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: 1168227
Sex: F
Age: 50
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
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: egg, flu vaccine

Symptom List: Dysphagia, Epiglottitis

Symptoms: dizzy within 15 minutes, pallor, ice pack. improved. 15 later throat felt cold and numb, took benadryl 25 mg , 10 minutes later throat swelling, hard to breath, went to ED. Gave epinephrine, decadron, 1L IVF, non-rebreather 02. Within seconds of epi, throat felt better. Normal EKG. Transferred to adult facility because again started to have a hard time breathing just prior to being discharged. Continued observation at adult ED but no other medications. Discharged home about 8 hours after vaccine administration.

Other Meds: allegra, lisinopril, hydrochlorothyazide, vitamin D

Current Illness: none

ID: 1168228
Sex: F
Age: 43
State: TX

Vax Date: 04/03/2021
Onset Date: 04/05/2021
Rec V Date: 04/05/2021
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: None known

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever, aches, chills, pain and rash on arm near injection site

Other Meds: None

Current Illness: None

ID: 1168229
Sex: F
Age: 51
State: WA

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 04/05/2021
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: Sulfites and MSG.

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

Symptoms: Fever of 102.4 to 99.5, all over body aches, mild headache, nausea and physical exhaustion for roughly 3 days.

Other Meds: None

Current Illness: None.

ID: 1168230
Sex: M
Age: 48
State: NC

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Body aches, diarrhea, nausea, headache, sweating, swelling at injection site

Other Meds: Glipizide, Metformin, Lantus

Current Illness: NA

ID: 1168231
Sex: F
Age: 38
State: PA

Vax Date: 04/01/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: depoprovera, lisinopril

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

Symptoms: headache within 15 minutes of administration, 16 hours following administration fever and chills began, 22 hours after administration a recorded temperature of 100.7 was noted, 27 hours after administration a fever of 101.1 was noted upon which 200mg ibuprofen was taken along with rest and fluids, 49 hours after administration a 99.4 degree fever was noted and 200mg ibuprofen was taken, 72 hours after administration a 99.8 degree fever was noted and 200mg ibuprofen was taken with an additional dose of 200mg ibuprofen taken at 77 hours after administration due to feeling fever-ish.

Other Meds: metformin, losartan, hydrochlorothiazide, Xyzal, montelukast

Current Illness: none

ID: 1168233
Sex: F
Age: 34
State: OK

Vax Date: 03/25/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin Tramadol Toradol

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

Symptoms: Fever 103 3/27, stomach pain, vomiting, diarrhea, headache, chest pain, SOB Hospital 3/29, critically low potassium, D-Dimer elevated, chest CT clear, admitted 3/30 HIDA scan, gallbladder removed 3/31 woke with vision issues, seeing multiples of things, slanted hallways, can?t stay awake 4/1 CT and MRI of brain show venous blood clot Started on blood thinners, stopped birth control (had only been on birth control about 5-6 months)

Other Meds: Potassium citrate Tums Levothyroxine Trilessa Zoloft

Current Illness: None

ID: 1168234
Sex: F
Age: 28
State: MO

Vax Date: 03/24/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: Kiwi, possibly scallops

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Swelling at injection site, itching, redness, lump.

Other Meds: Birth control

Current Illness: No

ID: 1168235
Sex: M
Age: 65
State: MD

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Amantadine

Symptom List: Pharyngeal swelling

Symptoms: Pain and persistent tingling throughout arm and hand after first and second dose of vaccine. The tingling in my left arm and hand persisted after the first dose, and increased after the second dose. The tingling in my arm has persisted for 4 weeks now. The tingling has not inhibited my normal activities. Even though I had the second dose in my right arm, the pain and tingling was in my left arm where I had the first dose, and first observed the persistent tingling.

Other Meds: None

Current Illness: None

ID: 1168236
Sex: M
Age: 49
State: NY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: Swelling and mild tenderness of lower left axilla; possible lymph node; developed the day after the vaccine which patient states was "injected roughly". Pt describes swelling into left chest; was seen in the ER on 4/3-4/3/21, and seen via video visit with me on 4/5/21.

Other Meds: aspirin, atorvastatin, lisinopril, metoprolol, nifedipine, pregabalin, tamsulosin, tapentadol

Current Illness: none

ID: 1168237
Sex: M
Age: 57
State: NY

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: doxycycline

Symptom List: Diarrhoea, Nasal congestion

Symptoms: shivering/shaking chills, fever as high as 100.4, body aches, fatigue, disrupted sleep

Other Meds: synthyroid, famotidine, omeprazole, sertraline, trelegy, centrum silver, vitamin C, vitamin D3

Current Illness: none

ID: 1168238
Sex: F
Age: 30
State: OR

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Excruciating pain on the arm the vaccine was administered from shoulder to wrist. Was unable to use a for nearly 24 hours due to extreme pain

Other Meds: None

Current Illness: None

ID: 1168239
Sex: F
Age: 71
State: FL

Vax Date: 03/27/2021
Onset Date: 03/30/2021
Rec V Date: 04/05/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: I had ligament repair surgery on my right ankle on 01/06/2021. My recovery was going well. I was walking well without pain and was gaining balance and strength with physical therapy. I had almost no discomfort at the site of my surgery. Three days after having my J&J vaccination I woke up to a lot of discomfort in my right ankle, making it difficult for me to walk as I had been able to walk. I have struggled over the last six days to get back to the mobility I had prior to getting my J&J vaccination. I spoke with representative from my orthopedic surgeon?s office this morning who confirmed that I am most likely suffering from the side effects of the J&J vaccination, and she suggested that my lack of normal mobility will most likely last another week.

Other Meds: l-thyroxine, Asmanex HFA, Allegra, B-Complex, black elderberry, calcium, vit C, vitamin D3, glucosamine, vitamin K2-Mk7, krill oil, L-lysine, magnesium, probiotics, resveratrol. Selenium, zinc

Current Illness: Recovering from ligament repair surgery on my right ankle

Date Died: 03/23/2021

ID: 1168240
Sex: M
Age: 50
State: MO

Vax Date: 03/18/2021
Onset Date: 03/23/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient deceased 3/23/21 due to suicide.

Other Meds:

Current Illness:

ID: 1168241
Sex: M
Age: 17
State: NY

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 04/05/2021
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: Unknown

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

Symptoms: Patient was 17 years of age when vaccine was administered. Vaccine approved for 18 years of age and older. Patient did not experience any adverse reactions.

Other Meds: Unknown

Current Illness: Unknown

ID: 1168242
Sex: F
Age: 60
State: CO

Vax Date: 04/01/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: nuts , soy

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

Symptoms: soreness extreme dizziness 4 days after with vomiting , unable to keep food down. headaches still vomiting second day with no fever but on and off chills

Other Meds: glipizide, simvastatin, lozinipro vitamin D

Current Illness: one incident of suspected food allergy one month prior

ID: 1168243
Sex: M
Age: 63
State: NC

Vax Date: 03/22/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Tramasol only

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

Symptoms: 30 minutes after Vaccine developed fatigue that persisted until hospital admission as below. 9 days after Vaccine developed acute onset nausea with vomiting and diarrhea. The following day developed abdominal pain. Ultimately 11 days after admission was admitted to the hospital with acute pancreatitis with workup neg for any other etiology or reason.

Other Meds: ASA, HCTZ, Lisinopril, Plavix, Crestor, metformin, lopressor

Current Illness: none

ID: 1168244
Sex: F
Age: 37
State: MO

Vax Date: 03/20/2021
Onset Date: 03/25/2021
Rec V Date: 04/05/2021
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: Day of: Sore Arm, tingling sensation on left side of face and arm Next day: Fatigue, head aches Day 3-5: headache front and back of head, behind left ear. Face muscles twitching. Fatigue Day 7: Facial paralysis, low fever (99.1), elevated blood pressure

Other Meds: Levothyroxine Zyrtec

Current Illness: n/a

ID: 1168245
Sex: F
Age: 73
State: CA

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Kettamine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Nose bleeds, daily. 2-3 minutes, apply pressure to stop. Pain at injection site, lasted 3 days.

Other Meds: Paxil, Wellbutrin, Imodium, Latuda, Lamotrigine, Levothyroxine, Maxzide, Quetiapine, Rosuvastatin

Current Illness:

ID: 1168246
Sex: F
Age: 53
State: FL

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: asprin and penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: At 1:00 I started with severe chills and then began throwing up. Had chills and nausea for the next 24 hours with vomitting thru out. Also have fluid in clavicle area which maybe inflammation from vaccine injection, not sure.

Other Meds: Cosentyx - for psoriasis

Current Illness: none

ID: 1168247
Sex: F
Age: 49
State: MI

Vax Date: 02/02/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Tested Positive for Covid-19 on 4-1-2021. She was having cold/allergy type symptoms.

Other Meds: Calcium, Zinc

Current Illness: None

ID: 1168248
Sex: M
Age: 20
State: GA

Vax Date: 03/26/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Swelling, hotness, redness of injection site. In a triangle almost, put Bendaryl gel on it overnight and nothing changed.

Other Meds: None

Current Illness: None

ID: 1168249
Sex: M
Age: 78
State: CT

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Contrast Dye

Symptom List: Unevaluable event

Symptoms: Shingles eruption left arm 24 hours after 2nd vaccine

Other Meds: Aspirin, Atorvastatin, Bystolic, CoQ10, Enalapril, Eplerenone, Finasteride, Fish oil, Procardia, Sertraline, Tamsulosin, Vitamin B, Vitamin D

Current Illness: Covid vaccine #1 2/23/2021

ID: 1168250
Sex: M
Age: 44
State:

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/05/2021
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:

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

Symptoms: Left hand felt cold ~5 mins after the injection

Other Meds: Crestor, Vitamin D

Current Illness:

ID: 1168251
Sex: M
Age: 48
State: TN

Vax Date: 04/02/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: Felt really tired for two days. Arm hurt.

Other Meds: Paint at injection site. Fatigue.

Current Illness:

ID: 1168252
Sex: M
Age: 46
State: NY

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Pine nuts

Symptom List: Injection site pain, Menorrhagia

Symptoms: PT became dizzy and had a seizure like response with LOC and tonic/clonic activity only lasting 2-3 seconds. PT spontaneously woke up and was mildly confused. BP 143/93 other vitals stable

Other Meds: Atenolol

Current Illness:

ID: 1168253
Sex: M
Age: 75
State: MI

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 04/05/2021
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: Patient had an allergic reaction. Onsite EMS was called vitals HR 100 BP 134/80 99% O2. Patient refused evaluation or care. Released against medical advise.

Other Meds:

Current Illness:

Date Died: 04/01/2021

ID: 1168254
Sex: F
Age: 83
State: IA

Vax Date: 03/25/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was given vaccine on 03/25/21. On 04/01/21 patient found in yard and brought to ER, then transferred via air to ER. Patient had concussion due to fall, pneumothorax, and PEA episode. Chest tube placed in the ER, Comfort cares then administered per family request with patient passing that day.

Other Meds: MVI daily, Calrate twice daily, Ventolin Hfa 2 puff every 4 hours as needed, Irvesartan 150mg tablet daily, Simvastatin 40mg daily, Levothyroxine 88mcg daily, Vitamin D3 daily, Prolia 60mg every 6 months, Spiriva daily, omeprazole 20mg dail

Current Illness: COPD severe, oxygen dependent, hypoxia, fall, PEA episode, pneumothorax, subcutaneous emphysema, and edema

ID: 1168255
Sex: F
Age: 21
State: CO

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
Hospital: Y

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

Lab Data:

Allergies: Ciprofloxacin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Hospitalization with pneumonia and E coli sepsis on 4/2/2021 Symptoms started with sore arm on 3/30/2021. Patient called healthcare provider on 3/31/2021 because patient developed headache, myalgias, fatigue, fever to 100. On 4/2/2021, patient presented to ER and admitted to hospital with fever, chills, shortness of breath, productive cough, labored breathing. CXR showed left upper lobe pneumonia and small pleural effusion. Blood culture subsequently grew E. coli. Work up for source of E. coli is ongoing including CT scan due to patient's history of rectal inflammation and presacral abscess several months back.

Other Meds: Sirolimus, Sertraline, Famotidine, Atorvastatin, Aspirin

Current Illness: Tooth extraction 2/24/2021

ID: 1168256
Sex: F
Age: 32
State: PA

Vax Date: 04/02/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: Bactrim & Diflucan (Steven-Johnson Syndrome reaction); Ceclor (mild rash reaction)

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

Symptoms: Approximately 42 hours after receiving my second vaccination, felt tenderness, soreness and inflammation at both the injection site on my arm, and swelling/tenderness in the lymph nodes under my armpit.

Other Meds: Generic form of Yaz birth control pills, daily women's probiotic

Current Illness: None

ID: 1168257
Sex: F
Age: 50
State: PA

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 04/05/2021
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: chills; extreme body aches fever up to 101

Other Meds: Insulin Plavix Zoloft Linsiprol

Current Illness: None

ID: 1168258
Sex: F
Age: 56
State: MN

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: Injection site pain

Symptoms: Due to patient severe anxiety, she received her injection and monitoring in her car outside of the facility. When vaccine was documented into her medical record, it was found that the patient came one week early. Contacted patient 4/5/21 to inform of the med error. Patient states she has been having increased panic attacks since Saturday. Has appointment scheduled with her primary provider today.

Other Meds:

Current Illness:

ID: 1168259
Sex: F
Age: 30
State: NC

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: The day of the vaccine I was very tired. The next day I had muscle pain, 100 degree fever and my skin felt very sensitive. light touch caused small amount of pain at surface level

Other Meds: none

Current Illness: a cold (two negative covid tests)

ID: 1168260
Sex: F
Age: 67
State: MD

Vax Date: 03/17/2021
Onset Date: 03/24/2021
Rec V Date: 04/05/2021
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: None

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

Symptoms: Arm at injection sight started to itch. Ended up looking like hives. Next morning hives were gone and just a red flat spot at sight. Slightly warm to the touch. 3 days later it was gone. No fever, headache or any other symptons. Just red spot.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1168261
Sex: F
Age: 21
State: TX

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 04/05/2021
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: Unknown

Symptom List: Tremor

Symptoms: 21 year old female stated that she felt lightheaded after taken the vaccination. Patient stated that she gets light headed when she gets vaccinations. Vital signs was taken at 10AM BP 138/60 HR 78 RR16. Patient was in observation for 30 minutes. 1030AM vital signs was taken before leaving BP 118/67 HR 81, RR16, Patient stated that she feels good.

Other Meds: Unknown

Current Illness: Unknown

ID: 1168262
Sex: F
Age: 23
State: WI

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/05/2021
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: not provided on consent form

Symptom List: Erythema, Pruritus

Symptoms: While pushing the syringe plunger to administer vaccine into the patient's deltoid, some vaccine sprayed out at the point where the needle inserts into the hub. Upon inspection, the hub was attached tightly to the syringe, however the needle was loose in its seat on the hub. A second dose was not administered. Patient was informed that she will be notified if an additional dose would need to be administered.

Other Meds: not provided on consent form

Current Illness: not provided on consent form

ID: 1168263
Sex: M
Age: 42
State: AZ

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 04/05/2021
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: Sulfa

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

Symptoms: A few days after receiving my second dose of Moderna, I began having very loud tinnitus in both ears that has not subsided.

Other Meds: Multi vitamin Fish oil Probiotic Vitamin D

Current Illness: none

ID: 1168264
Sex: M
Age: 34
State: CA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/05/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Patient reported feeling hot and dizzy brought to the EMS room for observation. Doctor at bedside. patient denies chest pain shortness of breath or nausea. Vitals taken, blood sugar 103. Patient given some apple juice and discharged in no distress @ 8:50am.

Other Meds: none

Current Illness: none

ID: 1168265
Sex: F
Age: 59
State: MI

Vax Date: 03/29/2021
Onset Date: 03/29/2021
Rec V Date: 04/05/2021
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, codeine, sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 25 minutes Post injection: Left eye issues. Itchy, swollen behind the eye and feeling like something was in it or irritating it. It kept driving me to check if something was in it. I put in renu eye drops and did not think any more of it. 40 minutes post injection: both feet red and swollen left foot about half of the top, the whole right foot looked like a giant hive or welted area across the whole top of foot. The injection site began being quite sore, and it also looked welted and felt hot to the touch. I kept checking my left rib cage and my left thumb as I was sure there was going to be hives, because I could not stop rubbing or scratching them as they itched so badly. I continued itching and feeling weird tingly sensations and either rubbed or scratched these areas to no avail. Even my head itched terribly by the second day. 45 minutes post injection: Tightness and scratchiness in throat appeared and my throat was sore, my voice began going out and my voice got hoarse. There was about a two inch area of my throat in which I felt I needed to keep trying to clear something that was stuck. (This made no sense to me as I was able to drink water without any issues.) I had a slight cough every time I stopped drinking, so I continually drank water while I was not trying to sleep. My chest was tight, but because I have asthma I took albuterol and thought nothing of it. (This really did not help, but I did not get worse either.) About an hour after the shot, I constantly felt on the verge of shaking, much like when you have a fever, but I did not think to check my temperature until the following morning when I was extremely tired, felt like I had a sinus headache and possibly did have a fever. My temperature was 99.4 degrees farenheight. At this point, I felt very flu-ish and achy. My armpit area hurt a lot and I chewed two aspirin. I experienced wheeziness, chest tightness, and hoarseness the second and third day as well. I had the morning congestion and stuffiness as well as the need to keep clearing my voice still as of this morning but to much less degree as the initial onset. The skin itchiness is still ongoing, but to a much lesser degree than previously had.

Other Meds: Flovent 110, Vitamin D 2 50,000 IU's weekly, Albuterol, and Estradiol 0.05 mg daily / twice weekly.

Current Illness: None known

ID: 1168266
Sex: F
Age: 60
State: VA

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 04/05/2021
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: N/A

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

Symptoms: Morning of April 4th: Nauseous, Fever (100 F), High Blood Sugars -Took 2 Tylenol pills - Felt better early afternoon Late Afternoon April 4th: Dizzy, Nauseous, Light Headed, Collapsed and was unconscious for 2ish minutes - Called 911 -> Medics ran heart and bp tests which were all normal and did not consent to go to hospital Evening April 4th: Chills, Fever spiked to 100F, Nauseous, Light headed -Took 2 Tylenol pills - Did not take Ciprofloxacin evening dose Morning April 5th: Fever hovering around 100F, more color in face and up and moving around -Reported incident to doctor & pharmacist where Ciprofloxacin came from - Pharmacist contact information

Other Meds: Humalog, Ciprofloxacin, Vitamin. C (250 mg), Bayer Aspirin (81 mg),Vitamin D3(25 mcg), Atorvastatin Calcium (10 mg)

Current Illness: N/A

ID: 1168267
Sex: M
Age: 44
State:

Vax Date: 03/26/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: 3 inch diameter red rash at injection site. Lasted 3-4 days.

Other Meds: Crestor, Vitamin D

Current Illness:

ID: 1168268
Sex: F
Age: 48
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: Tetracycline

Symptom List: Pain in extremity

Symptoms: Moderna COVID-19 vaccine EUA I had a fever of 101.2 by 3/3:30pm and then it was 102.0 by 4:30pm and sustained at that level until around 1am. The fever was accompanied by chills that felt like the neuropathy you can have with Shingles - meaning my skin felt sensitive to the touch. It was not like normal flu muscle aches. My whole body felt like it was made of lead or concrete and I was just lethargic. It is curious that in hind sight the chills were not accompanied by any sweating. The chills and fever stopped about the same time (1am), but the fatigue carried on for a couple days. Additionally, my left arm where I had the injection was very painful and my range of motion was limited by the pain for probably 36 hours. 72 hours later the muscle is still sore, but the range of motion is fine. Further, on April 4th I experienced nausea with the beginning of my period which is not a normal menstrual symptom for me to have and the nausea has continued on to April 5th.

Other Meds: Multi vitamin, Vitamin C, and Fish Oil - taken at dinner two nights before 15ml NyQuil taken at 9pm the night before

Current Illness: Some nasal congestion, drainage, sore throat, and cough related to seasonal pollen allergies

ID: 1168269
Sex: M
Age: 65
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Received second dose Pfizer Covid-19 vaccination on day 16. First dose was given March 17, 2021 and would be due for second dose after April 7th. April 2, 2021 falls out of the 4 day early grace period.

Other Meds:

Current Illness: Received second dose Pfizer Covid-19 vaccination on day 16. First dose was given March 17, 2021 and would be due for second dose after April 7th. April 2, 2021 falls out of the 4 day early grace period.

ID: 1168270
Sex: F
Age: 52
State: CA

Vax Date: 03/23/2021
Onset Date: 03/30/2021
Rec V Date: 04/05/2021
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: Felt fine after vaccine - no effects at all. Then a week and a day later, my arm was swollen and red and itchy. It lasted for 2 days.

Other Meds: I am on Synthroid for my thyroid and take Vitamin E and Calcium most days.

Current Illness: none

ID: 1168271
Sex: F
Age: 64
State: TN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: Moderna COVID-19 Vaccine EUA

Other Meds: generic claratin, estradiol, sertraline

Current Illness: none

ID: 1168272
Sex: F
Age: 61
State: NC

Vax Date: 03/22/2021
Onset Date: 04/05/2021
Rec V Date: 04/05/2021
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: None

Symptom List: Vomiting

Symptoms: Circular rash on left arm at vaccine site. First noticed morning of Day 14 since shot. Did not sleep well prior night. No pain or itching at site so far.

Other Meds: Vitamin D3, B12, Algae Omega

Current Illness: None

ID: 1168273
Sex: F
Age: 19
State: WI

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/05/2021
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: none listed

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Approximately 15 minutes after receiving her vaccine, patient reported feeling "light headed". When I was called to help her, she had fainted. She was able to slowly respond to us and was breathing. We placed her on the floor laying on her side. A cold compress was placed on the back of her neck and a pillow was placed under her head. 9-1-1 was called. When EMS responded, she had normal blood pressure and blood sugar, but was still feeling "out of it". She was place on a stretcher and taken to the ambulance, but did not get transported. She had a family member pick her up from the clinic. She was able to walk from the ambulance to the car on her own.

Other Meds: unknown

Current Illness: unknown

ID: 1168274
Sex: M
Age: 68
State: KY

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 04/05/2021
Hospital: Y

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

Symptoms: About 24 hours after the vaccine administration, he became unresponsive at the nursing home. He was sent to the hospital where he is now on a heparin drip due to bilateral Pulmonary Embolisms and multiple DVTs.

Other Meds: Aspirin 81mg QD, Atorvastatin 80mg QD, Carvedilol 12.5mg BID, Clopidogrel 75mg QD. Fluoxetine 40mg QD , Furosemide 20mg QD, Gabapentin 300mt TID, Isosorbide Mononitrate ER 60mg QD, LIdoderm 5% patch on 12 hours off 12 hours Lisinopril 40m

Current Illness: M54.5 Low back pain (Primary / Admission) R27.0 Ataxia, unspecified I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris I69.30 Unspecified sequelae of cerebral infarction G30.9 Alzheimer's disease, unspecified E04.9 Nontoxic goiter, unspecified E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified F03.90 Unspecified dementia without behavioral disturbance M19.90 Unspecified osteoarthritis, unspecified site M51.36 Other intervertebral disc degeneration, lumbar region N28.1 Cyst of kidney, acquired N40.0 Benign prostatic hyperplasia without lower urinary tract symptoms R51.9 Headache, unspecified Z20.822 Contact with and (suspected) exposure to COVID-19 Z95.5 Presence of coronary angioplasty implant and graft W19.XXXD Unspecified fall, subsequent encounter

ID: 1168275
Sex: F
Age: 17
State: WI

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 04/05/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Client was only 17 years old when she received single dose Janssen. Client and parent notified. No adverse sided affects noted per parent.

Other Meds:

Current Illness:

ID: 1168276
Sex: M
Age: 38
State: MN

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: FAINTING AFTER RECEIVING DOSE OF PFIZER OCCURRED IMMEDIATELY AFTER ADMINSTRATION, PATIENT PASSED OUT IN CHAIR. THEN WAS MOVED TO THE FLOOR IN A PRONE POSITION WITH LEGS ELEVATED FOR 5-10 MIN. THEN MOVED TO SITTING POSITION WHERE HE PASSED OUT AGAIN. WE MOVED HIM BACK TO PRONE POSITION WHEN THE PARAMEDICS ARRIVED WE MOVED HIM TO A CHAIR WHERE HE PASSED OUT FOR A THIRD TIME. PATIENT DID REPORT SEVERE ANXIETY WITH VACCINATIONS AND HAPPENED TO PASS OUT WITH THE FIRST SHOT BUT DID NOT REPORT THIS TO THE PHARMACIST ADMINISTERING OR ON THE CONSENT FORM.

Other Meds: LISINOPRIL/HCTZ, HYDROXYZINE, FLUOXETINE

Current Illness: HIGH BLOOD PRESSURE

ID: 1168278
Sex: F
Age: 61
State: CA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: n/a

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

Symptoms: Fever: 101 degrees injection site soreness, redness, swelling and hot

Other Meds: Oracea Arnuity Citrical

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm