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: 1177984
Sex: M
Age: 33
State: TX

Vax Date: 04/03/2021
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: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: body Rash

Other Meds: Tylenol

Current Illness: None

ID: 1177985
Sex: F
Age: 36
State: NC

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Sulfa drugs, pertussis vaccine

Symptom List: Anxiety, Dyspnoea

Symptoms: Approximately 10 minutes after receiving the vaccine I began to notice generalized redness/flushing and an increase in temperature of my face, ears and neck. Started on the left side and spread to the right as well. Took 1000mg acetaminophen orally and the redness/flushing resolved after about 2.5-3 hours.

Other Meds: Metformin 100mg daily, seroquel XR 600mg daily, sertraline 100mg daily, buspar 45mg daily, levothyroxine 200mcg daily, B complex vitamin, women?s multivitamin

Current Illness: None

ID: 1177987
Sex: F
Age: 40
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: Injection site bleeding at time of shot. Second bandaid applied. Dizziness and nausea within 20 mins of shot Shortness of breath (when walking) within one hour Fogginess Extreme fatigue Muscle weakness Arm pain at and around injection site radiating up left side neck area Over 24+ hours later all side effects persists

Other Meds: Lamotrigine Prazosin Wellbutrin Lorazepam Metformin Ferrous sulfate Vitamin C Tylenol

Current Illness: Cervical dysplasia

ID: 1177988
Sex: M
Age:
State: AL

Vax Date:
Onset Date: 03/27/2021
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: FELT HOT; FATIGUE; This spontaneous report received from a patient concerned a 59 year old male. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805025, and expiry: UNKNOWN) dose was not reported, administered to left arm on 26-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-MAR-2021, the subject experienced felt hot. On 27-MAR-2021, the subject experienced fatigue. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from felt hot, and fatigue on 28-MAR-2021 17:00. This report was non-serious.

Other Meds:

Current Illness:

ID: 1177989
Sex: F
Age: 31
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: Vancomycin, penicillin, an effective, levaquin, hydroxychloroquine

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

Symptoms: Patient reported feeling dizzy, anxious, fatigued and chest tightness Patient provided with water and seen by medical team Patient refused medical transport and signed AMA form Patient stated symptoms improved and will be driven home by mother

Other Meds: Hydrochloroquine

Current Illness:

ID: 1177990
Sex: M
Age: 70
State: AZ

Vax Date: 03/27/2021
Onset Date: 04/02/2021
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: None

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

Symptoms: Had a 2nd Moderna vaccine on 3/27/21, developed hives all over body on 4/2/21.

Other Meds: Simvastatin, Amlodipine, Vitamin D

Current Illness: None

ID: 1177991
Sex: F
Age: 65
State: WA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: Severe Guillain Barre Syndrome

Other Meds:

Current Illness:

ID: 1177992
Sex: M
Age: 55
State: MI

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: ERYTHROMYCIN, CIPRO

Symptom List: Pharyngeal swelling

Symptoms: MY HUSBAND RECEIVED HIS SECOND COVID SHOT AT 1:30 PM AND WHEN I CAME HOME AT 5:30ISH HE WAS BEET RED ON HIS FACE ARMS AND UPPER BODY. HIS LEGS LOOKED FINE. HIS COLORING LOOKED LIKE HE WAS HOLDING HIS BREATH. HE FELT FINE AND HIS BLOOD PRESSURE WAS FINE. MY SON WAS ALSO CONCERNED WHEN HE SAW HIS COLORING. IT ENDED UP GOING AWAY AND THEN AGAIN IN THE MORNING IT WAS BACK AFTER HE WAS UP FOR A WHILE. THE REDNESS HAS SUBSIDED BUT HE IS STILL A LITTLE PINK . NO OTHER SYMPTOMS

Other Meds: METFORMIN 500MG 2XDAILY-PRAVASTATIN 80MG 1XDAILY-LOSARTAN 50MG 1XDAILY-AMLODIPINE 10 MG 1XDAILY VITAMINS DAILY D,C,ZINC AND BABY ASPRIN - HAD A KNEE REPLACEMENT IN JANUARY SO I TAKE MOTRIN OR TYLENOL AS NEEDED

Current Illness: NONE

ID: 1177993
Sex: F
Age: 53
State: VT

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: Cipro, Sulfa antibiotics.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient reports no reaction near injection site on arm, but swelling and inflammation near lips / cheek after injection about 5 hours after injection. Patient told to take a Benadryl if the swelling gets worse and if worsens further to seek urgent care. No reported breathing issues or throat swelling / closing.

Other Meds: Albuterol HFA, Buspirone, Flovent, Duoneb, Lisinopril, Rosuvastatin, Spiriva, Venlafaxine.

Current Illness:

ID: 1177994
Sex: F
Age: 52
State: IN

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: Dilapidated, nitroglycerin, morphine, ibuprofen, and many more listed on record

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Weakness, difficulty breathing. Lasted 3 days. Deep cough and lethargic still. Over a week later. Contact pc and advised if symptoms got worse to go to er. Not worse but won't go away

Other Meds: Valium, clonidine, nortriptyline

Current Illness:

ID: 1177995
Sex: F
Age: 35
State: AK

Vax Date: 04/02/2021
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: Codeine, penicillin, wheat, coffee, gold

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

Symptoms: Rash on back of neck that appears and goes away, bumpy, not red, itchy; happens daily multiple times a day since 4/3/21

Other Meds: Liothyronine, magnesium oxide, omega3/fish oil, curaphen, adrenaplex, vit d3, cal/mag/zinc, probiotic, methyl cobalamin

Current Illness: None

ID: 1177996
Sex: M
Age:
State: TX

Vax Date:
Onset Date: 03/31/2021
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:

Symptom List: Rash, Urticaria

Symptoms: FEVERISH; MUSCLE ACHES; This spontaneous report received from a consumer concerned a 28 year old male. The patient's weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1808609, and expiry: UNKNOWN) dose was not reported, administered on 31-MAR-2021 on right arm for prophylactic vaccination. No concomitant medications were reported. On 31-MAR-2021 18:00 pm, the subject experienced muscle aches. On 1-APR-2021 13:00 am the subject experienced feverish. On 01-APR-2021, Laboratory data included: Body temperature (NR: not provided) 102.5 F. Treatment medications (dates unspecified) included: dextromethorphan hydrobromide/doxylamine succinate/ephedrine sulfate/ethanol/paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from feverish, and muscle aches. This report was non-serious.

Other Meds:

Current Illness:

ID: 1177997
Sex: F
Age: 50
State: PA

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: LA

Lab Data:

Allergies: Benadryl & Codeine

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

Symptoms: Diarrhea, Vomiting, itching (on legs, arms, and stomach with no visible rash) - patient called today to discuss, she said there were no signs of swelling on her face, mouth or throat - we discussed taking an antihistamine (she's allergic to benadryl) and monitoring, if she felt symptoms were worsening then she will seek medical treatment

Other Meds: unknown

Current Illness: unknown

ID: 1177998
Sex: F
Age: 66
State: CA

Vax Date: 03/04/2021
Onset Date: 03/08/2021
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: Codein

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

Symptoms: Extremely bad case of Tinnitus and I am still suffering from it.

Other Meds:

Current Illness:

ID: 1177999
Sex: M
Age: 22
State: MT

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: 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: Erythema chest, abd, back, both upper extremities. Urticaris decranon regions both arms 8 hours after vaccine

Other Meds:

Current Illness: No

ID: 1178000
Sex: F
Age: 56
State: VA

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: None

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

Symptoms: Immediately dizzy when I walked out of room and within a few moments felt disoriented. I sat in my car for 20 min and felt ok enough to drive home but was overwhelmed with fatigue. It is 3 hours since vaccine and lethargy is same and am unsteady when walking

Other Meds: None

Current Illness: None

ID: 1178001
Sex: M
Age: 36
State: TN

Vax Date: 04/06/2021
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: None

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

Symptoms: I had a seizure around 5 minutes after the shot. I was feeling sweat and my vision started to fade...I can explain further on a call or email.

Other Meds: Bupropion XL 150mg

Current Illness: None

ID: 1178002
Sex: F
Age: 64
State: NC

Vax Date: 04/05/2021
Onset Date: 04/06/2021
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: History of penicillin allergy

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I began to get a severe hives reaction located on both hips, upper thigh on right leg, behind my neck and all across upper pubic bone. Very itchy and red rash. Do not recall this delayed reaction after the first vaccine. I did a virtual visit with ED. I do not tolerate Benadryl so was prescribed Vistaril and use hydrocortisone cream. I do have many pictures as documentation.

Other Meds: Multi- vitamin daily

Current Illness: None

ID: 1178003
Sex: F
Age: 69
State: PA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: environmental allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: needle broke in arm

Other Meds: restasis, allegra, vitamins

Current Illness:

ID: 1178004
Sex: F
Age: 69
State: NY

Vax Date: 03/15/2021
Onset Date: 03/15/2021
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:

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

Symptoms: Eight hours after receiving the shot, I experienced severe chills, headache, nausea, and dizziness. This subsided by 2PM the following day. However, within a few hours after it subsided, I experienced nausea, dizziness, heaviness in the back of my head and intermittent headaches on and off for the next 3 weeks. The severity is diminishing, but it has not gone completely away.

Other Meds:

Current Illness:

ID: 1178005
Sex: M
Age:
State: PA

Vax Date:
Onset Date: 03/31/2021
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:

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

Symptoms: SWEATING; DRY MOUTH; INAPPROPRIATE AGE AT VACCINE ADMINISTRATION; OFF LABEL USE; FEVER; This spontaneous report received from a patient concerned a 17 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included non alcohol user, and non smoker, and other pre-existing medical conditions included the patient had no known allergies. the patient did not have any drug abuse/illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 31-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 31-MAR-2021, the subject experienced sweating. On 31-MAR-2021, the subject experienced dry mouth. On 31-MAR-2021, the subject experienced inappropriate age at vaccine administration. On 31-MAR-2021, the subject experienced off label use. On 31-MAR-2021, the subject experienced fever. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from off label use, and the outcome of sweating, fever, dry mouth and inappropriate age at vaccine administration was not reported. This report was non-serious.

Other Meds:

Current Illness: Abstains from alcohol; Non-smoker

ID: 1178006
Sex: M
Age: 58
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish,levaquin,erthromycin, vancomycin,

Symptom List: Unevaluable event

Symptoms: Fever, fatigue, headache,lung congestion,eye pain,hand and feet pain(cramps needle/pins poking)eyes blurred,sleepness

Other Meds: Metformin, gabapentin, insulin, hydrocodone,vericonazole,plavix

Current Illness: Diabetes,valley fever,copd, neuropathy,cancer?,heart disease

ID: 1178007
Sex: M
Age: 20
State: GA

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: LA

Lab Data:

Allergies:

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

Symptoms: After the patient received the immunization for Moderna, he sat in the waiting area for about 5 minutes and started to sweat profusely and have blurry vision. that eventually resolved after 15-20 minutes of rest, cold compress, and drinking water.

Other Meds:

Current Illness:

ID: 1178008
Sex: F
Age: 26
State: IL

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

Lab Data:

Allergies: Covid-19 (mrna) Vaccine No severity specified - Other (see Comments) : Added today-itching, throat tightness (to premedicate wtih Benadryl prior to 2nd vaccine) Medication allergy Latex No severity specified - Swelling

Symptom List: Injection site pain, Pain

Symptoms: Patient is here today for COVID-19 immunization per federal guidelines/written order. See immunization activity for details. Patient was observed post-immunization for a minimum of 30 minutes due to previous history of immediate allergic reaction to a vaccine or injectable therapy and/or history of anaphylaxiswith evidence of throat tightness and itching. Anaphylaxis Management Standing Order protocol initiated. Physician/APP notified of patient condition. Additional orders received: per Doctor: Benadryl 50 mg IM x one. COVID-19 (MRNA) VACCINE Allergen added to patient's Allergies. VAERS reporting completed as appropriate. . 1400: At end of 30 minute observation period (due to hx of latex allergy), patient complained of itching on chest and throat with some 'tightness' in her throat. Patient escorted to exam room and met with RN and the doctor. 1405: Benadryl 50 mg IM given right deltoid per order of the doctor who examined and talked with patient. Will monitor additional 30 minutes post injection per MD order. 1412: BP 120/64, P 61, Pulse Ox 100% on room air. 1414: Patient states she can now swallow with ease. 1418: Patient states swallowing is good and itching is subsiding. 1425: Patient states feeling much better, just sleepy (spouse is driving her home). 1432: Redness on chest gone, patient states itching has resolved and throat is open. Breathing unlabored with no additional symptoms. Discharged ambulatory to meet husband downstairs who will drive her home. Per direction of Doctor, patient will premedicate with oral Benadryl prior to receiving 2nd COVID vaccine. Patient verbalizes understanding. COVID-19 post-vaccination Patient Instructions added to After Visit Summary for patient to review.

Other Meds: acetaminophen (TYLENOL) 325 MG Tablet atenolol (TENORMIN) 50 MG Tablet Etonogestrel 68 MG Implant hydrOXYzine (ATARAX) 25 MG Tablet ibuprofen (MOTRIN) 800 MG Tablet omeprazole (PriLOSEC) 20 MG CAPSULE DELAYED RELEASE ondansetron (ZOFRAN-ODT

Current Illness: Labor, false (Braxton-Hicks) 10 years ago CHB (complete heart block) (HCC) 2 years ago S/P placement of cardiac pacemaker 3 years ago Exercise intolerance 1 year ago Palpitations 2 years ago Pacemaker syndrome 1 year ago Acute respiratory failure with hypoxia (HCC) 1 year ago Acute post-operative pain 1 year ago Acute blood loss as cause of postoperative anemia 1 year ago Acute cholecystitis 1 year ago S/P laparoscopic cholecystectomy 1 year ago Urinary tract infection without hematuria 1 year ago Biventricular cardiac pacemaker in situ 1 year ago Family history of colon cancer in mother Unknown Family history of ovarian cancer Unknown Diverticulitis 1 year ago Elevated LFTs 1 year ago Diverticulosis of colon without hemorrhage 1 year ago PSVT (paroxysmal supraventricular tachycardia) 3 years ago AV block 3 years ago ADHD 2 years ago Cerebral palsy 2 years ago Chest pain 3 years ago Cephalalgia 5 years ago Essential hypertension 3 years ago Irregular menses 3 years ago Leukocytosis 6 years ago Ventral hernia 3 years ago Wide-complex tachycardia 3 years ago Nexplanon removal 1 year ago Insomnia due to anxiety and fear 2 years ago Witnessed apneic spells Unknown OSA (obstructive sleep apnea) Unknown H/O: Cesarean Section 7 years ago Shortness of breath 2 years ago ANA positive 6 years ago Fever, low grade 6 years ago Thrombocytopenia 6 years ago Viral infection 6 years ago Inappropriate sinus tachycardia 2 years ago

ID: 1178009
Sex: F
Age: 76
State: IL

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: NO

Symptom List: Injection site pain, Menorrhagia

Symptoms: PT FELET DIZZY. BP SHOWED 141/70. PULSE -64

Other Meds: PT FELT DIZZY. I CHECKED HER BP AND IT CAME AS 141/70. PULSE 64. SHE HAD LITTLE RINGING IN HER EAR ALSO

Current Illness: NO

ID: 1178010
Sex: M
Age: 29
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: pt said he was feeling anxious and sat near EMS, he was a bit sweaty and anxious. after sitting for 15minutes he felt better after getting snacks. pt decided to leave after feeling better and more calm. staff was with patient for reassurance and observation for any reaction.

Other Meds:

Current Illness:

ID: 1178011
Sex: F
Age: 63
State: NH

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: penicillin, sulfa drugs

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Sudden onset severe hypertension documented by on-site medical personnel followed by documentation by responding ambulance personnel.

Other Meds: fluticasone propionate 110 mcg

Current Illness:

ID: 1178012
Sex: M
Age: 34
State: FL

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: PATIENT INJECTED WITH A PRE-FILLED SYRINGE WITH A TEMP EXCURSION; PATIENTS WERE AFFECTED; This spontaneous report received from a consumer concerned a 34 year old male. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 31-MAR-2021 09:05 on left arm for prophylactic vaccination. No concomitant medications were reported. On 31-MAR-2021, the subject experienced subject injected with a pre-filled syringe with a temp excursion. On 31-MAR-2021, the subject experienced subjects were affected. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the patient injected with a pre-filled syringe with a temp excursion and patients were affected was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1178013
Sex: F
Age: 36
State: MI

Vax Date: 02/01/2021
Onset Date: 02/01/2021
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: NKA

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

Symptoms: I began to feel nauseous about 11.5 hours after my shot. I got chills, total body aches, nausea (though I never vomited), and headache for 15 solid hours. Afterward I felt weak, like getting over the flu. This is follow-up to VAERS .

Other Meds: Pristiq, Wellbutrin, Vit D

Current Illness: N/A

ID: 1178014
Sex: M
Age: 17
State: WA

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: Moderna Vaccine given by mistake to 17 year old.

Other Meds:

Current Illness:

ID: 1178015
Sex: F
Age: 46
State: NY

Vax Date: 01/15/2021
Onset Date: 01/21/2021
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: The week after the first dose of the vaccine, I had extreme pain in my arm pit and numbness in my left arm. My arm was cold to the touch. I went to Urgent Care after the pain lasted for over two hours. They did all sorts of tests to check my heart, lungs, blood pressure and everything was normal. I had a lump under my armpit and also swollen lymph nodes in my elbow. They thought the swelling of the lymph nodes were due to the vaccine. The pain in my arm pit went away after 48 hours, but the pain in my elbow still exists. I will be seeing an orthopedic doctor next week on April 13, 2021.

Other Meds: none

Current Illness: none

ID: 1178016
Sex: M
Age: 47
State: NC

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: Prior to this vaccine - No Known Allergies

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

Symptoms: Pfizer vaccine given IM and approximately 13 minutes after injection pt states that his throat felt tight and "funny". States he can swallow but it felt "funny". Denied shortness of breath or any other symptoms. Oxygen sat was 96%. BP 172/80 pulse 74. He was on hemodialysis treatment at the time. No other medications had been given. After initial assessment, S Standish, NP notified and Diphenhydramine 50mg was given IV and oxygen was given. Pt states he felt sleepy and after about 30 minutes his symptoms subsided altogether other than feeling anxious. Nursing staff stayed right with pt and helped to let him know that we were with him and pt verbalized that he was "fine." Vital signs remained the same and treatment continued. Pt left after his 3:30 treatment with all symptoms completely resolved.

Other Meds:

Current Illness:

ID: 1178017
Sex: F
Age: 61
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient administered 2.5mL

Other Meds:

Current Illness:

ID: 1178018
Sex: F
Age: 61
State: GA

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: IM
Vax Site: LA

Lab Data:

Allergies: Naproxen

Symptom List: Tremor

Symptoms: Moderna Covid-19 vaccine EUA - Patient was administered her 2nd Moderna vaccine 21 days after her 1st Moderna dose.

Other Meds: N/A

Current Illness: None

ID: 1178019
Sex: M
Age: 31
State: WA

Vax Date: 03/30/2021
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: Vertigo and dizziness (which I?ve never experienced before) began this morning and can think of no other probable explanation, thought I?d share.

Other Meds:

Current Illness:

ID: 1178020
Sex: F
Age:
State: MI

Vax Date:
Onset Date: 03/30/2021
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: HIVES RIGHT, LEFT LEG, BACK AND RIGHT CALF; This spontaneous report received from a patient concerned a female of unspecified age. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1805020 and expiry: UNKNOWN) dose was not reported, administered on 28-MAR-2021 17:00 vaccinated on left arm for prophylactic vaccination. No concomitant medications were reported. On 30-MAR-2021, the subject experienced hives right, left leg, back and right calf. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from hives right, left leg, back and right calf. This report was non-serious.

Other Meds:

Current Illness:

ID: 1178021
Sex: F
Age: 33
State: CT

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: Gluten, blueberries

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

Symptoms: Severe itching on chest, neck, face, throat felt like it was closing up, benadryl was taken twice

Other Meds: Zinc, Vitamin C, Claritin, Vitamin D,

Current Illness: none

ID: 1178022
Sex: F
Age: 47
State: FL

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: morphine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Slight loss of hearing, vision completely whited out, blood pressure dropped to 60/40. I felt very sleepy. This started about 2 or 3 minutes after the vaccine was injected. Medics started me on oxygen and elevated my feet. Attempted to start an IV (not successful because I have hard to find veins), checked blood sugar (normal) and did EKG (normal). After about 15 minutes my blood pressure returned to normal and I felt fine except for a headache. They wanted to send me to the hospital but I refused. My primary care physician advises me to not take the second dose of this vaccine.

Other Meds: Levothyroxine, pantoprazole, paroxetine, black cohosh, elderberry sambucus, multivitamin

Current Illness: a cold approximately 3 weeks prior

ID: 1178023
Sex: F
Age: 37
State: MA

Vax Date: 03/24/2021
Onset Date: 04/03/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

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

Symptoms: Admitted with ischemic stroke and multiple thrombi in extremities

Other Meds: Norethindrone-ethinyl estradiol Sertaline 50 mg Wellbutrin

Current Illness: none

ID: 1178024
Sex: F
Age: 33
State: CT

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Immediately following vaccination patient passed out in the chair. Woke up approximately 10-15 seconds later, skin very pale white, clammy. Patient stated she "did not feel right". When asked to describe her symptoms, the patient said she felt "tingly and dizzy". Pharmacist gave patient water bottle and a breakfast bar. Patient ate most of the breakfast bar and then said she felt like she was "going to throw up". Patient then vomited 3 times in the trash can. Immediately after vomiting, patient's color skin color returned to normal and she stated she "felt much better". BP checked and within normal range. Patient stayed at the pharmacy for 45 min for observation and drank a second water bottle. Refused medical care and refused to have someone pick her up from the pharmacy. Pharmacist followed up with patient via a phone call at 6:20pm. Patient said she was feeling much better and had no other adverse reactions.

Other Meds:

Current Illness:

ID: 1178025
Sex: M
Age: 36
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: LA

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: patient felt as if he was having an asthma attack following vaccination. he denied chest pain. no cough.

Other Meds: none

Current Illness: none

ID: 1178026
Sex: F
Age: 52
State: WI

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: Codeine - nausea

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

Symptoms: Patient developed a headache over the frontal region, above left eye and back of head at 4 PM following the vaccination. The headache was followed by nausea and fatigue the following morning and left her in bed through Saturday (day 3 following vaccination). She was seen by ER on Saturday morning and was given lorazepam, ondansetron, scopolamine and IV fluids. She was diagnosed with vertigo and the scopolamine continued in place through Tuesday. Symptoms resolved following the Emergency Room visit and she remains asymptomatic today (21 days later).

Other Meds: Prevagen, multiple vitamin

Current Illness: None

ID: 1178027
Sex: F
Age: 68
State: CA

Vax Date: 03/26/2021
Onset Date: 03/28/2021
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: Latex

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

Symptoms: Eye and face Shingles

Other Meds: Lisinopril

Current Illness: None

ID: 1178028
Sex: M
Age:
State:

Vax Date:
Onset Date:
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: VOMITING; CHILLS; NOT FEELING WELL; This spontaneous report received from a consumer concerned a male of unspecified age. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the subject experienced vomiting, chills, and not feeling well. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the chills, vomiting and not feeling well was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1178029
Sex: F
Age: 66
State: IN

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Sulfa drug allergies

Symptom List: Vomiting

Symptoms: Started with headache, aches in joints and muscles, stomach pain. Slept most of the day Wednesday and by Wednesday evening was feeling a little better. No appetite.

Other Meds: As listed in my medical profile Cholesterol medicine Blood pressure medicine

Current Illness: None

ID: 1178030
Sex: F
Age: 72
State: MD

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: On the day after my second shot, I woke up feeling poorly. I had a headache and my body ached all over. I was fatigued. The injection site was sore.

Other Meds: Aimovig, Lunesta, Verapail, Meloxicam

Current Illness: None

ID: 1178031
Sex: F
Age: 69
State: NV

Vax Date: 03/22/2021
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: RA

Lab Data:

Allergies: Erythromycin

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

Symptoms: Rash and itching on neck and chest in V-shape Looks like sunburn from V-neck tee-shirt Itchy and rough little bumps some neck swelling taking Benadryl April 6 April 7 taking Hydroxyzine 25mg applying cold pack to reduce swelling

Other Meds: simvastatin 40mg levothyroxin 75mg fluoxetin10mg alprazolam 25mg calcium citrate +D3

Current Illness: none

ID: 1178032
Sex: F
Age: 68
State: TX

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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Arm slightly swollen. Sore to touch Extremely tiredness slight headache in frontal lobes Took Tyninol to aleve headaches no need to go to doctor at this time if symptoms persist in 3 days. I will

Other Meds: None

Current Illness: None

ID: 1178033
Sex: M
Age: 59
State: PA

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

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

Symptoms: Maderna COVID19 Vaccine EUA Resulted in mild sore left arm only.

Other Meds: Omeprazole 40 mg PO QD Calclium Plus D 600mg PO QD Slow FE 45 Mg PO QD

Current Illness: none / N/A

ID: 1178034
Sex: F
Age: 56
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
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: Pt experienced Mild SOB and instant fatigue 5 min after receiving the dose. Pt c/o tingling/numbness in her lips. Pt was given 50 mg diphenhydramine 50mg PO.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm