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: 1170095
Sex: F
Age: 57
State: OR

Vax Date: 03/04/2021
Onset Date: 03/11/2021
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: penicillen, sulfa drugs, levaquin, cocoa butter, eucalyptus

Symptom List: Dysphagia, Epiglottitis

Symptoms: Random, temporary buzzing or vibrating sensation in chest. Sometimes also appears in upper arms, hands, neck and lower jaw. Sometimes accompanied by a brief sensation of dizziness or disorientation.

Other Meds: multivitamin, B-complex, ubiquinol, Vitamin D, Vitamin K2, fish oil, Ioderal, phosphatidylserine

Current Illness:

ID: 1170096
Sex: M
Age: 51
State: KY

Vax Date: 03/29/2021
Onset Date: 03/30/2021
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: nka

Symptom List: Anxiety, Dyspnoea

Symptoms: The morning after his vaccination, his left elbow swelled up and was tender. The elbow gradually decreased in size. Patient wants to get his next dose in his right arm.

Other Meds: Adderall

Current Illness:

ID: 1170097
Sex: F
Age: 64
State: WA

Vax Date: 01/05/2021
Onset Date: 01/14/2021
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: Sulfa

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

Symptoms: Shingles at the injection site. Treated with Valacyclovir. Responded well to Valacyclovir. Pretreated and taken prophylactically upon second dose with no breakout.

Other Meds: Thyroid, Pepcid

Current Illness: None

ID: 1170098
Sex: F
Age: 25
State: WA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
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: Allergic to coffee

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Injection site immediately grew a red spot after vaccination. This spot turned into hard red bump with a hight temperature that was painful to the touch. Over the course of the next 10 days, the bump increased in size until it was about 5 inches in diameter. On day 9, the swelling and hardness went away but the arm became numb. On day 10, arm feels heavy and sluggish, but the spot has begun fading away from red but is showing a purplish tint growing in it's spot.

Other Meds: Fluoxitine and Birth Control

Current Illness:

ID: 1170099
Sex: F
Age: 35
State: AZ

Vax Date: 03/25/2021
Onset Date: 03/26/2021
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: Amoxicillin

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

Symptoms: I received the vaccination on 3/25. On 3/26 and 3/27 I experienced vaccination site soreness, which began to dissipate on 3/28. On 3/29 and 3/30 I experienced a persistent headache and also newly appearing red splotches at the injection site that went away within 48 hours. Then, on 3/30 I also began to experience extreme fatigue and felt "foggy," which persisted on 3/31. During the night of 3/31-morning of 4/1, I woke up multiple times during the night alternating between hot flashes and cold sweats and feeling slightly short of breath, and my eyes were very bloodshot upon fully awakening. I recorded a temperature of 99.9 degrees F the morning of 4/1 and still felt fatigued, so I called off of work and slept most of the day. By the evening of 4/1 I felt entirely better, as if nothing had happened. I want to note that I was diagnosed with a mild case of COVID-19 during early December 2020, so I wanted to submit my vaccination experience in case you are disaggregating side effect data by whether or not patients have previously had COVID-19. Of course I cannot be sure that my symptoms were definitively related to the vaccine, but if they were then the duration of symptoms seems quite lengthy.

Other Meds: Oral birth control pills, vitamin B12, vitamin D, oral probiotic pill

Current Illness: None

ID: 1170100
Sex: F
Age: 45
State: AZ

Vax Date: 04/04/2021
Onset Date: 04/04/2021
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: Grass trees cats horses mold pollen dust

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

Symptoms: Fever chills joint and muscle aches headache fatigue beginning about six hours after receiving the vaccine

Other Meds: Bupropion adderall seasonique advorstatin Allegra multivitamin fish oil supplement

Current Illness: None

ID: 1170102
Sex: M
Age: 32
State: MD

Vax Date: 02/24/2021
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: Dust Mites

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Shingles - Diagnosed 40 days after second vaccination (05APR2021). Symptoms developed 37 days after second vaccination (02APR2021). Painful, swollen lymph nodes at top of groin; red blistering rash, initially very mild, later very inflamed. Shingles diagnosis made at health clinic.

Other Meds: Melatonin, Diphenhydramine,

Current Illness: None

ID: 1170103
Sex: F
Age: 39
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: Soy, Nuts (peanuts, pecans, walnuts, pistachios), Shrimp, Tuna, Oysters, Wheatgrass, Sesame Seeds, Pollens, Grass, Trees, Mold, Dust, Dogs, Cats

Symptom List: Pharyngeal swelling

Symptoms: Within 30 minutes of first dose of vaccine reported fever/sweaty, higher blood pressure and lightheadedness. Went to the clinic and confirmed through nurse triage that fever and blood pressure were elevated. Blood pressure ~128/86 Patient's normal range is 90/60 Fever was 99 Next three days: On and off fever that never went above 99. Patient has chills, and normal symptoms when having a 99 degree fever. For the next 10 days continued to have elevated blood pressure (123-128/80), lightheadedness and vertigo. Blood pressure, lightheadedness and vertigo continued even when patient is laying down. Stronger adverse effects included numbness, leg pain and chest pain that felt like a heart attack, especially whenever bending leg at the knee. Symptoms remained constant and did not lessen over the 10 days. On the 11th day adverse effects drastically reduced though blood pressure was still higher than normal but closer to normal range.

Other Meds: None

Current Illness: Asthma Allergies

ID: 1170104
Sex: M
Age: 33
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: Patient reports "upset intestines" with alcohol, "diarrhea" with cephalosporins, "mild seizure" as a child after pertussis vaccine, and "diarrhea" with dairy.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient lost color in his face, felt sweaty, lightheaded, and warm a few minutes after first dose (10:04 AM). The warmness lasted 2-3 minutes, and then he felt cool. The lightheadedness subsided about 10:15 AM. This is when his mother called me over and told me what was going on. His BP (using automatic cuff) was 110/58 with a pulse of 55. He denied any other sx, and said he ate Special K Protein and soy milk for breakfast. We gave him a bottle of water to sip, and he continued to sit with his head near his knees. At 10:30 AM, his BP was 101/56 with pulse of 51. He said the lightheadedness returned slightly, but the sweatiness subsided. By 10:43 AM, he said he felt all better. At 10:36 AM, he took his pulse manually, and it was 66. By 10:43 AM, he felt "all better" and his BP was 135/75 at 10:54 AM, with a pulse of 57 (per automatic cuff).

Other Meds:

Current Illness:

ID: 1170105
Sex: F
Age: 61
State: HI

Vax Date: 03/24/2021
Onset Date: 03/26/2021
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: Meto, Bixain,

Symptom List: Diarrhoea, Nasal congestion

Symptoms: "Received second at 1520 on 3/24/2021. At 3/25/2021 at 1600 spike a temp at 101, fever, chills, and mild nausea. Pt. took 1gm of Acetaminophen. Repeated at 0030 on 3/26/2021, "fever never broke." temperature went to 101'F and took another 1gm at that time. 0700, fever was back to 101, took a tepid shower, notice rash mid-sternal to nipple line of each breast, red and blotchy, raised, no pruritus. At 0715 took Benadryl 25mg po, and 1gm of Tylenol again. Noticed a blanched patch after another a2-3 hours later. 5-6 hours symptoms to start to resolve so no further Acetaminophen taken. No breathing difficulty noted throughout the event. 3/27/2021 everything was resolved, no further issues or Acetaminophen taken."

Other Meds: N/A

Current Illness: none

ID: 1170106
Sex: F
Age: 46
State: NY

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

Lab Data:

Allergies: No

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

Symptoms: Fever, Body Aches, Headache, Nausea

Other Meds:

Current Illness: No

ID: 1170107
Sex: F
Age: 43
State: UT

Vax Date: 03/08/2021
Onset Date: 03/12/2021
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: Fish, shellfish.

Symptom List: Rash, Urticaria

Symptoms: Nausea and vomiting, headache, muscle ache, painful red rash on left upper arm.

Other Meds: Sertraline, MVI, Vit D, levothyroxine, Reglan, medroxyprogesterone.

Current Illness: None.

ID: 1170108
Sex: M
Age: 78
State: CA

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/05/2021
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: None

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

Symptoms: The patient had an ischemic stroke (confirmed by MRI) on Friday, 4/2, approximately 24 hours after the 2nd dose of the Moderna vaccine given on 4/1. The symptoms of the stroke began in the evening on 4/2 and consisted of left face, arm, and leg weakness.

Other Meds: Aspirin 81 mg daily

Current Illness: None

ID: 1170109
Sex: F
Age: 26
State: VA

Vax Date: 03/26/2021
Onset Date: 04/04/2021
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: sulfa

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

Symptoms: 2cm tender lymph node, axillary, on the same side where she got the vaccine

Other Meds: Zyrtec, Nuvaring

Current Illness: none

ID: 1170110
Sex: F
Age: 61
State: CA

Vax Date: 04/04/2021
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: None

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

Symptoms: Monster headache, Chills, Intense back, hip and neck pain (aches), nausea, fatigue

Other Meds: Levothroxine

Current Illness: None

ID: 1170111
Sex: M
Age: 17
State: NJ

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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: Anaphylactic to dairy, egg, peanuts, tree nuts, sesame; Gadolinium

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

Symptoms: April 2- woke up with extreme fatigue, achy, headache, had trouble sleeping. In afternoon had 100 fever. April 3 - woke up with migraine type headache; fatigue; lack of energy; had trouble sleeping; had weird dreams. April 4 - work up with same headache; had trouble sleeping; had a neck ache and sore throat. Overnight, 230 am April 5, had severe stomach pain, breathlessness, pain in left elbow. Had headache after waking up, missed school, still feeling drained.

Other Meds: Advair 115/21, calcium pills, minocycline ER 45 mg; Xolair shots 1 a month as part of food allergy research trial, last given March 26, the week prior

Current Illness: none

ID: 1170112
Sex: F
Age: 39
State: TX

Vax Date: 03/22/2021
Onset Date: 03/22/2021
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: Pt received shot at 1626. At 1637, pt reported that her lower lip felt itchy, cheeks were red. Pt has hx anaphylaxis to multiple food allergies and carries epi pen with her. At 1638, VS: BP 168/112, P 86, O2 100% RA.Lungs clear bilaterally. Pt then reported that her tongue felt ?numb? and ?pins and needles? sensations. Recheck BP is 200/130 at 1644. Pt is awake, alert, oriented. She states that when she has anaphylaxis in the past, this is how it initially presents. Dr. called at 1645 and notified of pt condition and advises to give epi and benadryl and call ems. EMS called at 1650 by RN. Pt requested to wait until EMS is closer to take epi as she said that it can make her blood pressure raise. At 1653, pt willing to take epi. Pt?s seat reclined. Epi pen 0.3mg given at 1653, Benadryl 50mg liquid given at 1654 by RN. EMS on site to take over care at 1655. Pt remains A&OX4 at this time. No difficulty breathing at this time. Pt remains fully conscious. Pt transferred to hospital in EMS. Pt notified that due to her having anaphylactic reaction to vaccine, she will not be able to receive another vaccine. Pt advised to follow up with PCP. RN

Other Meds:

Current Illness:

ID: 1170113
Sex: F
Age: 66
State: CO

Vax Date: 03/18/2021
Onset Date: 03/18/2021
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: milk proteins

Symptom List: Ear pain, Hypoaesthesia

Symptoms: severe fatigue, body aches, headache lasting approximately 24 hours

Other Meds: statins, iron, Thorne multiple vitamin and mineral, chelated mg, probiotic, CoQ 10, THC, CBD

Current Illness: none

ID: 1170114
Sex: F
Age: 29
State: PA

Vax Date: 02/13/2021
Onset Date: 03/01/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: My menstrual period lasted from March 1st to March 21st, which is two weeks longer than usual.

Other Meds: Synthroid, Lisinopril, benadryl, norethidrone

Current Illness:

ID: 1170115
Sex: F
Age: 62
State:

Vax Date: 04/03/2021
Onset Date: 04/04/2021
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: Patient has bumps on shoulder and it is itching/red

Other Meds:

Current Illness:

ID: 1170116
Sex: F
Age: 39
State: CA

Vax Date: 04/03/2021
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: 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: Muscle aches, right arm/lat soreness, raised temp. Mild stomach cramp in morning after, brief. General malaise and fatigue during day, fever and more extreme chills next evening.

Other Meds: LDN, vitamins

Current Illness: Fever one week prior, 24 hrs, neg covid test

ID: 1170117
Sex: M
Age: 28
State: WY

Vax Date: 03/05/2021
Onset Date: 03/24/2021
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: Unevaluable event

Symptoms: 03/24/2021- ct called c/o new loss of taste/smell post vaccination, similar to when he had COVID infect 01/18/21. WPHL and Vault tests were both negative. Both sense of taste/smell have now returned. 03/26/21-Ct had 2nd dose. 04/05/21-Ct states he did fine after the 2nd dose, no problems at this time. Unsure if loss of sense of taste/smell with 1st dose was related to the vaccine or if he is a COVID long hauler.

Other Meds:

Current Illness:

ID: 1170118
Sex: M
Age: 57
State: IA

Vax Date: 02/09/2021
Onset Date: 02/09/2021
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: Penicillin, erythromycin,

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

Symptoms: Immediate weakness, nausea, and fatigue. Then 6 weeks of low-grade fevers, chills, body aches, nausea, progressing to shortness of breath, coughing and extreme fatigue. One round of prednisone and zithromycin.

Other Meds: Eliquis, montolukast, trazadone, tamsulosin,Bayer low dose aspirin, ,zyrtec, Vitamin D3, B12, tagamet, centrum silver multivitamin, Vitamin C, albuterol inhaler, symbicort inhaler

Current Illness: None

ID: 1170119
Sex: F
Age: 74
State: NY

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Nausea, sweating, chills, then fainted. Woke up on kitchen floor. Felt sick all day. Next day much better and able to eat normally.

Other Meds: Metoprolol. vit.B3

Current Illness: None

ID: 1170120
Sex: F
Age: 68
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: Zoloft

Symptom List: Injection site pain, Menorrhagia

Symptoms: Friday, April 2, 2021: Evening beginning around 6 PM?sore arm; chills so bad I couldn?t hold a glass of water and teeth were chattering. Fever of 102.8. F; coughing & congestion. Saturday, April 3,2021: All day: arm extremely sore; headache; nausea, fever 101.2 F; fatigue all day. Sunday, April 4, 2021: All day: fatigued; dizzy; shortness of breath; headache worse, so took Tylenol at around 3:pm; after 1st meal since Friday, had diarrhea once. Headache went away. Monday, April 5, 2021: woke up feeling normal except for mildly sore arm. A little light-headed. Felt weak in afternoon and took a nap. Have been unable to take temperature as battery died in digital thermometer.

Other Meds: Triamcinotone Acetonide Ointment USP, 0.5% for psoriasis on feet

Current Illness: Covid: had symptoms beginning 03/08/2021. Tested positive on 03/10/2021. Self-quarantined until 03/18/2021.

ID: 1170121
Sex: M
Age: 51
State: MA

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: shot at 9:15 am, about 2:45 pm I started to feel a bit nauseous, but it was gone by 3:30 pm, but I then started to get a headache. it started in the back of my head/neck area then more in the forehead then both by 5:00 pm. At same time (3:30 pm) I felt very tired, achey. I took 2 Aleve and went to bed and slept till about 6:15 pm, ate dinner and went to bed for the evening. Headache persisted, aches, and general tiredness.

Other Meds: Elderberry Gummies, Tumeric. I am also getting seasonal allergy injections weekly (cider, dust mites, ash) but did not the day of COIVD injection.

Current Illness: None

ID: 1170122
Sex: F
Age: 72
State: SC

Vax Date: 03/04/2021
Onset Date: 03/06/2021
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: Patients husband said that she normally needs a walking stick to help her get around, but that two days after her second shot she could not get out of bed. She went to the ER, but they couldn't figure out what was going on and sent her home with APAP. She went back to the ER 5-4-2021 and she was diagnosed with a TIA.

Other Meds:

Current Illness:

ID: 1170123
Sex: F
Age: 15
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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: n/a

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient lied on form stated she was 16 when she wasn't - intern pharmacist administered vaccine but DOB wasn't confirmed until later with passport dob. Patient is aware she is ineligible for further dose until approval

Other Meds: n/a

Current Illness: n/a

ID: 1170124
Sex: M
Age: 16
State: CO

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: no

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

Symptoms: Pt was sitting down, and mother was standing by patient. Pt fainted and fell out of chair, Did not hit head per mother. Patient was awake and aware right away and sitting up. EMS came to evaluate patient.

Other Meds: None Known

Current Illness: None known

ID: 1170125
Sex: F
Age: 16
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Patient became unresponsive within 15 minutes of getting vaccine. Her eyes were wide open, lips were turning blue, and had appeared to stop breathing.

Other Meds:

Current Illness:

ID: 1170126
Sex: F
Age: 23
State: CA

Vax Date: 03/29/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: abdominal pain, chest pain, rapid heart rate, fever, chills/hot, headache, body aches, vomited once, pain at injection site, lethargy, brain fog.

Other Meds: vitamin C, calcium

Current Illness: none other than 1st Moderna vaccine

ID: 1170127
Sex: M
Age: 17
State: IA

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:

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA Second dose of Pfizer vaccine received Friday afternoon (4/2/2021). Went to bed Friday evening with "normal" side effects of mild fever and sore arm at injection site. Woke up Saturday morning with no sense of smell or taste. Called primary care provider who conducted a video visit and expressed concern that he may have had an asymptomatic case of COVID-19 prior to injection (no symptoms displayed at all in weeks prior). Order a COVID test for Sunday morning. Woke up Sunday morning with sense of taste and smell back. Proceeded with PCR test, which came back as "negative" on Sunday evening. No other symptoms observed, and other side effects noted above (sore arm, fever) resolved by Sunday morning as well. Seems to suggest loss of sense of taste and smell likely due to vaccine since there was a clear temporal relationship which resolved in approximately 24 hours.

Other Meds:

Current Illness:

ID: 1170129
Sex: F
Age: 21
State: OK

Vax Date: 04/01/2021
Onset Date: 04/03/2021
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: Anaphylaxis to peanuts and some tree nuts

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

Symptoms: 1st dose Moderna adm 3/4/2021 developed mild flu like sx lasting 2-3 days. 2nd dose Moderna adm 4/1/2021 developed moderate flu symptom.. Left arm injection site swelled to size of a peach. On 4/3/2021 noted heart racing and chest tightness. Her pulse 90-120 by home pulse ox monitoring. Taken to ER by her mom. She had blood work, EKG and rec to f/u with her primary care physician for "adverse reaction to Moderna". 4/5/2021 had office appt. The PA stated an adverse reaction to the shot. Her pulse 133 in office. BP 138/70. She has received a referral to a cardiologjst. Continues to feel like her heart races, approx. 6 times today, with sharp chest pain or tightness.

Other Meds: Amitriptyline 10mg daily Norethindrone .35mg po daily Vit D, zinc and magnesium

Current Illness: None

ID: 1170130
Sex: U
Age:
State: WA

Vax Date:
Onset Date:
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: Nausea, vomiting, constipation, abdominal pain, body aches, heart hurts, fever, chills, rash, feeling faint, headache, eyes hurt, extreme fatigue.

Other Meds:

Current Illness:

ID: 1170131
Sex: M
Age: 42
State: NC

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: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: Patient fainted about 2 minutes after vaccination. Was awake and alert within 2 seconds after fait and falling from observation chair.

Other Meds: none

Current Illness: none

ID: 1170132
Sex: F
Age: 57
State: IN

Vax Date: 03/19/2021
Onset Date: 03/29/2021
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: No

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

Symptoms: Coughing, fever, body aches, breathing issues, sores on roof of mouth, still sick today one week later 4/5/2021

Other Meds: Lantis solo star, glimperide, metformin 500 ER, lisinopril, rosuvastatin, nabumetone, hydro condone 5/350, gabepentin, one a day vitamins, elderberry gummies

Current Illness: None

ID: 1170133
Sex: F
Age: 40
State: VT

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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Approximately 24 hours after injection, I developed a red blotch two inches below the injection site. It is painful and hot to touch . As of now (57 hours later) it is expanding in size, hot to touch, but is expanding downward toward hand.

Other Meds: None

Current Illness: None

ID: 1170134
Sex: F
Age: 46
State: WV

Vax Date: 03/27/2021
Onset Date: 04/04/2021
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: Erythromycin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Red circular raised rash, itchy and hot to the touch at injection site. Rash was approximately 1 inch in diameter at Initial onset. Rash grew to approximately 2 inches in diameter after 24 hours. All other symptoms remain unchanged.

Other Meds: None

Current Illness: Rotator cuff and bicep muscle and tendon repair surgery on 02/19/2021

ID: 1170135
Sex: F
Age: 54
State: FL

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

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

Lab Data:

Allergies: contrasting dye, steroids

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

Symptoms: head fog within 2 mnutes, heart rate fas, 10 hours

Other Meds: lisinopril, vitamin c 1000 mg, omega 3

Current Illness:

ID: 1170136
Sex: F
Age: 58
State: CA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: Hepatitis A Virus Vaccine Not Specified Other Lichen planus Hepatitis B Virus Vaccine Class Not Specified Other Lichen planus Sulfa (sulfonamide Antibiotics)

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

Symptoms: Patient received 1st Dose Covid 19 Vaccine Pfizer 3/8/2021 Patient received 2nd Dose Covid 19 Vaccine Pfizer 3/29/2021 Patient brought family member for vaccine on 3/30/2021 and beleives she received the wrong 2nd Dose. Patient beleives they received Moderna as a 2nd dose. Clinical documetation shows otherwise, but member is insisitent. No complaints of any adverse reaction noted.

Other Meds: Triamcinolone Acetonide (KENALOG) 0.1 % Top Crea Apply to affected area(s) 2 times a day Insulin Glargine (LANTUS SOLOSTAR U-100 INSULIN) 100 unit/mL (3 mL) SubQ Insulin Pen Patient reported Insulin Regular Human (HUMULIN R/NOVOLIN R) 100

Current Illness: Unknown

ID: 1170137
Sex: F
Age: 17
State: CA

Vax Date: 03/08/2021
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: Pain in extremity

Symptoms: Patient is 17 years old and received the Moderna Vaccine

Other Meds:

Current Illness:

ID: 1170138
Sex: F
Age: 16
State: FL

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: NKA

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

Symptoms: Patient received her vaccination and stated that she was feeling lightheaded. Patient was cool and clammy, sweating and stated she didnt feel good. EMS notified and hooked up to monitors. IV line was started and patient was transported to the hospital. Patients mother and sister were on site.

Other Meds: none

Current Illness: None

ID: 1170139
Sex: M
Age: 33
State: IN

Vax Date: 04/01/2021
Onset Date: 04/03/2021
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: Sulfa, Vantin, Levaquin

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

Symptoms: Skin sensitivity, chills, uncontrollable shaking for ~25min on first day of symptoms , fever, muscle/body aches, stomach pain

Other Meds: None

Current Illness: Sinus infection, throat ulcers, acid reflux

ID: 1170140
Sex: F
Age: 68
State: NJ

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: 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: Headache, fatigue, fever, chills, joint pain, pain at injection site and rash near injection site

Other Meds: Diovan 80mg, Armour Thyroid 75mg

Current Illness: None

ID: 1170141
Sex: M
Age: 71
State: NY

Vax Date: 04/04/2021
Onset Date: 04/04/2021
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: Began complaining of blurry vision in BOTH eyes that has progressive gotten worse beginning 3 hours after exmination

Other Meds: Metoprolol, Lipitor

Current Illness: None

ID: 1170142
Sex: F
Age: 22
State: TX

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Dizziness ~4 hours post vaccine (3/29/21) Fatigue and chills following day (3/30/21)

Other Meds:

Current Illness:

ID: 1170143
Sex: F
Age: 63
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Clarithromycin Tetracycline

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

Symptoms: Patient developed scattered erythematous maculopapular rash to bilateral arms 20 minutes post vaccination. Denies itching, lip/ throat swelling, dizziness, shortness of breath. Patient appears comfortable and talking in complete sentences. Vitals: BP: 135/69 BP Location: LA-LEFT ARM Pulse: 78 Resp: 16 SpO2: 99% Benadryl 25 mg po administered. 15 minutes post Benadryl administration: patient remains comfortable, no distress. Rash stable, not worse. Denies itching, lip/ throat swelling, dizziness, shortness of breath. BP 141/79, pulse 68, O2 sat 99%. Patient discharged in no distress. Ambulated out of observation area. Advised to follow up with primary care physician. Go to ED for life-threatening events.

Other Meds: Levothyroxine Latanoprost ophth drops

Current Illness: Hypothyroidism Postmenopausal bleeding

ID: 1170144
Sex: M
Age: 30
State: NY

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: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: CPT administered Janssen COVID-19 vaccine to the pt 4/5. While sitting in the pharmacy area for his 15 minute observation period, he fainted. He said that he was texting on his phone and the next thing he knew, he was on the ground with people around him asking if he was ok. He stated that he was very sweaty, nauseous, and a little dizzy. We called a code white, provided the pt with a cold compress and elevated his feet. Pt did not want us to call 911. Pt did not have PCP and has not been to a doctor in about 5 years. He said he was very nervous getting the shot and is afraid of needles so that may have contributed. Pt stayed in the pharmacy area for about 45 minutes until he started to feel better and his mom came to get him. I tried calling pt again at 7:10pm to check in, but there was no answer and I could not leave a voicemail due to mailbox being full.

Other Meds: N/A

Current Illness: NONE THAT PT IS AWARE OF

ID: 1170145
Sex: F
Age: 56
State: NY

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

Lab Data:

Allergies: TETRACYCLINE ERYTHROMYCIN

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

Symptoms: THE DOSE WAS 0.5 TEN MINUTES AFTER THE VACCINE I HAD A RASH ON MY LEGS & ARMS. ALSO MY TONGUE WAS SWOLLEN & I HAVE NUMBNESS IN MY RING FINGER & THE OUTER PALM OF MY HAND.

Other Meds:

Current Illness:

ID: 1170146
Sex: M
Age: 61
State: IL

Vax Date: 02/09/2021
Onset Date: 02/13/2021
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: None

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

Symptoms: A wart-like boil developed in on left hand index finger a few days after the first Moderna vaccine shot. I googled this and saw this: ....... Doctors continue to learn more about the coronavirus as they study the lasting effects it can have on people. COVID toes and fingers in one of them. It's not a very common or dangerous complication, but it? s caused by inflammation to the blood vessels in your fingers or toes, and it's directly linked to the virus. "Ironically people who have a mild case of COVID are getting this unusual complication and some of them have had weeks or months for that to clear up, said Dr. .Many doctors have been calling this unusual complication 'COVID toes' or 'COVID fingers.' "Basically it's a funny reaction to the infection, where you have actually an exaggerated or a strong immune response, Dr. said. It's being seen more in healthy individuals who don't have a severe case of the coronavirus. Dr. suggests seeing your doctor if you are experiencing these symptoms. "So because you have damage to the vessels, fluid just leaks and causes local swelling and the redness,? he said.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm