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: 1172504
Sex: F
Age: 61
State: MI

Vax Date: 04/01/2021
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: NA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient calling with complaint of vertigo, feeling off balance, and headache that began 24 hours after receiving her first Moderna Covid vaccine. She had her first covid vaccine and says ever since she has been having balance issues. Last night she states she could hardly walk to the bathroom when she got up in the middle of the night, because she was so dizzy/room was spinning. She also says she has been experiencing heart palpitations. Patient has not had any known recent exposure to Covid, but did return approximately 1 month ago. Patient has history of hypertension, but has not had her blood pressure checked in a very long time (does not currently take any medications for hypertension- no PCP at this time). Patient states that the vertigo is happening on and off, but mostly when she is laying down in bed. Reports that she feels off balance when she first stands up to walk after laying down. Also reports that she is noticing heart palpitations on and off for the past 2 days. Patient has not had difficulty breathing, difficulty swallowing, facial swelling, rash, or chest pain.

Other Meds: NA

Current Illness: NA

ID: 1172505
Sex: F
Age: 57
State: CA

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

Symptom List: Anxiety, Dyspnoea

Symptoms: Initial adverse symptom: Headache On April 4, 2021, woke up since my left arm had a burning sensation. Noticed that it was very red around the injection site. It was a bit tender too.

Other Meds: Losartan Potassium, 25 mg Retaine dry eye relief

Current Illness: None

ID: 1172506
Sex: F
Age: 62
State: WI

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: None

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

Symptoms: Chills, severe headache, joint pain, fatigue, vomiting, unable to do daily functions

Other Meds: Nasacort, Chlorpheniramine, Acidophilus, Calcium, Vitamin D3, L-Lysine, Multivitamin

Current Illness: None

ID: 1172507
Sex: F
Age: 59
State: AZ

Vax Date: 04/03/2021
Onset Date: 04/06/2021
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: dairy

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Woke up last night with a large swollen lymph node near my left collar bone (shot was in left arm). I can't get in to see my health care provider until the 14th of April. I am under care of a Naturopath in the meantime--castor oil packs, warmth, and tomorrow, some lymphatic herbs. No history of breast cancer. It's painful but not unbearable. Thought it important that this is recorded, though I expect to be fine--I wish I had heard about it before I went looking for it online as a possibility, though.

Other Meds: levothyroxine, liothyronine, low dose naltrexone(for autoimmune)

Current Illness: none

ID: 1172508
Sex: F
Age: 62
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: ancef, iodine , seafood, sulfa and doxycycline

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

Symptoms: A 62 year old female who has completed a 30-minute observation period with the following signs and symptoms of an adverse reaction: swollen and tingling lips area after . Pfizer-BioNTech COVID-19 vaccine # 1 in series administered. Vital sign at 10:40 blood pressure ; 190/120, heart rate: 94, respiration ; 18, Spo2: 99% Repeat Vital sign at 11:02: blood pressure ; 189/102, heart rate: 89, respiration ; 16, Spo2: 99% - patient denies chest pain ,shortness of breath, nausea vomiting, diarrhea, abdominal pain, difficulty swallow, headache, dizziness, or vision changes Action(s) taken: Transferred to higher level of care Patient advised to discuss second dose considerations with a clinician

Other Meds: none

Current Illness: none

ID: 1172509
Sex: F
Age: 20
State: MA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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: none

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

Symptoms: extremely restless sleep, persistent mild nausea, minor headache, generally feeling run down and unwell. It's been a little over 24 hours since I got the injection. Symptoms started about 7 hours after injection. Advil helps a bit for nausea and headache

Other Meds: buproprion, lamatrogine, adderal

Current Illness: none

ID: 1172510
Sex: F
Age: 74
State: VA

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

Lab Data:

Allergies: No drug allergies. Only allergies to environmental - dust, pollen, etc.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Shortly after vaccination, patient reported swollen tongue. Also found to have rash on her neck and arms. Also found to have hives on the back of her neck. EMS on site. Given 125 mg solumedrol and 50 mg benadryl. Patient transported to ED for follow up.

Other Meds: UNKNOWN

Current Illness: unknown

ID: 1172511
Sex: F
Age: 42
State: KY

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: Pharyngeal swelling

Symptoms: c/o mouth swelling, tingling.

Other Meds:

Current Illness:

ID: 1172512
Sex: F
Age: 69
State: OK

Vax Date: 02/21/2021
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: LA

Lab Data:

Allergies: sulfa drugs, hydrocodone

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: CLIENT STATES SYMPTOMS BEGAN ON 2/25/21 WITH EXTREME FATIGUE AND SWOLLEN LYMPH NODES. STATES SHE BEGAN LOSING HER VOICE. STATES ONE OF THE DOCTORS SHE HAS FOLLOWED UP WITH STATES HER VOICE BOX WAS ATROPHYING. CLIENT STATES SHE WAS GIVEN A STEROID SHOT, PENICILLIN SHOT, AUGMENTIN AND A PROBIOTIC TO HELP BUT NOTHING HAS HELPED AT THIS TIME.

Other Meds: baby aspirin, metformin, tramadol, Wellbutrin, lisinopril

Current Illness: none

ID: 1172513
Sex: F
Age: 58
State: MD

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 04/06/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine induced pancytopenia / thrombocytopenia - STILL ONGOING WITH TREATMENT. My mom felt very tired the 2nd day after the vaccine; blood taken ~5 days after vaccination showed lower HgB count (8.8 from her normal range of 11+). She remained at home for recovery and then consulted a hematologist. During this period she still felt extremely tired / dizzy / headaches / couldn't walk up the stairs without breath. 13 days later - more blood sample was taken and now she is diagnosed with pancytopenia - lowered count of RBC (it down further), HgB (down further to 7.1), and Platelets (down to 80 from ~170 her first blood sample). And she was hospitalized. They gave her Prednisone, and a blood transfusion at the hospital. During this first stay - her RBC / HgB and Platelets seemed to have stablized and went higher but they didn't pay attention to her WBC - which went down to 2 (below normal range). A day later during follow up around WBC - it went lower to ~1.2 (her platelets ~117). She developed a fever - now it is considered a neutropenic fever and she was hospitalized once again (platelets was back down to 84 at the beginning of her stay). During this past week in the hospital, they gave her meds to induce WBC growth - which worked but it overshot to 12 (above normal range) and at the same time her platelets and RBC and HgB dipped again lower. Platelets dipped to 43 on Saturday along with HgB down to 7.1 after 2 days of sustained high WBC count so they gave her IVIG and another blood transfusion. After that, her WBC dropped a little further and is stabilizing around 6 along with HgB around ~10. However her platelets remain high volatile - it went to 51 on Sunday, dropped to 46 on Monday, and now it is 38 today. She was discharged from the hospital today and we have a standing order to have her blood tested everyday.

Other Meds: Tenofovir

Current Illness: None

ID: 1172514
Sex: F
Age: 63
State: CT

Vax Date: 01/14/2021
Onset Date: 01/14/2021
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: No

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

Symptoms: Immediate metallic taste within seconds of the injection and the taste stayed for a month. Notified the nurse and they did not aware of this and asked her questions and observed her and she was allowed to leave. By the time she was at the lobby she you felt tingling in lips, difficulty swallowing, tongue swelled and turned black and throat was closing. She drove to the ER and they gave her an EpiPen and fluids and kept her for observation. An hour later she had severe chills and was offered 5 warm blankets and erratic heart rate and blood pressure fluctuation. In hospital for 6 hrs.

Other Meds: Rosuvastatin 5mg

Current Illness: No

ID: 1172515
Sex: F
Age: 37
State: MN

Vax Date: 03/07/2021
Onset Date: 03/07/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: Janssen COVID-19 Vaccine EAU Sore arm, headache, body aches, chills, and fatigue, mostly from 10pm and on through the night. Symptoms subsided within 24 hours of injection.

Other Meds: prenatal vitamin, vitamin D, fish oil, probiotic

Current Illness: none

ID: 1172516
Sex: F
Age: 65
State: CA

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient fell 15 minutes after vaccine. BP 168/93 (pulse 90), 97% O2 sat. BP 151/84 (pulse 89), 97% O2 sat.

Other Meds:

Current Illness:

ID: 1172517
Sex: F
Age: 75
State: WA

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: unkown

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

Symptoms: Guest in Post vaccine monitoring area. Reported to staff she had skipped breakfast and was feeling nauseated. Was provided juice and fig bar. Monitored for 15 minutes, no further complaints. Was able to leave facility with friend who brought her under own power alert oriented to home.

Other Meds: unknown

Current Illness: none

ID: 1172518
Sex: F
Age: 73
State: MS

Vax Date: 01/22/2021
Onset Date: 01/22/2021
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: Cannot tolerate any aspirin products; azithromycin ; MSG products

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

Symptoms: Five minutes after receiving vaccine, it started with heat in my lower stomach and the heat kind of moved up a little bit and I got real hot and then my noticed my heart rate increased. I knew my blood pressure was up. Normally, it's very controlled with meds. They took my blood pressure and it was high . Much higher than what I normally have. It started to subside but then I felt the heart rate increase again. And they took me to the hospital and by the time I got to the hospital my symptoms seemed to be gone - I felt okay. Doctor checked me and said that everything looks good. I walked out on my own. I was a little tired later on but I had no other symptoms.

Other Meds: Singulair for sinuses; statin drug for cholesterol; -atorvastatin ; Allegra; blood pressure medicine - - 1/2 tablet ; Vit B12; Tylenol; eye drops - Restasis

Current Illness: no

ID: 1172519
Sex: F
Age: 44
State: PA

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Increased heart rate, tingling in hands and face, respiratory difficulty when having a mask on.

Other Meds:

Current Illness:

ID: 1172520
Sex: F
Age: 66
State: MI

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: cipro, flagyl, bactrum, adhesive tape.

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

Symptoms: throat tightening, hard to swallow, voice affected. chest tightening, difficulty breathing fast heart rate and higher blood pressure, dizzy, nausea. Hospitalized at a Hospital by ambulance. Benadryl 50cc, iv with pepcid (antihistamine-type 1)

Other Meds: metoprolol tartrate 25, lebothyroxine 10mcg, humilin-R 5 units.

Current Illness: none

ID: 1172521
Sex: F
Age: 23
State: AZ

Vax Date: 01/22/2021
Onset Date: 01/23/2021
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: I had an allergic reaction the day after the vaccine. I started to get a headache and my eyes became very dry and itchy. They were swollen red and irritated. I consulted a doctor and they prescribed a Z Pack and Covid-19 tested me and told me to take Benadryl. My eyes became better by the fifth day after the shot. I got the second dose and I had no reaction to that.

Other Meds:

Current Illness:

ID: 1172522
Sex: F
Age: 55
State: FL

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chills, vomiting, fever, headache 8 hours after shot that lasted about 12 hours

Other Meds: fluoxetine

Current Illness: None

ID: 1172523
Sex: F
Age: 31
State: OH

Vax Date: 04/05/2021
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: Pfizer-BioNTech COVID-19 Vaccine EUA High heart rate (138 bpm) at rest

Other Meds:

Current Illness: COVID-19 between 3/9-3/19

ID: 1172524
Sex: F
Age: 30
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: patient received covid vaccine today ( moderna). Within 15 mins she developed hives and throat tightness. She received diphenhydramine IM 50 mg. After 30 mins she was administered methylprednisolone 125 mg IM and famotidine. warm all over especially upper body (throat/chest), and hives (chest, neck, upper arms). Diffuse flushing.

Other Meds:

Current Illness:

ID: 1172525
Sex: F
Age: 31
State: TX

Vax Date: 03/30/2021
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: Penicillin and fish

Symptom List: Unevaluable event

Symptoms: Severe chills, body aches, muscle tense, headache, low grade fever for about 24 hrs

Other Meds: None

Current Illness: RA

ID: 1172526
Sex: M
Age: 72
State: MO

Vax Date: 03/12/2021
Onset Date: 03/19/2021
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:

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

Symptoms: The patient states he wears a heart monitor and his pulse has been going up by 2-3 beats per minute each week since he received his second dose.

Other Meds:

Current Illness:

ID: 1172527
Sex: F
Age: 67
State: KY

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

Symptom List: Injection site pain, Pain

Symptoms: "feels like ants walking on top of my hand"

Other Meds:

Current Illness:

ID: 1172528
Sex: M
Age: 72
State: TN

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: The vial of Pfizer vaccine was not diluted prior to administration. The patient got 0.3 ml of concentrated vaccine. We called the manufacturer and they did not see any increased side effects other than local site pain at high concentrations. I notified the patient, warned about possible issues and told them to call if they have any side effects.

Other Meds:

Current Illness:

ID: 1172529
Sex: F
Age: 77
State: IN

Vax Date: 03/04/2021
Onset Date: 04/03/2021
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: Tetracycline, toprol

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

Symptoms: Blood clot that caused total vision loss in right eye. It occurred on 04/03/2021. Was treated by ophthalmologist at eye Center, and at Hospital,

Other Meds: Valsartan, amylodipine, cymbalta. Potassium, vitamins A, E, C, B12, magnesium, fish oil

Current Illness: None

ID: 1172530
Sex: F
Age: 38
State: PA

Vax Date: 03/29/2021
Onset Date: 04/01/2021
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: Sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Two episodes of sudden dizziness, blurred vision, collapsing, unable to stand first on 4/1 and second on 4/2. No history of dizziness or fainting. Not dehydrated at the time. Duration of event was approximately 30-60 seconds with trouble speaking thereafter for 10 minutes. Resumed normal activities thereafter. Made a doctor's appointment.

Other Meds: Multi-vitamins

Current Illness: None

ID: 1172531
Sex: F
Age: 42
State: WI

Vax Date: 03/31/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Beginning the afternoon of 3/31/21: headache, chills (came and went for 3 days), body aches that were constant (head/neck/shoulders), soreness in spot of injection, night sweats, fever (came and went), fatigue and loss of appetite. Several days after the onset also had shortness of breath that lasted three days. I finally feel 90% normal on 4/6/21 with just a very slight headache in the morning and slightest tightness in chest. I only took one ibuprofen pill every 9 hours if my symptoms were terrible.

Other Meds: Spironolactone 25 mg, Mesalamine 0.75 mg

Current Illness: None

ID: 1172532
Sex: F
Age: 68
State: FL

Vax Date: 01/01/2021
Onset Date: 01/01/2021
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: I am not allergic to any medications or foods.

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

Symptoms: It was a little red and sore the first. It was more red and swollen the next day so I went to the doctor. The doctor said it was cellulitis and I was treated with antibiotics.

Other Meds: I was not taking anything.

Current Illness: I had no illness at the time of vaccination.

ID: 1172533
Sex: F
Age: 55
State: WY

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

Lab Data:

Allergies: Perfumes, nickel, gold, printer ink, polysobate, adhesive, food preservative, codeine and codeine substance, erythromycin, iodine, e-smokes

Symptom List: Nausea

Symptoms: Felt adrenaline rush right after shot, light headed, voice change, cough, scratchy throat, headache, aches and pain like having the flu, feeling of hives on arm, truck and all over body.

Other Meds:

Current Illness:

ID: 1172534
Sex: M
Age: 61
State: FL

Vax Date: 03/29/2021
Onset Date: 04/01/2021
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: Lysinopril blood pressure causes severe lethargy, lack of will to move

Symptom List: Injection site pain

Symptoms: Tinnitus in left ear. Soft high-frequency crickets when my throat gets stressed, including hiccups, burping, stretching, sometimes yawning, muscle tensing, sometimes swallowing, stretching to wake up in the morning. Last for the duration of the stress, a few seconds. Left eustachian tube slightly sore, slight earache. Has gone on for almost a week now. Best guess is nerve is pressured or damaged? Will try hydroxide in ear next, in hope it kills whatever's going on. Whether this will go away or not is unknown at present.

Other Meds: 75 mcg Levoxyl T4, Centrum Silver, Selenium 200mcg, Vitamin C 500mg, 100% cacao Baker's Chocolate 3cc

Current Illness: Hypothyroid

ID: 1172535
Sex: M
Age: 40
State: SD

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:
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: Patient came to Vaccination Clinic on 3/12/2021, filled out paperwork and stated it was his first vaccine. This writer went to document vaccine in patient's chart and noted it was actually patient's third vaccine.

Other Meds:

Current Illness:

ID: 1172536
Sex: M
Age: 70
State: MN

Vax Date: 04/01/2021
Onset Date: 04/02/2021
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: none

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

Symptoms: Tinnitus -- high-pitched clicking in right ear every 10-30 seconds Symptoms began 2am following injection #2 the previous morning Amplitude high enough to prevent sound sleep nights 1 and 2 after injection; now decreasing very slowly over following nights 3-6 Otherwise recovered in one day from expected mild muscle soreness, mild fatigue/malaise, slight fever

Other Meds: acetaminophen

Current Illness: none

ID: 1172537
Sex: M
Age: 23
State: IN

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: none

Symptom List: Tremor

Symptoms: syncope

Other Meds: none

Current Illness: none

ID: 1172538
Sex: F
Age: 17
State: OR

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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient was inadvertently vaccinated at age 17. No adverse effects during monitoring.

Other Meds:

Current Illness:

ID: 1172539
Sex: F
Age: 72
State: MI

Vax Date: 03/09/2021
Onset Date: 03/10/2021
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: Nauseous, headache, muscle aches, fatigue, dizzy....4days

Other Meds:

Current Illness:

ID: 1172540
Sex: M
Age: 68
State: CA

Vax Date: 03/09/2021
Onset Date: 03/11/2021
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: Bactrim(rash,itch);Clindamycin (rash,itch);Augmentin(diarrhea)

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

Symptoms: Parotitis - Primary Very swollen face on my right side (apposite side from injection site) On Thursday 3/11/21 (after injection Tuesday morning 3/9/21) woke with swollen right side of face. Eating painful. Friday extreme swelling, externally visible and very painful. Saw Dr. who started course of rimethoprim-sulfamethoxazole (Bactrim DS) 160-800 mg TABS. Over weekend swelling and pain went down, but it was a full 2 weeks before I felt almost all of the symptoms were gone. This is not a condition I have ever had before.

Other Meds: Amlodipine;rovustatin;valacyclovir;Visbiome;tirosint;Vitamin D;multi-vitamin

Current Illness: none

ID: 1172541
Sex: M
Age: 59
State: NC

Vax Date: 04/03/2021
Onset Date: 04/05/2021
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: IVP dye, penicillin, possibly ibuprofen, but I can take Naproxen with no difficulty, so as the two drugs are related, most docs do not feel the allergy pertains to ibuprofen.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I had common side effects including fever of 102.7, joint pain, body aches, headache, stomach pain from the evening of 4/3/21 until today, 4/6/21. The fever has fluctuated from no fever to102.7, to lower grade 99.1 to 100.5 to no fever to lower grade, 99.1 over the course of that time. The reason for my VAERS report is the major rash that I developed on the evening of 4/5/21 that covers my entire back, my chest, and up to the first two inches of my neck. I contacted my physician practice right away, and recommended that I take Benadryl every few hours. This morning, the surface area of the rash remains the same as yesterday, but is a much lighter hue. Yesterday was deep red and felt very hot. Today, is more of a pinkish red. Today my back feels as if I have a bad sunburn. Clothing touching my back causes a discomfort similar to sunburn. Parts of my back also now have white dryness lines/wrinkles.

Other Meds:

Current Illness:

ID: 1172542
Sex: F
Age: 51
State:

Vax Date: 03/19/2021
Onset Date: 03/20/2021
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: none

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

Symptoms: pt had systemic rash to injection site and waist/ abdomen area that was very itchy and had blisters/red bumps

Other Meds:

Current Illness:

ID: 1172543
Sex: M
Age: 34
State: WI

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: NKA

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

Symptoms: NAUSEA, EMESIS, SYNCOPE

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1172545
Sex: M
Age: 50
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Fairly severe allergies to pollen, etc: Trees, Grass, Weeds, Mold, Cat/Dog Dander. Tested positive for all allergens in San Francisco Bay Area with medium to high severity.

Symptom List: Pain in extremity

Symptoms: About 10 minutes after injection, got dizzy/clammy. It took about 5-10 minutes after that with EMTs to wait until my blood pressure normalized, and then I was fine. Walked off site. Slowly throughout the day had an increasingly bad headache, which peaked about 10 hours after the injection. Around that same time, bad fatigue started, and then slight chills. The headache at this point was extremely severe for about 10-12 hours. After that (so 20-22 hours after initial injection) the fatigue and chills subsided, but came back occasionally. The headache was less severe at that point, but in total did not go away until an additional 15 hours had passed. My estimate is that took about 36-40 hours to feel 100% normal again.

Other Meds: Advil, Allegra

Current Illness: No

ID: 1172546
Sex: M
Age: 17
State: NC

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: NO KNOWN ALLERGIES

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

Symptoms: NOTED TODAY THAT PATIENT RECEIVED BOTH DOSES OF MODERNA OUTSIDE OF THE LICENSED AGE GROUP. PATIENT IS 17 AND MODERNA IS ONLY LICENSED FOR 18 AND ABOVE. PATIENT REPORTED HE HAD NO ADVERSE EFFECTS FROM THE FIRST DOSE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1172547
Sex: F
Age: 50
State: MO

Vax Date: 03/26/2021
Onset Date: 04/05/2021
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: None

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

Symptoms: Started having mild to moderate seizures 4/5/2021. Continued off and on through 4//6/2021. Called Dr. She said do not get a second dose. Monitoring symptoms still.

Other Meds: Carbamazepine, L-thyroxin, allegra, flonase

Current Illness: None

ID: 1172548
Sex: F
Age: 17
State: CA

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

Lab Data:

Allergies:

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

Symptoms: 17 y/o F erroneously received first dose Moderna 3/1/2021. Returned for second dose when error was identified. RN notified site lead for additional review. Consent obtained from pt and pts father to proceed with dose 2 of Moderna vaccine. Pt waited for 15 minutes without adverse reactions observed.

Other Meds:

Current Illness:

ID: 1172549
Sex: F
Age: 67
State: IN

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 04/06/2021
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: Sulpha

Symptom List: Vomiting

Symptoms: Just minutes after my vaccine, the tinnitus that I already experience increased, and has never subsided.

Other Meds: Resuvostatin, levothyroxine, budesonide, vitamin D, fish oil, loratadine, melatonin, vitamin B12, multivitamin.

Current Illness: None

ID: 1172550
Sex: F
Age: 61
State: KY

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: c/o feeling dizzy

Other Meds:

Current Illness:

ID: 1172551
Sex: F
Age: 50
State: NY

Vax Date: 03/15/2021
Onset Date: 03/22/2021
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: Sulpha, Shell fish, and MSG

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

Symptoms: A sudden on set of dizziness or feeling of vertigo, loud buzz in my head, nausea, pain at back base of neck, numbness and tingling in face and hands, strange feeling in throat almost like a lump, extreme fatigue . It was not debilitating but I did not feel well enough to drive my car. Symptoms started March 22 and all have dissipated except feeling dizziness and buzz noise in my head.

Other Meds: Vitamin C and D

Current Illness: no

ID: 1172552
Sex: F
Age: 41
State: TX

Vax Date: 03/03/2021
Onset Date: 03/04/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever 101, lasting 3 days Chills, lasting 3 days Fatigue, lasting 5 days Redness, soreness at injection side, lasting 13 days

Other Meds:

Current Illness: None

ID: 1172553
Sex: F
Age: 27
State: TX

Vax Date: 02/04/2021
Onset Date: 02/08/2021
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: no known allergies

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

Symptoms: Fever the day following injection, sore arm, recovered. Woke up 3-4 days later (2/8/21) with left eye vision loss, pain with eye movements - 2/10/21 diagnosed retrobulbar optic neuritis on with vision 20/50. Vision continued to worsen to 20/150 over the next few days. After 6-8 weeks, vision recovered without intervention to 20/25 and with optic atrophy.

Other Meds: slynd, trazadone

Current Illness: COVID positive on 12/21/20, negative test on 12/31/20

ID: 1172554
Sex: F
Age: 27
State: MA

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

Lab Data:

Allergies: Anaphylactic allergy to cashews and pistachios; also allergic to sunflower seeds, pet dander, amoxicillin, and environmental allergens.

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

Symptoms: Injection technique seemed poor as it was the most painful vaccination I've ever received, and upper arm became tight and achy immediately. Soreness lingered but the sharper pain went away shortly after. About 8-10 hours later I began feeling nauseous and lightheaded. 12 hours after vaccine I had trouble falling asleep, overcome with nausea and chills. This turns into sweating and insomnia the rest of the night. The following day I felt better, but the next night (and following one) I continued feeling a bit sick. Currently (3 days later) my upper arm is still very sore and I have lots of muscle/joint aches throughout my whole body.

Other Meds: Prescriptions: Lexapro, Concerta, Tizanidine, Hydroxozine, Zyrtec Supplements: Vitamin D, Magnesium Citrate, Fish Oil, Docusate Sodium

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm