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: 1169635
Sex: M
Age: 17
State: WI

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

Lab Data:

Allergies: Unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient passed out, complained of being lightheaded and having loss of vision post 2nd COVID-109 vaccine. EMS was called. EMS evaluated patient and recommended going to the hospital for observation. Patient's father denied transfer to hospital and patient left with father to go home.

Other Meds: Unknown

Current Illness: Unknown

ID: 1169636
Sex: F
Age: 74
State: IL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Filing this report due to an administration error not associated with an adverse event. Employee was administered second dose earlier than the recommended timeframe. First dose administered 2/26 and second dose administered 3/25. Employee has not had a physical adverse reaction, and no treatment has been sought.

Other Meds:

Current Illness:

ID: 1169637
Sex: F
Age: 34
State: MA

Vax Date: 04/04/2021
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: none

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

Symptoms: Chills, body ache, headache. Treated with Tylenol 2x, chills relieved, headache and body ache lessened.

Other Meds: None

Current Illness: None

ID: 1169638
Sex: F
Age: 48
State: TX

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt called event coordinator that they were experiencing symptoms 3 hours post vaccination. Complaint of shoulder pain radiating to neck area, difficulty breathing, sharp chest pain, lightheaded. Patient stated that she had lunch after vaccination. Complained of "tightness" in neck area. Spoke to patient on phone and assessed as much as possible. When patient mentioned difficulty of breathing, patient was advised to go to ER. Patient stated she was on the way. At ER, EKG was done and patient was awaiting to be seen. Chest xray was done. BP was lower than usual and blood sugar "spiked up" - 340s according to patient. ER hydrated patient and blood sugar resolved to 140s. 04/05 Patient was checked on. She has fully recovered.

Other Meds: Levothyroxine, Novolog, Trulicity

Current Illness: none

ID: 1169639
Sex: F
Age: 38
State: CA

Vax Date: 04/02/2021
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: Penicillin/amoxicillin

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

Symptoms: Itchy/painful rash developed on back of left arm into armpit and down to mid side.

Other Meds: n/a

Current Illness: n/n

ID: 1169640
Sex: F
Age: 69
State: PA

Vax Date: 03/27/2021
Onset Date: 04/05/2021
Rec V Date: 04/05/2021
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: bee stings - butalbital-acetaminophen-caff - butalbital-aspirin-caffeine - celecoxib - gabapentin - tizanidine - topiramate - ziprasidone - axert [almotriptan malate] - clindamycin - geodon [ziprasidone hcl] - imitrex [sumatriptan] - metronidazole - penicillins - prochlorperazine - protonix [pantoprazole] - sertraline hcl - iodine and iodide containing products - contrast-ct

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

Symptoms: arm got red at the shot site and down arm big red patches to elbow. Got shot March 27 2021 and seen the red circle at shot site one March 31, 2021 on right arm.

Other Meds: pepcid ac, fish oil, one a day multivitamin/multimineral supplement 50+, meta mucil psyllium fiber supplement, d3, bayer chewable aspirin

Current Illness: none

ID: 1169641
Sex: M
Age: 50
State: SC

Vax Date: 04/04/2021
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: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Chills Fever (aspirin ever 4 hours) Muscle pain at injection site

Other Meds: Lipitor 10MG, Wellbutrin 150MG

Current Illness: None

ID: 1169642
Sex: F
Age: 57
State: TX

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: EES

Symptom List: Pharyngeal swelling

Symptoms: Dizziness, headache, nausea and tightening of the chest

Other Meds: Metropolol, naproxen

Current Illness: Broken wrist

ID: 1169643
Sex: F
Age: 40
State: MS

Vax Date: 02/23/2021
Onset Date: 02/23/2021
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: unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Client reported that she felt a "Charlie horse" in the muscle near her wrist on left arm. Client stated she felt "something " run down her arm when she rec'd her vaccine. Vital signs BP= 102/70 HR 81 R: 24: No complaint SOB or difficulty breathing. No visible injury to left arm or rash. Waited 75 6B 15 minute in parking lot.

Other Meds: unknown

Current Illness: unknown

ID: 1169644
Sex: M
Age: 18
State: WA

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient was administered Moderna as second dose in series instead of Pfizer. Discussed current CDC recommendations regarding mixed dose series and that repeating dose not needed however mixed series are not recommended

Other Meds:

Current Illness:

ID: 1169645
Sex: F
Age: 51
State: OH

Vax Date: 03/16/2021
Onset Date: 03/18/2021
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: NKA

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

Symptoms: The day of the vaccination, I felt a little woozy and tired; went to bed early, woke up the next morning feeling much better. But about two days later, I began feeling a slight vestibular disturbance. I wouldn't say I was nauseated, but I felt a little dizzy every time I turned my head, changed position, or breathed in. This was not debilitating, but also definitely wasn't normal. It lasted for about 10-12 days before beginning to get better, and now I feel completely fine. I didn't do anything to treat it except to exercise less (for fear of falling while running) and sleep a little more. I wasn't ill at any time during this period, had changed nothing else in my routine, and had no other symptoms. I'm assuming this event must have been related to the vaccine.

Other Meds: Propanalol (30 mg/day); Escitalopram (20 mg/day); Lo-Loestrin (1 tablet per day); multivitamins

Current Illness: None

ID: 1169646
Sex: F
Age: 44
State: GA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Client received Pfizer for first vaccine and Moderna for second vaccine dose.

Other Meds: unsure

Current Illness: unknown

ID: 1169647
Sex: M
Age: 30
State: OH

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: LA

Lab Data:

Allergies: NKDA

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

Symptoms: PT felt faint and lightheaded appox 5-10 minutes after vaccination. Lied down for approx 8 minutes and symptoms resolved.

Other Meds: N/A

Current Illness: N/A

ID: 1169648
Sex: F
Age: 51
State: TX

Vax Date: 03/25/2021
Onset Date: 03/27/2021
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: Pennicilian

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

Symptoms: Extreme pain and tightness on right side, back of head, back of neck, and right shoulder. Could not turn head to the right nor look up. Lasted 9 days.

Other Meds: Progesterone, DIM, Thyroid

Current Illness: n/a

ID: 1169649
Sex: F
Age: 46
State: IL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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:

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

Symptoms: Filing this report due to an administration error not associated with an adverse event. Employee was administered second dose earlier than the recommended timeframe. First dose administered 2/26 and second dose administered 3/25. Employee has not had a physical adverse reaction, and no treatment has been sought.

Other Meds:

Current Illness:

Date Died: 03/16/2021

ID: 1169650
Sex: M
Age: 46
State: TN

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 04/05/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: DIFFICULTY BREATHING, SEVERE CHEST PAIN, STOMACH ACHE, HEADACHE, JOINT PAIN WENT TO EMERGENCY ROOM THAT EVENING ON 3/15/2021 WENT TO BED WITH CHEST PAIN AND DID NOT WAKE UP THE NEXT MORNING PARAMEDICS WERE UNABLE TO REVIVE HIM, PRONOUNCED HIM DEAD AT THE SCENE.

Other Meds: INSULIN

Current Illness: NONE

ID: 1169651
Sex: M
Age: 55
State: IN

Vax Date: 04/03/2021
Onset Date: 04/03/2021
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: Wheat

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

Symptoms: Headache, low fever and diarrhea that lasted 36 hours

Other Meds: Chlorthalidone 50mg a day

Current Illness: None

ID: 1169652
Sex: M
Age: 29
State: IA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient experienced episode of syncope

Other Meds:

Current Illness:

ID: 1169653
Sex: F
Age: 42
State: NC

Vax Date: 04/03/2021
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: Dust, mold, cat dander

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Injection site pain (48+ hours & ongoing), tiredness (24 hrs), headache (24 hrs), muscle pain (30 hrs), joint pain (30 hrs), chills (12 hrs), fever (4-8 hrs), nausea (20 hrs)

Other Meds: Escitalopram, Clonidine HCL, Amlodipine Besylate, Low-Dose Aspirin, Daily Multivitamin, Metamucil capsule,

Current Illness:

ID: 1169654
Sex: M
Age: 44
State: NY

Vax Date: 03/23/2021
Onset Date: 03/24/2021
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:

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

Symptoms: Starts at 12 hour mark then I get fevers, then cold chills and then vomiting

Other Meds: Lexapro, losartan

Current Illness:

ID: 1169655
Sex: F
Age: 37
State: TX

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin - rash, Codeine - nausea

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

Symptoms: 4-inch by 2.5 inch red rash and soreness on injection site.

Other Meds: Pantoprazole 20mg

Current Illness: none

ID: 1169656
Sex: F
Age: 30
State: NY

Vax Date: 03/30/2021
Onset Date: 03/30/2021
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: Macrobid Latex

Symptom List: Unevaluable event

Symptoms: Moderna COVID-19 Vaccine Muscle aches (full body)- 9pm 3/30-4/1 Injection site pain (unable to lift arm or move outward more than roughly 30 degrees without severe pain)- 4pm 3/30, 24-36 hours Fever of 100.4, full body uncontrollable chills, sweating: 3 am 3/31- 9pm 3/31 (slept 19ish hours from night of 3/30 until 9:00 3/31, VERY unusual for me, and had nightmares) Only woke up a couple times long enough to take dog out briefly & go to bathroom. Had severe pain in upper body while trying to get out of bed or move around even slightly. Headache: 3/31 9pm- all day 4/1 Treatment: Tylenol (500mg) for fever but also helped pain beginning 3/31 3am through all day 4/1; heating pad for upper body cramps, water as able. Sleep.

Other Meds: Clonazepam, .5 mg twice daily Sertaline 100mg once daily Oxybutnin 5mg once daily Gabapentin 100mg twice daily

Current Illness: N/A

ID: 1169657
Sex: F
Age:
State:

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: Severe full-body ache 8 hours, headache 20 hours

Other Meds:

Current Illness:

ID: 1169658
Sex: M
Age: 77
State: OH

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

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Pt ingested a single martini two hours after injection . He loss conciousness for several hours. When he awakended he was confused , speech was slurred and appeared severely intoxicated

Other Meds: janumet , jardiance,atorvastatin and Meta MX

Current Illness: diabetes

ID: 1169659
Sex: F
Age: 40
State: FL

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: Penicillin, amoxicillin, bactrim, tamiflu

Symptom List: Injection site pain, Menorrhagia

Symptoms: Dizziness, tingling and itchy skin, swelling and tingling of lips and tongue, slight throat swelling. Treated at home with 50 mg Benadryl every 6 hours, Pepcid, and Predinsonl (steroid pack).

Other Meds:

Current Illness: Sinus infection (2 weeks prior)

ID: 1169661
Sex: M
Age: 53
State: AR

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

Lab Data:

Allergies: NONE

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

Symptoms: a few minutes after receiving the vaccine, the patient became flush and lightheaded. He was lowered to the floor where he never went unconscience, but did get very pale and sweaty. His blood pressure was low at 99/60. He reported he had not eaten. He was given glucose tabs and after 15 minutes began to feel better. he drank water and was observed for 30 minutes. He did not report this had happened previously, but did say he did not like needles or blood.

Other Meds:

Current Illness: NONE

ID: 1169662
Sex: M
Age: 57
State: IL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Filing this report due to an administration error not associated with an adverse event. Employee was administered second dose earlier than the recommended timeframe. First dose administered 2/26 and second dose administered 3/25. Employee has not had a physical adverse reaction, and no treatment has been sought.

Other Meds:

Current Illness:

ID: 1169663
Sex: F
Age: 38
State: SC

Vax Date: 03/23/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Positive Covid-19 Test on 4/5/21 with symptoms after vaccination on 3/23/21

Other Meds:

Current Illness:

ID: 1169664
Sex: F
Age: 58
State: MN

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: Doxycycline, Codeine, Oxycodone, Toradol, Reglan, Topical Iodine.

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

Symptoms: Janssen COVID-19 Vaccine EUA. Seven hours post-injection was dizzy. A half-hour later started chills, shaking, back ache, thigh ache. By 10 hours post-injection also had headache and fever of 101.0. Took 1 Tylenol 500mg. By 11 hours post-injection the headache progressed to migraine. Took 1 OTC migraine pill (like Excedrin Migraine). By 12.5 hours post injection, fever reduced to 99.3 and headache improving, however nausea started. Through-out the day, nausea and mild migraine continued. They were mostly resolved by 24 hours post-injection.

Other Meds: Supplements: Ocuvite Adult 50+, MacuHealth

Current Illness: Lower back ache.

ID: 1169665
Sex: M
Age: 72
State: FL

Vax Date: 03/04/2021
Onset Date: 03/07/2021
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: No

Symptom List: Nausea

Symptoms: Immune complex mediated Purpuric dermatitis to bilateral lower legs Reaction to COVID Pfizer vaccine 3/4/2021 Resolved with steroids Patient was advised to NOT get the second dose of the vaccine.

Other Meds: Patient reported taking the following meds: Warfarin Sodium 7.5 MG tabs once a day Lisinopril 10 MG tabs once a day Digoxin 0.25 MG/ML Inj Solution once a day Norvasc 5 MG tabs once a day Bisoprolol Fumarate 10 MG tabs once a day

Current Illness: Medical history of A-fib, hypertension, and abdominal aortic aneurism (treated with EVAR in 2017).

ID: 1169666
Sex: M
Age: 69
State: WA

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient was administered Moderna as second dose in series instead of Pfizer. Discussed current CDC guidelines recommend against mixed series but no repeat dose is recommended at this time. Provided correct documentation on vaccine card re: 1st dose Pfizer and 2nd dose Moderna

Other Meds:

Current Illness:

ID: 1169667
Sex: F
Age: 27
State:

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: LA

Lab Data:

Allergies:

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

Symptoms: diaphoretic, dizzy, presyncopal, waited additional 15 minutes, pt. left site

Other Meds:

Current Illness:

ID: 1169668
Sex: F
Age: 42
State: MS

Vax Date: 02/22/2021
Onset Date: 02/22/2021
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:

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

Symptoms: Medication Erroe: First Dose was Moderna. Second dose was Pfizer. No Adverse Reaction Noted or Reported

Other Meds:

Current Illness:

ID: 1169669
Sex: F
Age: 37
State: IL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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:

Symptom List: Tremor

Symptoms: Filing this report due to an administration error not associated with an adverse event. Employee was administered second dose earlier than the recommended timeframe. First dose administered 2/26 and second dose administered 3/25. Employee has not had a physical adverse reaction, and no treatment has been sought.

Other Meds:

Current Illness:

ID: 1169670
Sex: F
Age: 40
State: IA

Vax Date: 03/24/2021
Onset Date: 03/25/2021
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: allergy to doxycycline hyclate, biaxin, some amoxicillins, vicodin, aspergillis mold

Symptom List: Erythema, Pruritus

Symptoms: Day of, only slight tenderness at injection site. Neck soreness starting Day 2, lasting for about one week. Also on Day 2, swelling and redness at injection site that has remained and increased to present day - it is now a 2-inch red square that has become almost purple over the last 11 days. Sometimes it is mildly itchy, but otherwise no pain.

Other Meds: levothyroxine, valacyclovir, citirizine, montelukast - all dauly; immunotherapy (allergy shots - not within one week of vaccination)

Current Illness: none

ID: 1169671
Sex: F
Age: 46
State: GA

Vax Date: 03/24/2021
Onset Date: 03/31/2021
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: None known

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

Symptoms: Below shot site a small knot formed under the skin exactly 2 weeks following first dose. On day 15, site became reddened and raised (appearance similar to hives). Raised area was about the size of a quarter on day 15. It has progressed to about 4.5-5 inches in diameter as of today.

Other Meds: Tamoxifen Integra

Current Illness: None

ID: 1169672
Sex: M
Age: 42
State:

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: 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: swelling in throat

Other Meds:

Current Illness:

ID: 1169673
Sex: F
Age: 26
State: NY

Vax Date: 03/26/2021
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: None known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Developed a small itchy rash at the site of the injection. No other symptom. Never experienced this with flu shot or anything.

Other Meds: None

Current Illness: None

ID: 1169674
Sex: F
Age: 85
State: MI

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

Lab Data:

Allergies: NKA

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

Symptoms: Blood sugars running high, fever, dehydration, nausea, vomiting, poor appetite, electrolyte imbalance, ?WBC, lethargic about 1 week after.

Other Meds: Tylenol 325-650mg q4hr PRN Tylenol 325mg TID Calcium600 + vitD400 q day K+ 10mEq q day synthroid 88mcg q day Lovastatin 20mg q day Metformin 850mg BID Nystat powder BID PRN Oxybutnin ER 5mg q day Preservision Areds2 BID Zyrtec 10mg q day

Current Illness: No

ID: 1169675
Sex: M
Age: 51
State: IL

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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: Filing this report due to an administration error not associated with an adverse event. Employee was administered second dose earlier than the recommended timeframe. First dose administered 2/26 and second dose administered 3/25. Employee has not had a physical adverse reaction, and no treatment has been sought.

Other Meds:

Current Illness:

ID: 1169676
Sex: F
Age: 68
State: IL

Vax Date: 03/08/2021
Onset Date: 03/29/2021
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: Allergen Reactions ? Arthrotec [Diclofenac-Misoprostol] Hives ? Gabapentin Other/Unknown (See Comments) and Depression States "made me crazy" ? Ibuprofen Rash

Symptom List: Pain in extremity

Symptoms: 3/29/21 ER HPI: 68 y.o. female who presents with 3 day history of left anterior chest pain. The pain radiates into her back. Pain has been constant and severe at times. It has no relieving or exacerbating factors. Patient denies fever chills cough dyspnea diaphoresis nausea or vomiting. She denies prior similar history. Patient has taken nothing for the pain 4/2/21 ER presentation - flexed to clinic 4/2/21 Clinic HPI: 68 y.o. female who presents today for suspected shingles vs laceration that is infection on her L posterior back. She was seen in the ER for anterior chest wall pain on 03/29 which had started 3 days prior and then saw Dr. again yesterday for follow-up. He gave her a steroid shot and treated her with oral prednisone. In the ER, patient had elevated D-dimer but this was thought to be from her renal insufficiency. She had no other symptoms that suggested pulmonary embolism. No CT angiography of chest was done due to renal insufficiency.The rest of her workup was negative. Rash broke out the day she saw Dr. but didn't mention it to him at that visit. There was no rash on her anterior chest wall where she was hurting at the time.

Other Meds: Current Outpatient Medications: ? aspirin 81 MG chewable tablet, Take 81 mg by mouth daily, Disp: , Rfl: ? Calcium Carbonate-Vitamin D3 (CALCIUM 600/VITAMIN D) 600-400 MG-UNIT TABS, Take, Disp: , Rfl: ? furosemide (LASIX) 20 MG tablet

Current Illness:

ID: 1169677
Sex: F
Age: 16
State: CA

Vax Date: 04/05/2021
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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Anxiety Felt like fainting Dizziness Tingling and cramping in hands Weakness EMT came to Observation area Vitals BP #1) 173/133 Pulse 86 O2 Sat 100% #2) 95/72 Patent refused transport to hospital

Other Meds:

Current Illness:

ID: 1169678
Sex: F
Age: 73
State: LA

Vax Date: 03/09/2021
Onset Date: 03/10/2021
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: NKDA

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

Symptoms: Patient stated that her tongue swelled, she had difficulty breathing, and she developed hives

Other Meds: Novolin N, lovastatin, allopurinol, albuterol hfa, metoprolol tartrate, lisinopril/HCTZ

Current Illness: none

ID: 1169680
Sex: F
Age: 57
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Patient had a blank stare on her face and did not respond to stimulus. She went limp slumped back, she was pale, hypotensive, and unable to follow directions. We called 911 and the Medics took her to hospital where she was released around 5pm

Other Meds: unknown

Current Illness: None disclosed

ID: 1169681
Sex: F
Age: 76
State: CA

Vax Date: 01/23/2021
Onset Date: 01/29/2021
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: no

Symptom List: Vomiting

Symptoms: Macular/papular red rash started on upper chest then spread over weeks to both arms mostly above elbows then to back . Basically rash is above the waist with very sporadic small red dots on legs .

Other Meds: Synthroid, Liothyronine, Low dose Naltrexone 4.5mg, Atorvastatin, Metformin, EC ASA 325mg, Loratadine, Mebendazole Berberine, Twice daily multivitamin, omega 3 caps. turmeric. .Natural Calm, triphala, Glucosamine & Chondritin, Magnesium Cap

Current Illness: no

ID: 1169682
Sex: M
Age: 37
State: NJ

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Headache, eye discomfort, muscle pain

Other Meds: Advil

Current Illness:

Date Died: 03/08/2021

ID: 1169683
Sex: F
Age: 77
State: WI

Vax Date: 02/25/2021
Onset Date: 02/25/2021
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: Unknown

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

Symptoms: Within 5-10 hours of the second dose: nausea, vomiting, chills, fever, fatigue. Chills, fatigue and nausea continued for 10 days until death

Other Meds: Lantus insulin, levothyroxine, losartan, Protonix, potassium, sertraline, spironolactone, vitamin D3, amiodarone, aspirin, atorvastatin, clonidine, plavix, donepazil, iron, and labetolol.

Current Illness: Cerebrovascular disease, vascular dementia with hallucinations, atherosclerotic cardiovascular disease, hypertension, atrial fibrillation, pacemaker placement, Watchman placement (Aug 2020), congestive heart failure, pulmonary hypertension, peripheral vascular disease, diabetes mellitus type II, reflux, anemia, hypothyroidism, osteoporosis, history of compression fracture, anxiety, depression, and history of nicotine use. Hospitalized in November 2020 for fatigue and not eating - was reportedly losing blood but unknown from where. She was given a blood transfusion and fluids. It was a suspected GI bleed but family declined a hematology workup.

ID: 1169684
Sex: F
Age: 65
State:

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: nausea, lightheaded, dizzy, EMS evaluated, pt. refused transport

Other Meds:

Current Illness:

ID: 1169685
Sex: M
Age: 46
State: MN

Vax Date: 12/22/2020
Onset Date: 03/31/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Developed Covid-19 symptoms on 3/31/2021. Tested positive on 4/2/2021.

Other Meds:

Current Illness:

ID: 1169686
Sex: F
Age: 53
State:

Vax Date: 03/12/2021
Onset Date: 03/13/2021
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:

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

Symptoms: day immediately following vaccination, watery diarrhea (too many to count), hoarseness, achy, malaise, abdominal cramping with diarrhea, uncontrolled nausea, dizziness upon standing, went to emergency center for observation, discharged home, same day with anti-nausea and anti-diarrhea prescriptions

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm