State: PA

Vax Date: 03/27/2021
Onset Date: 04/01/2021
Rec V Date: 04/02/2021
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: arm tenderness, hot, blotchy,

Other Meds: Benadryl

Current Illness:

ID: 1160910
Sex: M
Age: 35
State: OH

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/02/2021
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: Amox Diary protein

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

Symptoms: Fever of 100.6f Extreme full body muscle pain. Headache Shortness of breath. Shivering Labored breathing Chest pain Unable to eat or drink. Symptoms lasted from 10:30pm till 9 am the next morning. Extremely painful experience. Able to drink and eat again at 5pm 4/2/21

Other Meds: Cetirizine hydrochloride

Current Illness: None

ID: 1160911
Sex: F
Age: 81
State: GA

Vax Date: 02/24/2021
Onset Date: 02/26/2021
Rec V Date: 04/02/2021
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: Erythromycin Penicillin Clindamycin

Symptom List: Tremor

Symptoms: On that Friday, I had a fever and started shaking. I took my temperature the next morning, it was 100.7 and my normal temp is 97.7. I felt bad all day. I took some Tylenol, my temperature came down, I started feeling better and haven't had a temp since. Didn't seek treatment because I had already been warned about the side effects.

Other Meds: Dexilant - 60mg - once a day Crestor - 5mg - once a day Amlodipine - 5mg - once a day Valsartan - 160mg - at night Prolia shot - every 6 months Carvedilol - 6.25 - am and pm 325 Aspirin each day Fish oil - 1000 Tran resveratrol - 250 Biotin

Current Illness:

ID: 1160912
Sex: F
Age: 79
State: FL

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: Hydrochlorothiazide

Symptom List: Erythema, Pruritus

Symptoms: Swollen left elbow that decreased over time. Was still somewhat swollen 4 hours later. Pt reports she experiences no pain at the swollen site

Other Meds: Amlodipine, Eliquis, Symbicort, vitamin D3, clonidine, famotidine, hydralazine, lisinopril, clpoidogrel, Lexapro, doxazosin, nitroglycerin, folic acid, meclizine, metoprolol succ, rosuvastatin

Current Illness:

ID: 1160913
Sex: F
Age: 24
State: VT

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: 4 minutes after administration of 0.3 ml of Covid-19 vaccine pt experienced audible weezes and swelling of tounge as well as itching to tounge and throat. Pt was administered .3 MG Epinephrine VIa Epi-pen auto injector to Left VL by RN @ 1510. EMS called and Pt Transferred to ED.

Other Meds:

Current Illness:

ID: 1160914
Sex: F
Age: 19
State:

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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:

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

Symptoms: Patient received first dose of COVID-19 vaccine. Within a few minutes after vaccination, patient reported feeling lightheaded with blurred vision and rapid heart rate. Patient drank some juice and sat for an additional 10 minutes; patient reported she felt better and opted to leave. Suspected vasovagal reaction.

Other Meds:

Current Illness:

ID: 1160915
Sex: F
Age: 28
State: CA

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Arm pain after shot, no other symptoms until going to sleep. Woke up with headache around 1:45am Tried to get water at 2:20am to help headache Got nauseous next to sink - feeling like throwing up while pouring water Passed out Woke up shortly after on kitchen floor Stumbled to bedroom on super weak legs (which were kinda giving in) When laying back down ringing (like static) in ear for about 1min and tingly feet and hands for about 3min Afterwards still feeling weak and having headache but no other symptoms. Awake with headache until 6am, slept 6am-7am, woke up with slight feaver, headache persisted 8:30am took daily meds, had food and water, took sumatriptan for headaches and awake until 11:30am Slept from 11:30am to 1:30pm - woke up feeling A LOT better, little to no headache left, only still feeling weak and armpain

Other Meds: Lexapro 10mg Adderall 10mg twice a day 400mg Magnesiums 200mg Riboflavin Progestin Only Birth Control 5000IU Vitamin D3

Current Illness: none

ID: 1160916
Sex: M
Age: 58
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/02/2021
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: none reported

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

Symptoms: Evaluated patient in Covid vaccine clinic after alerted that patient developed severe occipital headache about 10 minutes after his 2nd dose of Moderna Covid vaccine. He denies any history of headaches. He denies any other symptoms. No nausea, no vision changes, no numbness or weakness. No swelling, itching, rash, no shortness of breath, dizziness, or abdominal symptoms. He denies side effects from his 1st Covid vaccine. He denies a history of significant health problems and states he takes no medications. Exam revealed a middle aged male sitting comfortably in NAD. Alert and oriented x3 PERRL, no photophobia, EOMI, CNs grossly intact. RRR without murmur. Neuro exam without focal deficits. Normal gait. Patient was monitored for about 20 min at which time he felt he could safely drive himself home - 4 blocks down the road. He was instructed to take some Tylenol when he gets home and rest. Call 911 in the event of numbness, weakness, vision changes, dizziness, slurred speech or other severe symptoms. He is supposed to work and plans to call in sick so he can rest. I did mention his elevated BP which is probably isolated but he should make an appt with his PCP for a recheck of his blood pressure. Vitals BP=157/94; Sitting Temp=97.1 F Oral; Pulse=76; Resp=20; Vitals Comment: SaO2 96% 3/31/2021 2:20 PM by MD

Other Meds: none known

Current Illness: none known

ID: 1160917
Sex: M
Age: 28
State: NJ

Vax Date: 03/05/2021
Onset Date: 03/08/2021
Rec V Date: 04/02/2021
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: Constant twitching in right eye, and above left ear.

Other Meds: Sertraline, vitamin D, multi-vitamin.

Current Illness:

ID: 1160918
Sex: F
Age: 40
State: CA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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; Mushrooms; Vaccines

Symptom List: Pain in extremity

Symptoms: 12:32 (aprox) patient entered observation area 12:39 patient reported feeling dizzy; juice & crackers provided. 12:46 patient reported rash and itching to face, neck back. Mild rash noted. Moved to triage area for medical consult. Dr. responded 13:18 VS-130/74, HR 95, SpO2 97% on RA 13:19 Pt. given Zyrtec 10 mg p.o per Dr. and monitored 13:40 Rash resolved, patient without complaint; released home per Dr. 13:40

Other Meds: Singular

Current Illness:

ID: 1160919
Sex: F
Age: 65
State: MA

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

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

Lab Data:

Allergies: codeine, simvastatin, ambien, diphenhydramine hcl

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

Symptoms: throbbing arm, tiredness, clammy skin, headache, overall achy feeling

Other Meds:

Current Illness:

ID: 1160920
Sex: F
Age: 83
State: VA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/02/2021
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: 5 to 10 minutes after receiving the vaccine, said she felt nauseous and light-headed. About 5 minutes after that she slumped in her chair and began vomiting. She was non-responsive, vomiting and shaking. We called 911 and kept her upright, allowing her to vomit while waiting on ambulance. When they arrived she was still vomiting but becoming aware of her surroundings. She was taken to Hospital and given fluids and Zofran and sent home about 7pm. Today she is feeling much better.

Other Meds: Thyroid

Current Illness: None

ID: 1160921
Sex: F
Age: 71
State: MA

Vax Date: 03/21/2021
Onset Date: 03/22/2021
Rec V Date: 04/02/2021
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: Latex, Erythromycin, Shellfish, Bee Stings, Nickel, Adhesives I.E, Paper tapes, Band-Aids.

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

Symptoms: Massive headaches, overall muscle aches, weakness in left arm, minor nausea, loss of appetite. Disruption to INR.

Other Meds: Verapamil, Carvedilol, Warfarin, Extra Strength Tylenol.

Current Illness: None

ID: 1160922
Sex: M
Age: 63
State: OH

Vax Date: 03/28/2021
Onset Date: 03/29/2021
Rec V Date: 04/02/2021
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: Penicillan

Symptom List: Vomiting

Symptoms: 100 degree temp, mild chills and body aches, headache.

Other Meds:

Current Illness:

ID: 1160923
Sex: M
Age: 66
State: CA

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

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

Lab Data:

Allergies: no known allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 5 days after second Moderna Covid vaccination, patient had sudden onset severe right leg swelling and pain, found to have extensive right lower extremity DVT and bilateral pulmonary embolism

Other Meds: none

Current Illness: none

ID: 1160924
Sex: F
Age: 51
State: OH

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 04/02/2021
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: Celiac disease (gluten), several dermatitis allergies, no IgE

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

Symptoms: Immediate whole body sensation. Dissasociative feeling at leaving injection booth. Tachycardia started immediately when sitting in observation room. Observer noted rash and flushing on chest and face. Medics called. Blood pressure 182/108, heart rate 152, o2 sat 100. Taken to triage area. Had a hard time responding to questions because tongue felt thick. Airway was clear despite edema. I was taken by ambulance to to Medical Center. The paramedics wanted to administer Epi but I was hesitant since I was still able to breathe and I didn?t want to further increase blood pressure. I have a narrative to paste but the Continuation Page is not letting me input text. Please email me.

Other Meds: L-Carnitine, Alpha Lipoic Acid, CoQ10, Fish Oil, Multivitamin

Current Illness: All illnesses being managed and in remission

ID: 1160925
Sex: F
Age: 48
State: AK

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/02/2021
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: Amoxicillin.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On 3/31/21 patient was observed for 15 minutes following vaccination and reported no change to health status, so was cleared to leave the clinic area. Patient called the next day (4/1/21) to report that approximately 40 minutes following her vaccination, while driving home, she experienced sudden shortness of breath, muscle spasms, and increased heart rate. Patient reports that she pulled her car over to the side of the road, and then "blacked out". Pt does not know how long she was "out", but upon waking she vomited and called a family member for a ride home. Patient reports that when she got home, she slept for 14 hours. Woke up the next day (4/1/21) and felt sore and exhausted. Vomited a few more times throughout the day, and was on the toilet and she "saw spots" and "blacked out" again. Patient say she did not fall over or collapse. Family member observed this "black out" to last about 30 seconds. As of 4pm that day, more than 24 hours post-vaccination, she was still feeling unwell and not able to keep food down. Patient denies hives, itching, fever, congestion, swollen lips/face. Patient was advised to drink water or electrolyte-drink, rest, and call 911 or her PCP if she experienced another episode of SOB, "black out" period, prolonged vomiting, or new symptoms. Patient agreed to suggested course. Patient has no health insurance, doesn't want to come to a medical clinic for evaluation.

Other Meds: Unknown

Current Illness: None

ID: 1160926
Sex: F
Age: 19
State: WI

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/02/2021
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

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

Symptoms: fainted briefly, pallor - happened within a couple minutes of receiving vaccine. patient recovered within 10-15 minutes, sat with ice packs, had a glass of water, and a granola bar.

Other Meds: unknown

Current Illness: unknown

ID: 1160927
Sex: F
Age: 33
State: IL

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

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

Lab Data:

Allergies: N/A

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

Symptoms: I ultimately suffered from Acute Disseminated Encephalomyelitis and was hospitalized for 5 days due to brain and spine inflammation. I had numbness in my feet 2 days after my vaccine, then suffered from dizziness and nausea 3 days after my vaccine, and had face paralysis 4 days after my vaccine. I went to the ER 4 days after the vaccine and was told I have Bell's Palsy and Vertigo. I was prescribed oral steroids and anti-nausea medicine. In the following weeks, I had more tingleness/numbness of the legs, brain fog and confusion, blurred vision, unsteady gait, loss of balance, blurred vision and leg muscle weakness, increased anxiety, hearing sensitivity, lethargy, sleeplessness, 6th cranial nerve palsy, tingles in the face, and headaches. I finally got an MRI and when doctor?s saw the MRI results 3 days later, I was told to go to the ER immediately because I had brain and spine inflammation that needed treatment, and was diagnosed with ADEM. I then spent 5 days in the hospital to receive intravenous steroids and monitoring. During this stay, I had more MRIs and a lumbar puncture. I was released on oral steroids for 25 days, as well as follow up appointments and monitoring progress in recovery. Inflammation has decreased. I continue to have tingleness in lower extremities, headaches, pain in legs, and sensitive hearing.

Other Meds: Vitamin C

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm