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: 1171749
Sex: M
Age: 54
State:

Vax Date: 03/26/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Rash

Other Meds:

Current Illness:

ID: 1171750
Sex: F
Age: 68
State:

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/06/2021
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: had a syncopal episode and fell after receiving vaccine

Other Meds:

Current Illness:

ID: 1171751
Sex: F
Age: 81
State: CA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 04/06/2021
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: Many pollen allergies and food allergies and intolerances: wheat/gluten, dairy, egg, yeast, chili of any kind, strawberries, banana, pineapple, kiwi, cantaloupe, chia seed, guar gum, xanthan gum, carageenan, sulfites, histamine containing foods, preservatives, sunflower oil and seeds, wine

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

Symptoms: Developed acute pain in right hip and muscles in anterior lateral half or thigh and posterior lateral portion of thigh down to knee. Acute pain lasted 2 1/2 days and continued pain for week, but lessened a little, pain increasingly lessened, but lasted 1 month.

Other Meds: Deltasone 2.5 mg., Allegra 180 mg., monteluikast 10 mg., hydroxychloroquin 200 mg., acetaminophen 1000 mg. QID, methocarbamol 500 mg. (QID), multivitamin, zinc 50 mg., Ester C 500 mg. QID. Co-Q 10 100 mg., biotin 2500 mg.

Current Illness:

ID: 1171752
Sex: F
Age: 49
State: CA

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

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache: Took Advil, A fast heart beat, Dizziness and weakness: Rest, Lay on the bed, Drink a lots of water, Rash all over the body: Apply Peppermint Essential Oil on the skin

Other Meds: Vitamin B complex, Advil 120 Liquid Filled Capsules

Current Illness:

ID: 1171753
Sex: F
Age: 16
State: CA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient was under age 18 and received the Moderna vaccine. She did not have any reaction to the vaccine as far as we know. Patients Mother was contacted to let her know that her child did receive the vaccine and was told if she had any concerning symptoms she was to take her child to the ER.

Other Meds:

Current Illness:

ID: 1171754
Sex: M
Age: 47
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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:

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

Symptoms: arm pain, dizziness, passed out x2. Evaluated by EMS-Refusal to transport.

Other Meds:

Current Illness:

ID: 1171755
Sex: M
Age: 26
State: CA

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/06/2021
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: Seafood (hives)

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient had a few pinpoint papillae red in color, on arms. Vital signs stable. The doctor on site gave 10 mg of Zyrtec. No wheezing, no dyspnea. Has a history of hives and throat closing up but does not have his own epi pen.

Other Meds: Unknown

Current Illness: None reported

ID: 1171756
Sex: F
Age: 34
State: NY

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Penicillin and Mangos

Symptom List: Pharyngeal swelling

Symptoms: Pain in right arm, fatigue, and low grade fever began at 11:00 am. Pain in right arm greatly decreased by the following day, low grade fever and fatigue still present. Fever has hovered between 99.2 - 99.6 Fahrenheit.

Other Meds: None

Current Illness: None

ID: 1171757
Sex: F
Age: 65
State: IA

Vax Date: 03/18/2021
Onset Date: 03/25/2021
Rec V Date: 04/06/2021
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: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Moderna COVID Vaccine EUA Pt received Dose 1 of Moderna vaccine 3/18/21. Developed symptoms 3/25/21. Presented to ED 3/28/21. 3/28/21: 65-year-old female with past medical history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presented to ER with complaints of shortness of breath. Per patient she received her 1st COVID-19 vaccination last Thursday. Since Monday the patient has felt "unwell." Three days ago she started having shortness of breath which has progressively worsened, especially with exertion. She has developed increased fatigue, cough, nausea and decreased appetite. Denies chest pain. No vomiting or diarrhea. On arrival to ED patient she had a low-grade fever and was hypoxic at 87% on room air. Supplemental oxygen with 2 L NC with improvement in oxygenation saturation to 94%. Laboratory findings were significant for hypokalemia 3.0, transaminitis ALT 55, AST 44. COVID positive. Chest x-ray revealed bilateral airspace disease with obscured pulmonary vasculature. Favored to represent pneumonia over heart failure. EKG normal sinus rhythm, rate 74, QTC 472. Patient was given IV fluid resuscitation with NS 3 L bolus. Potassium 60 mEq p.o. given. IV Rocephin was initiated and DuoNeb treatment given in ER. 4/2/21: Pt received remdesivir, convalescent plasma, ceftriaxone, doxycycline, dexamethasone, vitamin C, zinc sulfate. Patient discharged on doxycycline course, PO zinc and vitamin C, supplemental oxygen. Instructed to follow up with PCP in 3-5 days.

Other Meds: Acetaminophen 650 mg PO QID PRN Albuterol 2 puffs Q6h PRN Atorvastatin 40 mg PO QD Furosemide 40 mg PO QD Lactobacillus rhamnosus GG 1 cap PO BID Multivitamin 1 tab PO QD

Current Illness:

ID: 1171758
Sex: F
Age: 65
State: KS

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 04/06/2021
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: dizzy, nausea, loss of appetite, headache, diarrhea, unable to leave bed for 2.5 days, fever, chills, body aches, swollen gland on right side of neck

Other Meds:

Current Illness:

ID: 1171759
Sex: M
Age: 61
State: CT

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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: Inability to fall asleep at regular bedtime and through the night. Restlessness. 2 other friends reported same issue after Moderna Dose 2

Other Meds: Allopurinol Simvastatin Chlorobenzaprine Melatonin Ibuprofen

Current Illness: None

ID: 1171760
Sex: F
Age: 21
State: TN

Vax Date: 03/30/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: NO

Symptom List: Rash, Urticaria

Symptoms: LYMPH NODE SWELLING ON SIDE OF INJECTION

Other Meds: NO

Current Illness: NO

ID: 1171761
Sex: F
Age: 44
State: CT

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: seasonal (pollen), latex

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

Symptoms: Red macular rash on upper chest, neck area (lacy looking), and left arm around vaccination site. Flushed cheek. No itchiness, or breathing difficulties. Chest clear. Throat not swollen. No swallowing difficulties. Stated she was nervous. P 148, BP 168/84/ SPaO2 98, R 16. Stated when she goes to doctor she gets high heart rate and BP and they have to wait awhile befor it returns to normal. After speaking with her it appears she had the same reaction after 1st vaccine. She did tell vaccinator but vaccine was still administered. She also stated she had a slight rash from the sun when she arrived. She complained of dry throat but on further questioning she stated she has that this time of year due to seasonal allergies. By 11:54 pulse down to 105, BP 140/82. Respirations 18. Rash still present but faded. Lungs remain clear. Discharged to home.

Other Meds: Claritin prn

Current Illness: none

ID: 1171762
Sex: M
Age: 68
State: IL

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 04/06/2021
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: none known

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

Symptoms: Sore RT arm for over thirty hours could not move the arm up or down, like a frozen shoulder. After a few days, it seemed better but not back to normal use. Around 8 - 10 days later both arms are now frozen with extreme pain as well as his hip flexors are bad. Both arms continue to freeze up where the pain and movement are extreme. Hips and legs also have heaviness feeling, cramps, and pain in LT hip flexors.

Other Meds: B12 vit, vit D3, ASA, Tylenol, Ibuprofen

Current Illness: none known

ID: 1171763
Sex: M
Age: 29
State: WI

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

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

Lab Data:

Allergies: N/A

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

Symptoms: Patient was given the vaccine and advised to wait 15 minutes in the pharmacy area. About 13 minutes into that time he fainted onto the chair next to him. help patient onto the floor and pharmacy staff assisted afterwards. called EMT and they came out to asses the patient. Patient was given OJ and some food and advised to remain in the pharmacy area an additional 15 minutes and to have another person drive him home.

Other Meds: N/A

Current Illness: N/A

ID: 1171764
Sex: F
Age: 36
State: VT

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
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: N/a

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

Symptoms: Rash, difficulty breathing, severe flu-like symptoms, brain fog and memory recall issues, fatigue

Other Meds: Loratadine 10mg daily, famotidine 20mg daily

Current Illness: None

ID: 1171765
Sex: F
Age: 57
State: CA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/06/2021
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: shellfish

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

Symptoms: light headedness very soon after shot, discomfort in chest, tingling in fingers, low blood pressure. several hours later very fatigued and slight body chills

Other Meds: multivitamin, fish oil, turmeric

Current Illness: none

ID: 1171766
Sex: F
Age: 30
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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 said she walked two miles and didn't eat breakfast before the vaccine and doesn't do well with needles. Patient has had fainting spells in the past from vaccines. She reports feeling much better is eating, drinking and taking it easy today. If she experiences other symptoms she will contact her PCP.

Other Meds:

Current Illness:

ID: 1171767
Sex: F
Age: 33
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: Throat swelling (lymph nodes), pain-jawbone. Evaluated be EMS-Refusal to transport.

Other Meds:

Current Illness:

ID: 1171768
Sex: F
Age: 61
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: Chest flushing and gagging 25 minutes after initial dose. Symptoms were reported by patient and husband to be consistent with previous episodes of "chemical sensitivity" that have not required epinephrine. Pt was given benadryl PO and transported to ED for EMS.

Other Meds:

Current Illness:

ID: 1171769
Sex: M
Age: 20
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: Pt received first dose of vaccine, while he was waiting in observation for his 15 minutes he was seen slumping over and the nurse approached him. He said he did not feel good and the paramedics took him outside to assess him. His BP and HR were abnormal and they decided to take him to a nearby hospital. Before he was transported he said before the shot he smoked weed and did not eat.

Other Meds:

Current Illness:

ID: 1171770
Sex: F
Age: 57
State: NY

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

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

Lab Data:

Allergies: metal

Symptom List: Unevaluable event

Symptoms: Reports face and neck swelled, no difficulty breathing or swallowing, face remained swollen x 5 days, seen by PMD, prescribed steroid medpack but declined to take it, reports she instead took Benadryl x 5 days with resolution of symptoms. She does report her face and neck had significant swelling.

Other Meds: none

Current Illness: knee surgery 3/18/21

ID: 1171771
Sex: F
Age: 36
State: OK

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient immediately started feeling anxious, heart palpitating, dizzy, and soon started feeling nauseous. She thought maybe it was a panic attack or low blood sugar as she had not eaten this morning, so we continued to monitor her, blood pressure and effects, for 45 minutes until we felt necessary to call.

Other Meds: Unknown

Current Illness: No medical conditions

ID: 1171772
Sex: F
Age: 71
State: NV

Vax Date: 02/01/2021
Onset Date: 02/08/2021
Rec V Date: 04/06/2021
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: Multiple food and allergic sensitivities.

Symptom List: Injection site pain, Pain

Symptoms: Have had atopic disease since I was age one. Currently have occasional Eczema outbreaks. After the second shot, my Eczema turned into a month outbreak of raw, weeping patches under my breasts, in my groin area and patches on my torso. It was extremely painful. I could not wear underwear or bras for much of that time. It is now healing; It was weeping so badly, all I could do is not irritate it further and try to keep it clean and dry. Cortisone creams were useless and I did not at the time think of seeing a doctor or taking a short dose or oral prednisone. This was the worst outbreak I have ever had.

Other Meds: Flovent, Singulair, Perforamist,

Current Illness: Chronic asthma, allergies, and atopic disease.

ID: 1171773
Sex: F
Age: 27
State: NJ

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Mone

Symptom List: Injection site pain, Menorrhagia

Symptoms: Rapid heart rate starting 30 minutes post-injection, lasting roughly 4 hours. Fever starting about 12 hours after the injection, still ongoing as of now (30 hours post infusion), arm pain at injection site (still ongoing as of yet, 30 hours post injection) chills and weakness (still ongoing as of 30 hours post injection)

Other Meds: None

Current Illness: None

ID: 1171774
Sex: F
Age: 42
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: lightheaded, dizziness, "salivating" like she going to throw up. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1171775
Sex: F
Age: 40
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: beer

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: patient reported feeling hot in the observation area and was brought to the EMS room H2O given allowed to rest discharged in no distress @ 935.

Other Meds: allegra, lexapro, estogen progesterone patch vitamin D and calcium

Current Illness: premature ovarian failure, allergies

ID: 1171776
Sex: F
Age: 16
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: PCN - stomach upset; seasonal allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient is a 16yo seen for her first dose of the COVID-19 vaccine. She was seated in the back seat of the car. Shortly after receiving her vaccine (within a few minutes), she chose to move to the front passenger seat of the car, and after sitting in the passenger seat she became lightheaded and lost consciousness. Syncopal event was witnessed and lasted a few seconds. She spontaneously regained consciousness, and complained of some lightheadedness and tunnel vision. No significant confusion was noted, her responses to questions were appropriate. Initial pulse was thready and heart rate initially difficult to auscultate. Pale color noted on the face. Initial pulse approximately 50bpm. Breath sounds clear with good air exchange. Patient was placed in a reclined position with feet on the dash. She quickly recovered and repeat heart rate was auscultated at approximately 70bpm, stronger pulse noted. She was noted to have improvement and she was then driven out of the vaccine site after obtaining consent from her mother (who was the driver) and parked beside EMS. BP was 100/50 and HR 68-72, SaO2 97%. Lightheadedness resolved and she was feeling well, at her baseline. She was monitored for 30 min then allowed to leave with her mother, she was at her baseline at last evaluation. Per history review with her mother, she has had 2 prior episodes of syncope with pin removal from hand after surgery and IV placement.

Other Meds: Singulair

Current Illness: None known

ID: 1171777
Sex: M
Age: 29
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Pt was sitting in waiting area after receiving #1 injection of Pfizer Covid vaccine. He bagan to feel faint and presented to EMS Vitals taken BP 70/40 HR 40 O2 100% Blood sugar 96. Pt diaphoretic. No difficulty breathing.

Other Meds: none

Current Illness: none

ID: 1171778
Sex: F
Age: 50
State: CA

Vax Date: 01/07/2021
Onset Date: 01/16/2021
Rec V Date: 04/06/2021
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: I could not work but my knees hurt so bad. I had an arthritis pain in my joints, wrist knee and my fingers. I was in a lot of pain and limping at the end of the day. I went to the ER and they did tests. A few days later I developed a rash on my thighs and when it started to spread to the other thigh. It looks like hives and it is was very itchy. The rash then appeared on my buttock and then to the other side. It proceeded to spread in patches in different areas of my body and then spread to the contralateral side of the same body area. I had swelling in my right hand on two fingers. A month after vaccination I also got a fever. All tests were negative except my CRP was elevated each time. I was prescribed Prednisone, but the rash still appears periodically, and my joints still hurt after 12 weeks. The rash is not as itchy when it appears. I have had another course of Prednisone after seeing the immunologist.

Other Meds: Pepsid; Vitamin D

Current Illness:

ID: 1171779
Sex: M
Age: 19
State: AZ

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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: low bp , dizzy

Other Meds:

Current Illness:

ID: 1171780
Sex: F
Age: 29
State: PA

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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: Day of I was dizzy off and on, day after my arm was very sore which I felt was normal. 4/5 I woke up with a very bad headache. 4/6 i woke up with chills, body aches, dizzy

Other Meds: liletta IUD

Current Illness: none

ID: 1171782
Sex: F
Age: 63
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: Patient came for second Covid vaccine. She stated that she was here for her Moderna. . Her fist covid vaccine was a Pifizer .I gave Moderna and did not note it was given in error until after vaccine given. Charge nurse and pharmacist and patient notified. Patient counseled on normal side effect and adverse side effects. Her adult son is coming to stay with her as this was prearranged.

Other Meds:

Current Illness:

ID: 1171783
Sex: F
Age: 38
State: MI

Vax Date: 12/31/2020
Onset Date: 01/05/2021
Rec V Date: 04/06/2021
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: Seasonal allergies

Symptom List: Tremor

Symptoms: I noticed swelling upper right eye lid initially then little whitish bumps (2 small) on the lower eye lid.My doctor thought it was a growth gave me a antibiotic. I exp some drainage from eye and bumps lasted 3 weeks.

Other Meds: No

Current Illness: No

ID: 1171784
Sex: F
Age: 38
State: UT

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/06/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: Patient was sitting in chair while person giving vaccine was standing at elevated level. Pain Immediately injection sight once given, Nerve was hit by needle Right arm/shoulder: pins/needles, numbness, muscle spasms/twitching Right Face: Pins and needles

Other Meds: Spironolactone, Ibuprofen, Fluoxetine, Buspirone, Adderall

Current Illness: N/a

ID: 1171785
Sex: F
Age: 44
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: PT STARTED XOLAIR OVER A YEAR AGO & STARTED WORKING WELL FOR HER W/IN 2 DOSES & WAS CONTROLLING HIVES UNTIL ABOUT NOV/DEC 2020. AT THAT TIME SHE STARTED NOTICING VERY MINIMAL HIVES COMING BACK. PT RECEIVED 1ST PFIZER COVID VACCINE ON 3/11. NO CHANGES TO HIVES, STILL MINIMIAL. RECEIVED 2ND DOSE OF VACCINE ON 4/1. THAT DAY/EVENING SHE HAD ARM PAIN & FATIGUE (EXPECTED OF VACCINE). SHE WOKE UP OVERNIGHT W/ SEVERE ITCHING. FRIDAY AM HIVEALL ALL OVER BODY & SEVERE ITCHING. SAT/SUN THE HIVES STARTED RAISING & STILL ITCHING. MONDAY THE SX WERE SO SEVERE SHE WAS NAUSEOUS. MD STARTED HER ON TOPICAL CORTISONE & 5 DIFFERENT ANTIHISTAMINES. CORTISONE HELPS FOR ABOUT 15 MINUTES & ANTI-HISTAMINES DON'T SEE TO RESOLVE ITCHING. PATIENT IS TO FOLLOW-UP WITH MD FOR TREATMENT OF HIVES & POTENTIAL OF COVID VACCINE CAUSING SUCH AN IMMUNE RESPONSE THAT IT OVERWHELMED THE XOLAIR'S EFFECTS AND CAUSED THE HIVES TO OUTBREAK SEVERELY.

Other Meds: Xolair PFS

Current Illness:

ID: 1171786
Sex: M
Age: 53
State:

Vax Date: 02/17/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital: Y

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: VTE- PE and DVT dx on 4/5/21

Other Meds:

Current Illness: hyperlipidemia, L inguinal hernia, seasonal allergies, colon polyps

ID: 1171787
Sex: F
Age: 18
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: dizziness, nausea. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1171788
Sex: M
Age:
State: MD

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 04/06/2021
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: Allergic to all statins Flow max

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

Symptoms: Since receiving the vaccine experience chronic muscle pain in my back and neck and shoulders along with frequent headaches. When I go to the gym I can only lift have to wait so I normally do

Other Meds: None

Current Illness: None

ID: 1171789
Sex: F
Age: 68
State: CA

Vax Date: 02/10/2021
Onset Date: 03/10/2021
Rec V Date: 04/06/2021
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: Sulfa

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

Symptoms: Patient developed cold like symptoms on 3/10- nasal congestion, cough that progressed to left lung ache/pressure, cough worsened, chest congestion, sore throat. On day 3/17 and 3/18 patient became SOB, malaise, chills/sweats, achy, tired, nausea, emesis, anorexia, "heart tightness' with ambulation, presyncope. Right leg started to feel tight and painful behind the knee, tachycardia.

Other Meds: Levothyroxine, Ibuprofen

Current Illness: None

ID: 1171790
Sex: F
Age: 63
State: AL

Vax Date: 03/24/2021
Onset Date: 03/31/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Mildly allergic to wheat and garlic; mild skin irritation to prolonged use of latex.

Symptom List: Pain in extremity

Symptoms: Redness near injection site, 3 x 1 with a bit of heat. Did not materialize until a week or more later, or I only noticed it later. In having my routine mammogram earlier today the technician noticed it and felt the heat. As I understand it I have a mild case I f Covid arm. A non-issue to this happy recipient!

Other Meds: ImmuneCalm Herbal capsules, Apple Cider Vinegar capsules, D3, Melatonin, magnesium, Manuka Royal Honey capsules, B Complex and Sublingual B12

Current Illness: None

ID: 1171791
Sex: F
Age: 57
State:

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Dexlansoprazole; Hydromorphone; Meperidine; IV dye; Pfizer Covid vaccine

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

Symptoms: Patient received her first Pfizer COVID-19 vaccine. Approximately 25 minutes later she developed a feeling of throat swelling, hoarse voice and difficulty swallowing. She was unable to swallow water. She was treated in the ED with EpiPen, Solumedrol and Benadryl. Patient was admitted to ICU for airway monitoring.

Other Meds:

Current Illness:

ID: 1171792
Sex: M
Age: 30
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/06/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient came in for second dose of Vaccine. Upon injection, the hub of the syringe became faulty and vaccine leaked out. Per the nurse, the patient received approximately 0.2mL of the vaccine. Pharmacist notified and aware of the situation; she gave the okay for the nurse to redose the patient. Patient aware of the situation and was comfortable with a redose.

Other Meds:

Current Illness:

ID: 1171793
Sex: F
Age: 39
State: IA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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: Amoxicillin

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

Symptoms: Light headed, runny nose, sore throat, tiredness, watery eyes. Started to get a sore throat about 11 pm on 4/5 and by the time I woke up at about 6:30 am on 4/6 turned into "cold-like" symptoms. Seems to be getting worse throughout the day.

Other Meds: None

Current Illness: None

ID: 1171794
Sex: F
Age: 78
State:

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Amoxicillin, sulfa, azithromycin

Symptom List: Vomiting

Symptoms: Pt developed stroke like sx the morning after second COVID vaccine including weakness and numbness of R extremities. PCP ordered MRI the following Monday that showed an acute lacunar infart of the L periventricular white matter between the caudate nucleus and thalamus, likely embolic from untreated afib and CHADS-VASC 4.

Other Meds: Amlodipine, atorvastatin, diltiazem, aspirin 81 mg, lisinopril, HCTZ, levothyroxine

Current Illness: n/a

ID: 1171795
Sex: F
Age: 44
State: TX

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Flank pain: left and right kidney.

Other Meds: None

Current Illness: No

ID: 1171796
Sex: F
Age: 58
State: MI

Vax Date: 04/01/2021
Onset Date: 04/04/2021
Rec V Date: 04/06/2021
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: Gluten sensitivity, iodine sensitivity,

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

Symptoms: Red itchy rash at point of injection started around 6 am on 4-4-21. Put topical benedryl on. Fine right now. Migraine on 4-5-21 started at 9:45 am. Slept and took 2 Advil. Headache on 4-6-21 and feeling congestion in head. Took 2 Advil. I wanted to report this because I tested positive for Covid on 10-21-20 and thought you should have this information on file. I had the Moderna COVID-19 Vaccine EUA.

Other Meds: Cod Liver Oil, vitamin D, B12, B6

Current Illness: none

ID: 1171797
Sex: F
Age: 54
State: FL

Vax Date: 03/29/2021
Onset Date: 04/05/2021
Rec V Date: 04/06/2021
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: RASH one week after that itches at the spot on the arm where they inserted the needle.

Other Meds:

Current Illness:

ID: 1171798
Sex: F
Age: 37
State: MD

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 04/06/2021
Hospital:

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

Lab Data:

Allergies: Fish and PCN

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

Symptoms: After 35 min: Right side facial itching and "hives" on side of face. Back itching and "hives" reported on arrival to mother's house (about 5-10 minutes away). Took Benadryl PO and reports "relief." No airway issues (denied). Reported High blood pressure of "154 over 12...Something." Reports fever of 101 and chills for three days afterwards. Also reports "red ring around injections site from the 2nd week up until 3/22/21."

Other Meds: Amlodipine daily, Metoprolol daily, Albuterol HFA (PRN)

Current Illness: none

ID: 1171799
Sex: M
Age: 60
State: NV

Vax Date: 03/26/2021
Onset Date: 04/02/2021
Rec V Date: 04/06/2021
Hospital: Y

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

Lab Data:

Allergies: No

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

Symptoms: On 4/2/2021 my dad feel headache and nausea. no power right side arm and leg

Other Meds: Asprin. Insulin. Dipyridamole . use them everyday

Current Illness: Diabetes only

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm