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: 1177679
Sex: F
Age: 58
State:

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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: I was told by the pharmacist that people like me who already had COVID (I had it in Nov 2020) may feel adverse effects after the first shot, and he was right. I had similar side effects as when I had COVID and those were: fatigue, muscle pain, joint pain, chills and fever (102 degrees)

Other Meds: Celebrex

Current Illness:

ID: 1177680
Sex: M
Age: 33
State: OK

Vax Date: 04/01/2021
Onset Date: 04/07/2021
Rec V Date: 04/07/2021
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: no

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient was recommended to wait for 15 minutes to monitor for any adverse reactions. Within 15 minutes patient has reactions of nausea, dizziness, paleness of face. We advised patient to sit down and elevated his feet. We gave patient some water. In a few minutes patient was doing better, after 15 more minutes patient was able to go home. No medications given.

Other Meds: no

Current Illness: no

ID: 1177681
Sex: U
Age:
State: AZ

Vax Date:
Onset Date:
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:

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

Symptoms: Fever, chills, pain when breathing in, stomach cramps, body aches. No treatment yet, just fluids.

Other Meds:

Current Illness:

ID: 1177682
Sex: F
Age: 38
State: NY

Vax Date: 03/31/2021
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: pennicillian, sudafed, sulfa drugs, gabapentin/neurontin, cherries, kiwi, other fruits, latex, adhesive

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 3 days later had swollen lymph nodes and my joints hurt, ankles, knees, back and a general malaise feeling 6 days later red itchy lump at injection site on right arm got progressively worse over the next 25 hours .. hot to touch, slightly painful lump and very itchy in that area

Other Meds:

Current Illness: herpes simplex outbreak

ID: 1177683
Sex: F
Age: 74
State: SC

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: codeine, morphine

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

Symptoms: headache, chills, arm and skin hurt, hair hurt, fever, lethargic,lt arm itched, blotchy red

Other Meds: Xanax, lisinopril, atorvastatin, halcyon, dalacyclovir

Current Illness:

ID: 1177684
Sex: F
Age: 48
State: MO

Vax Date: 04/07/2021
Onset Date: 04/07/2021
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: Unknown

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

Symptoms: Patient fainted within five minutes of receiving the shot, she recovered about 15 minutes later.

Other Meds: Unknown

Current Illness: Unknown

ID: 1177685
Sex: M
Age: 15
State: KS

Vax Date: 04/02/2021
Onset Date: 04/02/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient was vaccinated with Pfizer COVID-19 vaccination in error at the age of 15. Patient came to the clinic with both parents. The griage/triage person, table screener and nurse all missed the month and day of his birthdate. The error was discovered in post-dose observation during a casual conversation with nursing staff. Patient was observed for 60 minutes post-dose in abundance of caution, during which time he and his parents were notified of the error. They were instructed to seek medical assistance after discharge in the event of an emergency, and that Patient is not to obtain his second vaccination until is 16th birthday or after. Patient was discharged without any untoward symptoms or problems.

Other Meds: none known

Current Illness: none

ID: 1177686
Sex: M
Age: 34
State: CO

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Mild Fever, mild nausea, mild sore throat

Other Meds: Finasteride, Multi vitamin

Current Illness: None

ID: 1177687
Sex: F
Age: 78
State: PA

Vax Date: 03/05/2021
Onset Date: 03/30/2021
Rec V Date: 04/07/2021
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: penicillin amoxicillin azithromycin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: symptoms, signs, time course, etc.) 78 yo female patient with PMHx of paroxysmal atrial fib / COPD / smoking / anxiety-depression / obesity / arthritis and prior bil PE in 2018 after knee surgery (anticoagulated with Xarelto) who presented to FH on 03/30/2021 with SOB x2 weeks. Of note she received her 2nd COVID vaccine dose on 03/05/2021 and since she has worsening SOB. Pt reported cough w/ yellow sputum prior to her admission. At urgent care, she was hypoxic with Sat 82%, therefore she was transferred to ED for further w/u. Lab w/u showed BNP of 1,074 and trop of 32. She was found to have a negative POC COVID-19 and PCR is pending. Bil venous Dopplers show acute occlusive DVT in the R popliteal vein above and below the knee w/ slow flow in the R fem vein and no DV IN the LLE. TTE on 03/31/2021 showed EF 65-70% w/ G2DD, mod-severe RV failure and severe pulmonary HTN, mod TR, and dilated IVC. Decision was made to CT chest w/ contrast despite renal function given high suspicion for PE. CT chest w/ contrast showed large clot burden PE w/ findings c/w R heart strain, a 12x9 mm lobulated nodule in the RUL concerning for neoplasm, increasing patchy infiltrates, and increasing R pleural effusion and new trace L pleural effusion. Patient required 12L O2 via NC. IR was contacted at but felt that patient was not a candidate for CDT or for IVC filter. Patient was transferred to ICU for further care. Patient received IV heparin per the PE Protocol from, Alteplase 40mg on 4/1, and was started on treatment dose of Eliquis.

Other Meds: Norco 10mg/325mg Albuterol HFA Inhaler Alprazolam 0.5mg Xarelto Aspirin 81mg Dilitazem 120mg/24h Fluoxetine 40mg Trelegy Ellipta Inhaler Furosemide 20mg Ibuprofen 800mg Zofran 4mg

Current Illness: Unknown

ID: 1177688
Sex: F
Age: 19
State: WA

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

Lab Data:

Allergies: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient felt dizzy and sat on the floor. She did not fall or lose consciousness.

Other Meds: medroxyprogesterone, mirtazapine, buspirone.

Current Illness: None

ID: 1177689
Sex: F
Age: 29
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient presented for COVID-19 vaccination. Pfizer vaccine administered as first dose per protocol. Two minutes after vaccine was given (at 1:39pm), patient reported feeling lightheaded and history of passing out after any injections and sight of needles. Patient assisted to the floor to lay flat on back while legs were elevated and oxygen given. Patient stated feeling better while laying down. Patient continued to lie down for 10 minutes as lightheadedness resolved before slowly sitting up. After patient was able to sit up without any further symptoms, patient was able to stand on her own, no further symptoms reported. Patient observed for 30 minutes and left the facility without any further issues.

Other Meds:

Current Illness:

ID: 1177690
Sex: F
Age: 17
State: IA

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

Lab Data:

Allergies: unk

Symptom List: Rash, Urticaria

Symptoms: Patient was only 17, 5 days away from 18th birthday. Vaccination was administered by student. Patient had no side effects after 15 minutes. sister also had vaccine at same time. VAERS created for her as well.

Other Meds: unk

Current Illness: unk

ID: 1177691
Sex: F
Age: 46
State: AL

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

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

Symptoms: Five minutes after receiving her 1st COVID vaccine, patient began complaining about itchiness and swelling of her tongue, along with chest tightness and shortness of breath. Patient also begin feeling lightheaded. Patient was assessed and was found to be breathing, but her pulse was weak and thready. A blood pressure cuff was applied to patient right arm, but the monitor was unable to generate a specific blood pressure number. Patient was administered 0.3 mg of epinephrine intramuscularly in her right thigh. She was also given 10 ml (25 mg) of diphenhydramine. Patient was moved from the sitting to the supine position. Patient's subjective dyspnea improved, and her airway remained intact, with no cyanosis noted. Patient was able to talk normally after a few minutes. Her pulse improved and was strong (+2) about 5 minutes after the epinephrine injection. 911 was called and paramedics arrived about 5 minutes later. Patient was taken away by the paramedics to the hospital, stable and in good condition.

Other Meds: Asmanex, metoprolol er 25 mg

Current Illness:

ID: 1177692
Sex: M
Age: 33
State: MD

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: SYR
Vax Site: LA

Lab Data:

Allergies: N/a

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

Symptoms: Injection site soreness starting approximately 2 hours after injection. Still happening now Moderate Fatigue the following morning still happening now. Moderate Headache starting the next morning still happening now Severe Joint pain over entire body started approximately 24 hours after vaccination, lasting until now. Moderate chills/feeling feverish started approximately 24 hours after vaccination. Still happening now. Moderate Left arm weakness, grip weakness left hand

Other Meds: Adderall, effexor, amlodipine

Current Illness: N/a

ID: 1177693
Sex: M
Age: 17
State: KY

Vax Date: 02/05/2021
Onset Date: 02/05/2021
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: Unknown

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

Symptoms: There was no adverse event or unexpected side effects after vaccination. Instead, it was an administration error, as the Moderna COVID-19 vaccine is not authorized for persons younger than 18.

Other Meds: Unknown

Current Illness: COVID-19 in 01/2021

ID: 1177694
Sex: M
Age: 57
State: FL

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

Lab Data:

Allergies:

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

Symptoms: Patient administered 2.5 mL

Other Meds:

Current Illness:

ID: 1177695
Sex: F
Age: 29
State: NC

Vax Date: 04/02/2021
Onset Date: 04/05/2021
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: rocephin

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

Symptoms: itchy rash in several areas several days post vaccination starting under armpit and also in several other places in body including other armpit hip and side.

Other Meds: none

Current Illness: none

ID: 1177696
Sex: F
Age: 67
State:

Vax Date: 04/07/2021
Onset Date: 04/07/2021
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: patient experienced tongue numbness during the first 15 minutes after the vaccine was administered. Patient received diphenhydramine and felt better shortly after taking the diphenhydramine

Other Meds:

Current Illness:

ID: 1177697
Sex: F
Age: 58
State: CA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt received Pfizer vaccination 1st dose at 1125. Pt was in observation area and complained of an itchy throat, mouth, arms and legs at 1138. No facial swelling noted. No hives or rash noted. VS at 1125: BP 96/60,HR 72, O2 sat 98%, RR 14. VS remained stable. Given Benadryl 25mg PO at 1154. At 1214 pt stated that her throat stopped itching, her mouth still itched. Her arms no longer itched and her legs still itched. NP assessed pt at 1220. Pt voluntarily left at 1223. Had history of seasonal allergies (did not take allergy medicaitons prior to vaccination appt)

Other Meds:

Current Illness:

ID: 1177698
Sex: F
Age: 35
State: MD

Vax Date: 04/07/2021
Onset Date: 04/07/2021
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: none

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

Symptoms: Went to give patient covid shot, ancillary needle provided wouldn't pierce patient skins. Gave patient the 'husband's' dose and went to go get a new needle for husband's shot. Re-entered pharmacy, got needle, and accidentally gave the patient the second dose intended for husband to her. No signs or symptoms as of 3 hours later from event, had patient sit for 30 min to make sure no reaction - but patient reports none. Will follow up with patient tomorrow approximately 24 hours after event.

Other Meds: unknown

Current Illness: none

ID: 1177699
Sex: F
Age: 70
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: Ibuprofen, PCN, Qvar

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

Symptoms: Patient received a dose of Pfizer vaccine today. 10 minutes into her observation period, developed itchy rash over her chest, mild headache with pressure sensation behind her eyes with swelling of her face, shortness of breath and cough, mild chest tightness, nausea without vomiting. No lip swelling.

Other Meds: Metformin, losartan, atorvastatin

Current Illness: No current illness

ID: 1177700
Sex: F
Age: 48
State:

Vax Date: 03/30/2021
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:

Symptom List: Unevaluable event

Symptoms: redness and swelling at injection site

Other Meds:

Current Illness:

ID: 1177701
Sex: F
Age: 30
State: MN

Vax Date: 04/04/2021
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: PCN

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

Symptoms: Arm hurt very badly immediately during and after vaccine in similar sensation to ulnar nerve being struck in arm, bled only a little but caused swelling and then a large bruise developed over the evening of 4/4/2021 and is still dark today (4/7/2021). Concerned my bone was hit with a too long vaccine needle. Had chills/fever evening of 4/4/2021 into morning of 4/6/2021?had to take off work. Have had neurological symptoms ongoing with ?brain fogginess? since 4/5/2021. On 4/6/2021, began to see flashes/spots of light in vision of left eye, which worsened through today. Took off afternoon from work and went to an eye clinic to have eye dilated and looked at, but the spots in vision continue through reporting time (4/7/2021, 5pm CT).

Other Meds: Adderall XR, Wellbutrin, Junel FE

Current Illness: None

ID: 1177702
Sex: F
Age: 40
State: CA

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 04/07/2021
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: Allergic to grass

Symptom List: Injection site pain, Pain

Symptoms: Numb, swollen and tingling tongue and mouth (lasted for about a week) Headache, severe dizziness

Other Meds: Levothyroxine Gabapentin Lamotrigene Juice plus - fruit Juice plus -veggie

Current Illness:

ID: 1177703
Sex: F
Age: 24
State: CT

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: SYR
Vax Site: LA

Lab Data:

Allergies: unknown - on her consent form she stated she does not have any allergies to medications, food or other products

Symptom List: Injection site pain, Menorrhagia

Symptoms: The patient received the vaccine and was waiting her 15 minutes to make sure she didn't have any reactions. Approximately 8 minutes after the vaccine was administered and the patient passed out . She did not report that she was not feeling well until after she came to. She then reported dizziness and nausea. She laid on the floor in the recovery position on the floor for about 30 minutes before feeling ok enough to sit in the chair and eventually be able to walk out of the store.

Other Meds: unknown - patient doesn't use our pharmacy for medications

Current Illness: unknown

ID: 1177704
Sex: M
Age: 29
State: KY

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

Lab Data:

Allergies: NONE

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

Symptoms: PT came in to get his first Moderna Covid shot. After patient was done, patient walked out and sat in the waiting room chair. 7 minutes into sitting down patient passed out and fell out of the chair and hit the floor. When the pharmacist came out to the patient, to assure their safety, moments after getting his safety assured. Pt informed the staff that he had not eaten anything in 12 hours before getting the shot. Pt was given Orange juice, to get his sugar back up. The Pharmacist check his blood pressure and it was 117/78. Pulse was 53 so it was low as expected post- syncope episode. Pt waited for his mother before leaving allowing him to be safe afterwards.

Other Meds: NONE

Current Illness:

ID: 1177705
Sex: M
Age: 67
State: LA

Vax Date: 02/19/2021
Onset Date: 03/12/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: CHRONIC CHEST PAINS; SHORTNESS OF BREATH, NAUSEA all occurring in any physically involved activity such as walking, climbing the stairs, and wieght lifting.

Other Meds: None

Current Illness: None

ID: 1177706
Sex: M
Age: 25
State: FL

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: THE CUSTOMER WAS SWEATING AND TINGLING IN THE ARMS

Other Meds: N/A

Current Illness: N/A

ID: 1177707
Sex: F
Age: 41
State:

Vax Date: 03/21/2021
Onset Date: 03/21/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: nose bleed 15 minutes after vaccine administration, observed and discharged home

Other Meds:

Current Illness:

ID: 1177708
Sex: F
Age: 38
State: VA

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Fatigue, fever, headache, chills, muscle aches, injection site pain

Other Meds: Synthroid 100mg Loestrine Fe

Current Illness:

ID: 1177709
Sex: F
Age: 28
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: patient complains of pain shooting from injection site in upper left arm to left hand. no left hand weakness. no left or right arm numbness or tingling, no left or right arm weakness.

Other Meds: none

Current Illness: none

ID: 1177710
Sex: F
Age: 22
State: UT

Vax Date: 03/15/2021
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: None

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

Symptoms: Fever: 3/17 at 5:00 pm to 3/18 at 4:00 pm Headache: 3/17 at 4:00 to 3/18 at 10:00 pm

Other Meds: None

Current Illness: None

ID: 1177711
Sex: F
Age: 31
State:

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: flagyl

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

Symptoms: nausea, dizziness, fatigue, sweating, severe muscle aches

Other Meds: gabapentin 400 mg qd Metoprolol 25mg qd Midodrine 2.5mg TID Wellbutrin XL 300 mg qd Cymbalta 60 mg Bid Tizanidine 2 mg q8hrs prn Vistaril 25 mg q6hrs prn omeprazole 40mg qd

Current Illness:

ID: 1177712
Sex: F
Age: 50
State: MI

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: Dilantin - rash

Symptom List: Tremor

Symptoms: Patient developed throat swelling and difficulty swallowing within minutes of receiving the vaccine. She received EPI at the site and went to the ED where she was treated for allergic reaction. No other organ systems were involved. She received steroids and antihistamines.

Other Meds: none

Current Illness: None

ID: 1177713
Sex: F
Age: 41
State: NV

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Headache, body aches, fever, arm soreness

Other Meds: None

Current Illness: None

ID: 1177714
Sex: F
Age: 46
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: Approx 4 hrs after vaccine administration c/o back hurting at work. States it continued to bother her. She took her prn meds for back pain around 2200 that night with no relief. States it continues to hurt in lower back and down into legs

Other Meds: oral diabetes med celebrex methocarbamol

Current Illness:

ID: 1177715
Sex: F
Age: 58
State: MA

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: IM
Vax Site: LA

Lab Data:

Allergies: Peniccilin

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

Symptoms: Woke up this morning feeling fine, showered, went downstairs to make tea, felt suddenly strange. Intense nausea and faintness. Lost consciousness for about 30 seconds (according to my husband).

Other Meds: None

Current Illness: None

ID: 1177716
Sex: F
Age: 57
State: FL

Vax Date: 03/29/2021
Onset Date: 04/07/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: soreness in arm, lump, hot to touch, itchy, left arm tingly and numb

Other Meds: vitamins

Current Illness:

ID: 1177717
Sex: M
Age: 36
State: TX

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: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Lightheaded, dizziness, feeling warm BP 137/89 HR 101 Sp02; 99% seen and cleared by EMS

Other Meds: None

Current Illness:

ID: 1177718
Sex: F
Age: 63
State: TX

Vax Date: 03/22/2021
Onset Date: 03/22/2021
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: Pencillin

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

Symptoms: Approximately 30 minutes after injection, while driving to work. My vision became blurry and felt extremely weak. I arrived at my office very pale, weak, and very blurry vision, develop fever of 100.1. Symptoms lasted 12-18 hours

Other Meds: rovustatin

Current Illness: none

ID: 1177719
Sex: F
Age: 46
State: AZ

Vax Date: 03/24/2021
Onset Date: 03/27/2021
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: Pain in extremity

Symptoms: March 24-26: Pain in left arm March 27-April 2: Mild numbness on left side of upper body - starting at left shoulder blade March 3-Current: Tenderness/soreness under left armpit area and left breast. Painful sores/breakout on left side of left breast

Other Meds: NP Thyroid 30 MG Progesterone 100 MG Dim Evail (diindolylmethane) 100 MG Following only on day of vaccine: Boiron Ledum 30C: 3 pellets Boiron Arnica 30C: 3 pellets Boiron Thuja 30c: 3 pellets 200 mg Tylenol

Current Illness: None

ID: 1177720
Sex: M
Age: 60
State: NC

Vax Date: 03/10/2021
Onset Date: 03/20/2021
Rec V Date: 04/07/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient developed VI cranial nerve palsy 10 days after receiving immunization.

Other Meds:

Current Illness:

ID: 1177721
Sex: F
Age: 17
State: TX

Vax Date: 03/05/2021
Onset Date: 03/05/2021
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: No known allergies

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

Symptoms: Patient received the Moderna vaccine on 03/05/2021. Patient stated only experienced some soreness and fatigue after receiving the vaccine. Patient was 17 years old at the time of vaccination. No adverse reactions were noted as a result of receiving the vaccine.

Other Meds:

Current Illness:

ID: 1177722
Sex: F
Age: 55
State: WI

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

Lab Data:

Allergies: Latex, Sulfa, Silvadene

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

Symptoms: patient had completed wait time in the observation room and was at the main lobby door on her way out when she stated she was having trouble breathing. The concierge put the patient in a wheelchair and brought the patient to the emergency department. Nothing noted during the observation time.

Other Meds: not aware of medications

Current Illness: not aware of

ID: 1177723
Sex: F
Age: 43
State: UT

Vax Date: 03/26/2021
Onset Date: 03/26/2021
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: none reported

Symptom List: Vomiting

Symptoms: Vaccine mixed with incorrect diluent (sterile water instead of normal saline). Pt informed of error and offered revaccination. Pt reports no adverse reactions.

Other Meds: none reported

Current Illness: none reported

ID: 1177724
Sex: F
Age: 28
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: VACCINATOR WAS REMOVING THE CAP FROM A CLEAN NEEDLE AND SLIGHTLY STUCK HR LEFT MIDDLE AND RING FINGER. VACCINE WAS WASTED. VACCINATOR WASHED OFF AREA WITH SOAP AND WATER. THIS WAS A CLEAN NEEDLESTICK. SAFETY, DIRECTOR WERE NOTIFIED.

Other Meds:

Current Illness:

ID: 1177725
Sex: F
Age: 48
State: WY

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

Lab Data:

Allergies: Solumedrol Prednisone

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

Symptoms: Five min after vaccination pt felt tingling in tongue, lips, mouth, coughing, flushed skin . Os sat was 99% room air, pulse 67, lungs clear bilaterally to auscultation. Sx fully resolved at 3:55 pm without use of medication.

Other Meds: Coumadin Sertraline Vitamin D Vitamin B Ibuproprion

Current Illness:

ID: 1177726
Sex: M
Age: 25
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received vaccination at site and came to pod as elevate employee Patient reported feeling lightheaded and right hand pain with mild rash Patient provided with water and seen by medical team Patient refused medical transport and signed form Patient stated symptoms improved, Patient is an elevate employee and will be sent home early

Other Meds:

Current Illness:

ID: 1177727
Sex: F
Age: 63
State: NY

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: NKDA, NKFA, NKEA

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

Symptoms: 63 y/o female with PMH of GI issues, s/p ileostomy c/o pain (4/10) in her left shoulder and left SCM. Pt was assessed by clinical leads and a heat pack was applied to her left shoulder. Pt was re-assessed 2 minutes later to monitor symptoms. Pt appeared diaphoretic, pale, complaining of dizziness + nausea. Ice packs were applied to her neck and forehead and EMS was called to monitor vitals, lay pt on a stretcher, 2L O2 via nasal canula. Pt reported "feeling awful" and did not respond to any questions, pt maintained consciousness throughout the entire encounter. Pt was attached to a monitor and a 12 lead EKG was obtained that showed evidence of a wide QRS, new right bundle branch, prolonged QT and T wave changes. Pt denied any cardiac history or history of abnormal EKGs or similar prior experiences. She was immediately transported via EMS to the Hospital Emergency Room for further evaluation, pt gave consent for transport. Pt denied notifying / calling a family member or friend to inform them. Denies chest pain, LOC, SOB, respiratory distress, vomiting, itchiness, erythema, swelling, HA, similar prior experiences PMH: weak pelvic floor, IBS, imbalanced gut flora, ileostomy for unknown reason - DENIES history of: cardiac issues, pulmonary issues, diverticulitis, cancer, autoimmune conditions (ulcerative colitis, crohns) Surgical History: ileostomy, C-section Meds: Linzess, Motegrity, Baclofen, Liothyrozine Vaccine was administered at 11:48 am in the left deltoid. Pt began experiencing symptoms at ~ 12:03pm. General: A&Ox3 HEENT: NC/AT, EOMI, PERRL, airway patent, no trismus MSK: tenderness to left SCM, neurologically intact b/l, brisk capillary refill b/l, radial pulse 2+ b/l, full ROM b/l, 5+ strength b/l Skin: diaphoretic, pale Pulmonary: clear to auscultation b/l Vitals: @12:09: BP: 74/52, HR: 53, SpO2: 96% RA, @12:12 2L O2 NC @12:13: BP: 106/73, HR: 72, SpO2: 97% 2L NC @12:15: SpO2: 99% 2L NC @12:16: BGM: 118 @12:20: BP: 112/77, HR: 69, SpO2: 100% 2L NC

Other Meds: Linzess, Motegrity, Baclofen, Liothyronine

Current Illness: none

ID: 1177728
Sex: M
Age: 56
State: LA

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

Lab Data:

Allergies:

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

Symptoms: Upon verifying the vaccine information was documented correctly in our system we discovered that the patient has received another 2 dose series at another location. The patient did not disclose this information to us at any point while filling out his consent form.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm