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: 1176318
Sex: F
Age: 38
State: AZ

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: No

Symptom List: Dysphagia, Epiglottitis

Symptoms: Chills, muscle aches, low grade fever, fatigue, headache

Other Meds: No

Current Illness: No

ID: 1176319
Sex: M
Age: 69
State: FL

Vax Date: 03/24/2021
Onset Date: 03/25/2021
Rec V Date: 04/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Started with stomach pain that continued to increase. Went to E.R. After variouse test found a blood clot near stomach in vein.

Other Meds: Omeprazole

Current Illness: Acid refux

ID: 1176320
Sex: F
Age: 27
State: CA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: 15 hours after I was vaccinated I woke up with a severe headache and also felt very hot/feverish. When I got up at 3:30 am to get some water/Advil I also felt light stomach pain and dizziness. It took me about an hour to go back to sleep. Currently the time is 11:00 AM on 07APR2021 and I am experiencing a light headache, but am no longer experiencing dizziness or stomach pain. Arm is still sore from the site of injection.

Other Meds: None

Current Illness: None

ID: 1176321
Sex: F
Age: 37
State: MO

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Day 1: Severe arm pain, whole body aches, sharp nerve pains, lightheaded, feverish/chills, headache, and high pitch ringing in ears. Day 2: tolerable arm pain, whole body aches, feverish/chills, high pitch ringing in ears and scratchy throat.

Other Meds: Adderall XR Biotin Hydrochlorothiazide Chlorophyll

Current Illness:

ID: 1176322
Sex: F
Age: 22
State: NH

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 04/07/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Starting one day after Moderna dose 2, patient developed severe night sweats, which have persisted nightly for the past month. Also has noted diffuse on-going hair loss. More recently over past 1 week, developed some yellowish discoloration of her palms with some palmar petechiae, which resolved over 1 week. Has also noticed some bruising on her thighs without obvious injury. No fever.

Other Meds: Mirena IUD

Current Illness: None

ID: 1176323
Sex: F
Age: 44
State: PA

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 04/07/2021
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: Latex, compazine E-mycin Bees

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

Symptoms: Patient had groundglass opacity noted on her CAT scan negative for Covid per PCR test tachypneic on exertion

Other Meds: Victoza, Actos, effexor, bisoprolol fumarate prilosec, vitamin D3, iron

Current Illness:

ID: 1176324
Sex: F
Age: 70
State: NY

Vax Date: 02/09/2021
Onset Date: 03/09/2021
Rec V Date: 04/07/2021
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: Pyrexia, White blood cell count decreased

Symptoms: She was admitted at hospital on 3/9/21-3/11/21 due to ischemic stroke which she received TPA and mechanical thrombectomy for L MCA M1 occlusion. Her symptoms include aphasia, R facial droop, R side weakness. Patient report no residual deficits.

Other Meds:

Current Illness: carotid stenosis, newly reduced LVEF 35-40% with abnormal septal motion with negative bubble study

ID: 1176325
Sex: F
Age: 41
State: FL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: Dizziness, weakness, in 5 min. of receiving vaccine. VS 121/86, HR 86, O2Sat 100%. 11:30am Patient stated feeling much better and left.

Other Meds: N/A

Current Illness: N/A

ID: 1176326
Sex: F
Age: 60
State: SC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 04/07/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Systemic: Tachycardia-Medium

Other Meds:

Current Illness:

ID: 1176327
Sex: M
Age: 48
State: NC

Vax Date: 02/22/2021
Onset Date: 02/23/2021
Rec V Date: 04/07/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient had swelling under arms and around breast area. Became large, red ad painful. Came for 2nd dose and was referred to primary who stated he could still receive the 2nd dose.

Other Meds: none

Current Illness: none

ID: 1176328
Sex: M
Age: 18
State: WI

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: Tree nuts Corn

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

Symptoms: Fever Chills Terrible muscle and joint pain that Tylenol did not help with Headache that Tylenol did not help with Mouth sores Tired Still feels sick 4 days after the shot

Other Meds: Zyrtec Flonase

Current Illness: None

ID: 1176329
Sex: M
Age: 33
State: PA

Vax Date: 03/13/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
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: Pantoprozole, Pollen

Symptom List: Rash, Urticaria

Symptoms: I received the vaccine on 3/13 and my wife developed COVID symptoms on 3/23 and received a positive COVID result on 3/25. I felt fine the entire time and the morning of 4/6 I couldn't taste or smell. I was given a nasal test and it came back positive for COVID. It's likely that I contracted it from my wife before the full two weeks were up, but I thought it best to report so any information that could be helpful could be used. My symptoms have not changed and I don't feel near as bad as after the vaccine or as my wife who didn't have the vaccine was!

Other Meds: Armodafinil 250mg and Lisinopril 10mg

Current Illness: None

ID: 1176330
Sex: F
Age: 59
State: CA

Vax Date: 03/23/2021
Onset Date: 03/01/2021
Rec V Date: 04/07/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Tingling tongue and bottom lip

Other Meds: Morphine ,remeron,seraquel

Current Illness: None

ID: 1176331
Sex: M
Age: 58
State: SD

Vax Date: 03/29/2021
Onset Date: 04/01/2021
Rec V Date: 04/07/2021
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:

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

Symptoms: Have had increasingly significant pain in left shoulder. It is not at the injection site. It feels as though it is in the joint. I do not have a history of arthritis at the location. Has become increasingly worse to the point that I cannot lift the arm without severe pain in the shoulder joint area. Tylenol and ibuprofen do not seem to help.

Other Meds: Tylenol

Current Illness:

ID: 1176332
Sex: F
Age: 48
State: GA

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 04/07/2021
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: a lot of pain in the arm for 3 months.

Other Meds: Syntroy

Current Illness: none

ID: 1176333
Sex: F
Age: 33
State: IN

Vax Date: 03/29/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Large red rash at spot of injection. Hot to the touch. Lump in muscle

Other Meds: none

Current Illness: none

ID: 1176334
Sex: F
Age: 67
State: IN

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
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: Sensitive to oral narcotics

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

Symptoms: Headache, fatigue, extremely sore throat

Other Meds: Glipizide, metformin, omeprazole, amolodipine, januvia, synthroid, fish oil, colace

Current Illness: None

ID: 1176335
Sex: M
Age: 90
State: MO

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 04/07/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1176336
Sex: F
Age: 34
State: RI

Vax Date: 01/21/2021
Onset Date: 02/16/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Reporting as employee health: Staff member reported that she had miscarried as of 2/16/21

Other Meds: Unknown

Current Illness: Unknown

ID: 1176337
Sex: F
Age: 67
State: TX

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: sulfa

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

Symptoms: Severe chills with uncontrollable muscle contractions for 2.5 hours

Other Meds: multi vitamin, synthroid 112, calcium, meloxicam

Current Illness: none

ID: 1176338
Sex: F
Age: 50
State: CA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: NKA

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

Symptoms: Patient states she feels high/ and out of body experience. She is feeling Loopy

Other Meds: None

Current Illness: NONE

ID: 1176339
Sex: F
Age: 78
State: FL

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: dairy enzyme, multiple antibiotics

Symptom List: Unevaluable event

Symptoms: pt states that she has sore left arm. Pt has metal screws and plates in her left ankle and later that night after getting the vax she got severe shooting pain in left ankle. This pain lasted about 15 or 20 minutes. Today 4/7/2021 about 11 AM she started feeling like she has an exposed nerve in her mouth. She said the pain traveled through her mouth, to her ear, then to her head. She says it is now numb and tingling. She has a rod in her femur to her hip and so far has not had any pain in that location. Pt says called her PCP and she was instructed to take Tylenol or go to the ER if her pain persist.

Other Meds: Coreg 12.5 mg bds, Norvac 10mg qd, Synthroid 50mg qd, Hydrochloride 12.5 every other day, nasal spray, clarinet 5mg, vitamin D 2000IUD, magnesium 650mg, vitamin C 500mg, hydrocodone 2.5 mg,

Current Illness: no

ID: 1176340
Sex: M
Age: 17
State: TX

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
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: Patient under age 18 was vaccinated with Moderna, which is a vaccine error. Troubleshooting: Scribe and vaccinator did not validate age; screeners at the beginning of the process did not ask or turn her away on a Moderna-only day. An ID requirement has been put in place to prevent this situation from occurring in the future. Follow up to be done by Physician or delegee will include specific description of next steps for obtaining dose 2.

Other Meds:

Current Illness:

ID: 1176341
Sex: M
Age: 74
State: MN

Vax Date: 03/27/2021
Onset Date: 03/29/2021
Rec V Date: 04/07/2021
Hospital: Y

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

Lab Data:

Allergies: Amoxicilliln, azithromycin, doxycycline, levaquin, latex

Symptom List: Injection site pain, Pain

Symptoms: he developed a fever that lead to acute confusion which led to acute worsening of chronic weakness which required hospitalization

Other Meds: Prednisone, glipizide, acetaminophen, calcium, finasteride, lutein, miralax, pravastatin, risedronate, tamsulosin, detrol, vitamin D

Current Illness: no acute illness

ID: 1176342
Sex: F
Age: 62
State: NC

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 04/07/2021
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: Arm and shoulder still very sore after three and a half weeks

Other Meds: Metformin, aspirin, zyrtec, lantis, losartan, vitamin C, D3, zinc,

Current Illness: None

ID: 1176343
Sex: F
Age: 87
State: MO

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 04/07/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1176344
Sex: F
Age: 60
State:

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/07/2021
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: Heavy arms feel, dizzy observation. Patient states she has high blood pressure; no meds given/patient states feeling fine

Other Meds:

Current Illness:

ID: 1176345
Sex: F
Age: 68
State: WA

Vax Date: 03/15/2021
Onset Date: 03/23/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: adr

Other Meds:

Current Illness:

ID: 1176346
Sex: F
Age: 50
State: MD

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/07/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: after 3-4 hrs bit my tongue, blood pressure escalate extremely high

Other Meds:

Current Illness:

ID: 1176347
Sex: F
Age: 63
State: MD

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: Codeine, PCN-anaphylaxsis ?Dyes

Symptom List: Nausea

Symptoms: Immediate popping in the ears approx. 15 minutes after injection, then brain fog with fatigue. .. Then the next day fatigue was increased and had to get in bed. Also had a fullness in the ears. Then 2 days later there was headache, neck ache, nausea and vomiting. Unable to take anything by mouth. Heightened sensitivity to light and smells. Went to hospital on the 3rd day and was admitted. Blood pressure was extremely elevated at that time. Discharged 3 days later. Presently has dull ache in both ears and hears an echo. Hearing is slightly decreased. Affecting balance at present.

Other Meds: Asmanex Vitamin D 50,000 U Pepcid TUMS Protonix prn

Current Illness: History of Lyme Disease-2009 GERD Ulcers

ID: 1176348
Sex: F
Age: 30
State: MO

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/07/2021
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: I had a rash/hives break out all over my stomach. The entire front of my stomach was covered in small dots and scabs, almost looked like chicken pox. These bumps were extremely itchy, but never painful.

Other Meds: 20 mg Lexapro daily

Current Illness: None

ID: 1176349
Sex: M
Age: 36
State: CA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: Patient reported feeling anxious before vaccination Patient reported after of dizziness, lightheaded ness, anxious and appeared pale Patient provided with water and car AC turned on, patient seen by medical team, refused medical transport and signed AMA form Patient stated feelings have resolved

Other Meds: None

Current Illness: None

ID: 1176350
Sex: F
Age: 27
State: NJ

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: NO

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

Symptoms: PATIENT PASSED OUT LOST CONSCIOUSNESS ABOUT 2 TO 3 MINUTES .

Other Meds: NO LISTED

Current Illness:

ID: 1176351
Sex: M
Age:
State: KS

Vax Date: 03/11/2021
Onset Date: 04/01/2021
Rec V Date: 04/07/2021
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: Compazine and proponal

Symptom List: Tremor

Symptoms: Increased blood pressure and case of shingles

Other Meds: Levothyroxine

Current Illness: None

ID: 1176352
Sex: F
Age: 36
State: CA

Vax Date: 04/05/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: Macular rash on the upper abdomen and lower chest that started this morning. Rash is slightly raised, not itchy, no vesicles, no drainage, no crusting. Slightly tender to the touch. Advised to try treating with antihistamine. Resolution unknown since seen today for the first time. Patient gets a similar rash on her neck as a prodrome to viral illnesses.

Other Meds:

Current Illness:

ID: 1176353
Sex: F
Age: 46
State: CA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 04/07/2021
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: patient presented to the emergency dept with lip swelling and throat fullness after receiving the vaccine. symptoms occurred about 15min after receiving the vaccine. IM diphenhydramine given and symptoms resolved within 15min.

Other Meds:

Current Illness:

ID: 1176354
Sex: F
Age: 84
State: MO

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1176355
Sex: M
Age: 63
State: NJ

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
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: Cipro

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Soreness at the location of shot, fever, chills accompanied by shaking, bad headache, body aches, general weakness and fatigue. Began about 11 hrs after vaccine was administered.

Other Meds: Bentyl Protonix Diclofenac Lexipro Atorvistatin Depacote Baclofen Fish Oil Multi-Vitamin Saw Palmetto Milk Thistle Glucosamine-Chandrotin Quercatin-Bromelain Melatonin Turmeric-Curcumin complex Angelica Root tincture Vitamin C

Current Illness: None, just seasonal pollen allergies

ID: 1176356
Sex: F
Age: 53
State: GA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: Bees/Pollen

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

Symptoms: I have a blister on my arm below injection site and it?s red around the blister.

Other Meds: Metformin 50mg Lisinopril 40mg Amlodepine 10mg Zyrtec Multivitamin Vitamin D3 Vitamin B12 Potassium

Current Illness:

ID: 1176357
Sex: F
Age: 37
State: CA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 04/07/2021
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: Gluten Contrast Dye

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

Symptoms: Muscle Spasms, Nerve Pain, Pain and weakness in left side of face, pain around my eyes, Pain at the base of the skull, face twitching, confusion, dizziness, memory loss, mixing up letters and numbers, slurred speech, brain fog, extreme fatigue, nausea. This was very very intense for about 4 weeks. (At 3.5 weeks started taking 40 milligrams of loratadine daily). I am still experiencing symptoms but less intense than the first month. I am very concerned about my health and well-being. Scared and deeply saddened.

Other Meds: Innate Response Womens once daily vitamin supplement

Current Illness:

ID: 1176358
Sex: F
Age: 41
State: CT

Vax Date: 01/13/2021
Onset Date: 02/02/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Pain in extremity

Symptoms: Dermatitis type rash beginning on left arm then spreading to BUE, upper chest, inner knees, torso, intensely itchy almost hives but not quite. Itched so intense that I itched my skin open. Saw MD was put on prednisone, due to no diagnosis and intensity of itch requested permethrin cream for scabies. I am an LPN at a LTC facility, I sleep in bed with my toddler and not one other person with any of these symptoms so scabies was ruled out. We had a covid outbreak that ended around xmas 2020 I did not catch covid. Rash eventually went away after 2 weeks. I still have some scarring.

Other Meds: Synthroid, topomax, trazadone, neurontin, flexeril, Zyrtec, Wellbutrin

Current Illness: N/a

ID: 1176359
Sex: F
Age: 56
State: MN

Vax Date: 03/11/2021
Onset Date: 03/21/2021
Rec V Date: 04/07/2021
Hospital: Y

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: Burning, sharp pain in middle of chest and back. SCAD. Hospitalized, angiogram and let it heal on its own for 5 weeks. No stress. Outcome unclear.

Other Meds: Atenolol 25mg 1 tablet daily Citalopram 10mg 1 tablet daily Aspirin 81mg chewable 1 tablet daily

Current Illness: None

ID: 1176360
Sex: F
Age: 17
State: TX

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
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 under age 18 was vaccinated with Moderna, which is a vaccine error. Troubleshooting: Scribe and vaccinator did not validate age; screeners at the beginning of the process did not ask or turn her away on a Moderna-only day. An ID requirement has been put in place to prevent this situation from occurring in the future. Follow up to be done by DCHHS Physician or delegee will include specific description of next steps for obtaining dose 2.

Other Meds:

Current Illness:

ID: 1176361
Sex: F
Age: 62
State: CA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
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: I had a bad flare up on my left knee,, I?ve never had one on my knee before. I am taking daily dose of hydroxychloroquine for my rheumatoid arthritis. This is day 3, and it?s getting better. I am taking prednisone and Voltare.

Other Meds: Hydroxychloroquine for RA

Current Illness:

ID: 1176362
Sex: M
Age: 42
State: CA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: PT states he has no allergies.

Symptom List: Vomiting

Symptoms: Paramedic called to observation for 42 YO male with dizziness, lightheaded, and anxiety. Upon arrival PT found sitting in chair A&OX4, skins: pink/warm/dry, pupils: Equal and reactive. Pt speaks very little English and PT's wife translated for him. PT states that he started feeling symptoms 10 minutes after receiving his Pfizer vaccine. Upon assessment PT states he has 10/10 chest pain non radiating/dull in nature with increased pain on inspiration. Pt states that this has happed before a few months ago and was diagnosed with HTN but was not prescribed any medication by his primary care physician. PT does not take any medications and has no allergies. Pt status did not improve or decrease while in the care of the paramedic. Pt vitals then assessed and were as follows: 0943: BP 172/118, HR 71, RR 24, SPO2 99% RA, Lungs clear/equal bilaterally. 1002: BP 180/131, HR 80, RR22, SPO2 98% RA, Lungs clear/equal bilaterally. The paramedic made the decision to activate the EMS 911 system. Upon EMS arrival report given to responding paramedics and PT care transferred. EMS Paramedics began to treat patient for Chest Pain Protocol, and transported PT to Local ER.

Other Meds: PT states he is not taking any medications.

Current Illness: PT states he has HX of HTN and Hyperlipidemia.

ID: 1176364
Sex: M
Age: 64
State: SD

Vax Date: 03/13/2021
Onset Date: 03/27/2021
Rec V Date: 04/07/2021
Hospital: Y

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

Lab Data:

Allergies: Shellfish, Iodine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: SEVERE CHEST PAIN emanating from solar plexus area. Head/Neck/Body aches, chills/fever, nausea, loss of appetite, difficult to breath, sleep and urinate. Dr. told me I have a virus (unknown). COVID-19 Rapid Test- None Detected. LAB RESULTS - 11 anomalies; P02 Venous-23 low, 02 Saturation-43% low, RBC-3.77 low, Hemoglobin-11.7 low, Hemocrit-39.5% low, MPV-7.3 low, Potassium-3.3 low, CK-293 high, Alkaline Phosphate-29 low, Amylase-108 high, Leukocyte Esterase- Trace. Script for 2 days med for nausea and released after 4hours. Symptoms lasted 8 days.

Other Meds: Fenofibrate, Bupropion, Vyvanse, Vitamin C, Multivitamin

Current Illness: NONE

ID: 1176365
Sex: F
Age: 72
State: CA

Vax Date: 04/02/2021
Onset Date: 04/04/2021
Rec V Date: 04/07/2021
Hospital: Y

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

Lab Data:

Allergies: No Known allergies

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

Symptoms: fever, Fatigue, malaise, patient admitted to hospital for adverse events.

Other Meds: N/A

Current Illness: fatigue, malaise, emesis

ID: 1176366
Sex: F
Age: 34
State: MA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/07/2021
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: Tired, chills, achy, slight fever of 99. Tylenol taken, increased water intake, additional hours of bed rest.

Other Meds: Vitamin D

Current Illness:

ID: 1176367
Sex: F
Age: 54
State:

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: dizziness, lightheadness, anxious, headache, observation done, water offered, symptoms resolved, pt went home

Other Meds:

Current Illness:

ID: 1176368
Sex: F
Age: 68
State: SC

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm