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: 1178035
Sex: M
Age:
State:

Vax Date:
Onset Date: 03/10/2021
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: TIRED THAT LATE AFTERNOON; HEADACHE; This spontaneous report received from a patient via a company representative concerned a male of unspecified age. The patient's height, and weight were not reported. The patient's concurrent conditions included diabetes type 1.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Company is unable to perform follow-up to confirm batch/lot number. No concomitant medications were reported. On 10-MAR-2021, the subject experienced tired that late afternoon. On an unspecified date, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tired that late afternoon, and headache. This report was non-serious.

Other Meds:

Current Illness: Type 1 diabetes mellitus

ID: 1178036
Sex: F
Age: 61
State: AL

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

Lab Data:

Allergies: IODINE

Symptom List: Anxiety, Dyspnoea

Symptoms: ITCHING TO THROAT, HANDS, AND "ALL OVER", REDNESS AND SWELLING TO PALMS OF HANDS, STATES THROAT "FEELS LIKE IT MAY CLOSE". GIVEN IM SOLU-MEDROL AND IM DIPHENHYDROMINE PER CRNP ORDERS. PT REQUESTED & GIVEN ICE. PT OBSERVED AND NO SYMPTOMS NOTED. ADVISED TO GO TO HOSPITAL IF SYMPTOMS RETURN.

Other Meds: ALBUTEROL, BUSPIRONE, CITALOPRAM, LOSARTAN, LYRICA, MECLIZINE, MELOXICAM, PREMARIN, SINGULAIR, SYNTHROID

Current Illness: NONE

ID: 1178037
Sex: F
Age: 65
State: IN

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: amoxcicillin , lortab

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

Symptoms: About 6 pm I got really fatigued. Went to be at 9. Shivered under the covers all night and body aches. Woke up at 6:30. My whole body hurt. Every joint, even my toes. Week. All day on Tuesday my heat rate was 95. Went to be at 8:30, took a night time Tylenol and slept pretty good. On Wednesday I felt better but still week. My heart rate was 88 all day.

Other Meds: Wixella, Eliquis, Sertraline, metoprolol, Preservision AREDS2

Current Illness:

ID: 1178038
Sex: F
Age: 43
State: TX

Vax Date: 03/05/2021
Onset Date: 03/06/2021
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: Penicillin, wasp venom, pollen

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Left eye began feeling odd the next morning, face pins and needles, eye feeling weird

Other Meds: Daily vitamin

Current Illness: None

ID: 1178040
Sex: F
Age: 52
State: IN

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

Lab Data:

Allergies: Levaquin, sulfa, cipro, macrobid, seafood shell fish, nuts

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

Symptoms: Severe anaphylactic shock reaction. Hives, throat swelling, breathing affected, blood pressure spiked 178/118, dizzy / lightheaded.

Other Meds: Albuterol vials nebulizer PRN, Miralax daily, losartan 100 mg x1 daily B12 vitamin x1 daily, magnesium 250mg c1 daily, D2 50,000 rx x2 week, fiber supplement capsules OTC. X1daily, Advair powder x2 day

Current Illness: Prior history of not getting flu shot Guillian Barre Syndrome

ID: 1178041
Sex: F
Age: 39
State: CA

Vax Date: 03/30/2021
Onset Date: 04/06/2021
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: sulfa

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

Symptoms: Approximately 1 week after receiving the shot, the injection site and about 2 inches around it in every direction started to itch, my skin turned red, the area is swollen, and it aches (off-and-on)

Other Meds: birth control, burpropion

Current Illness: n/a

ID: 1178042
Sex: F
Age:
State: NY

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: SWELLING; RAISED RED MARK UNDER THE INJECTION SITE DESCRIBED THAT IT LOOKED LIKE WICKED SPIDER BITE; RASH; This spontaneous report received from a patient. 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: 1808980 and expiry: UNKNOWN) dose was not reported, administered on 31-MAR-2021 11:00 on left arm for prophylactic vaccination. No concomitant medications were reported. On 31-MAR-2021, the subject experienced swelling. On 31-MAR-2021, the subject experienced raised red mark under the injection site described that it looked like wicked spider bite. On 31-MAR-2021, the subject experienced rash. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash, swelling, and raised red mark under the injection site described that it looked like wicked spider bite. This report was non-serious.

Other Meds:

Current Illness:

ID: 1178043
Sex: M
Age: 38
State: VT

Vax Date: 03/10/2021
Onset Date: 03/12/2021
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: Severe sciatic pain down my right leg. I have never had sciatica before. It has been going on for the past almost 4 weeks.

Other Meds: Wellbutrin Lamictal

Current Illness: None

ID: 1178044
Sex: F
Age: 19
State: TX

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: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Intense Migraine, chills, intense muscle spasms

Other Meds: N/A

Current Illness: None

ID: 1178045
Sex: F
Age: 24
State: MN

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: Pollen

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received her Janssen COVID vaccine and was sitting in a chair in the conference room when she slumped over in her chair and became unresponsive. Patient had just received her one dose Janssen vaccine and was sitting in a chair approximately 3-5 minutes after receiving the vaccine. She began to slump over in her chair and was unresponsive. Two RNs responded to assess the patient. Patients feet were elevated and ice packs applied to her neck and axillary areas. Patient was breathing and had a pulse. Patient responded to her name once and then passed out again. Patient was unable to respond after this. Her eyes were open. Patient was lifted into a wheelchair by three nurses and brought to a private area. Patient was warm and sweat was running down her face. Her sweater was removed and ice packs again were applied to her neck and axillary area. Patient continued to have a pulse and was breathing. EMS was called. Patient slowly began to come around and could answer questions after about 5 minutes of being unresponsive. She was confused and had no memory of what had occurred. She reported feeling light headed and seeing spots in her vision. She continued to feel light headed. EMS assessed patient. Vitals were stable and blood sugar was WDL. Patient reported feeling much better. She denied feeling light headed or dizzy any longer. She was able to answer all questions asked. Patient did not want to go to the hospital and refused transport to the hospital via ambulance. She was observed for an additional 20-30 minutes at which time her boss arrived to pick her up. She was educated on calling 911 if she began to feel light headed or dizzy again. Patient verbalized understanding. She was walked to the car by an RN.

Other Meds: None

Current Illness: None

ID: 1178046
Sex: F
Age: 21
State: PA

Vax Date: 12/23/2020
Onset Date: 12/26/2020
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: none

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

Symptoms: Initially thought ringworm, for which I applied topical ointment prescribed by a Physician Assistant for but it did not get better and then my primary doctor informed me it was likely pityriasis rosea and that it would go away. It lingered until the second dose which was on 1/23/2021 but did not resolve and only got worse after the second dose, the rash finally resolved 3 weeks following the second dose.

Other Meds: Lexapro

Current Illness: none

ID: 1178047
Sex: F
Age: 40
State: OK

Vax Date: 02/24/2021
Onset Date: 03/20/2021
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: Penicillin

Symptom List: Rash, Urticaria

Symptoms: Original Due Date: 11/4/2021. Miscarriage discovered 4/5/2021 and suspected to have occurred around 3/20/2021 (baby measured 7weeks,1 day on ultrasound). There were no indications of miscarriage before the ultrasound 4/5/201. Neither me, the patient, nor my doctor believe the miscarriage was a result of the vaccine but as it occurred a few weeks after I received the second dose in the series I felt it should be reported. I was approximately 4 weeks pregnant at the time of my second dose.

Other Meds: Sertraline 100mg, Prenatal Vitamin, Baby Aspirin, Progesterone Supplement

Current Illness: None

ID: 1178048
Sex: M
Age: 51
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: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: pt c/o feeling hot. Denies SOB pain, itch or diziness. appears diaphoretic. said he feels anxiety. Used interpreter. 140/92 HR 128 O2 sat 97 BS 196

Other Meds: Aspirin, Lisinopril

Current Illness: none

ID: 1178049
Sex: M
Age: 29
State: MD

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

Lab Data:

Allergies: None

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

Symptoms: Symptoms similar to days of positive COVID-19 but in 'fast-forward': intense chills/shivering (12:30-2AM), low-grade fever of 99.5-101.1 (3-6AM), moderate fever of 102.1 (7 AM) broke around 9-10AM. Followed by intense headache/migraine, photosensitivity, difficulty sleeping, and mild nausea (until 12PM). Headache finished around 230 PM. Loss of appetite all day. Still not feeling well at time of submission. Treating with Tylenol and forcing fluids.

Other Meds: None

Current Illness: None (COVID-19 positive diagnosis 1/20/2021)

ID: 1178050
Sex: F
Age: 51
State: MA

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

Lab Data:

Allergies: Allergic to sulfa, bananas, all stinging insects, penicillin and its relatives, poison oak/ivy

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

Symptoms: Pain, burning and swelling at injection site . Swelling of forearm with deep pain extending to heel of arm into thumb and little finger. Pain was so intense until 11:30 I was unable to sleep. Two days post-injection, injection site is still swollen, hot and hard to the touch. Overall, I am tired and headachy

Other Meds: Paroxetine 20mg daily

Current Illness: None

ID: 1178051
Sex: F
Age: 42
State: MO

Vax Date: 04/02/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: I experienced swelling and slight pain at the injection site in the afternoon of the day I received the vaccination. The swelling and pain resolved by the end of the day on the following day. Three days later a large inflamed area surrounds the injection site. the area is itchy and warm to the touch. There is slight discomfort but not pain.

Other Meds: duloxetine 60mg, Vitamin D 50,000 IU once weekly, sumatriptan succinate 100mg as needed,

Current Illness: None

ID: 1178052
Sex: M
Age: 58
State: NV

Vax Date: 02/05/2021
Onset Date: 02/12/2021
Rec V Date: 04/07/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: The patient developed lithium toxicity a week after getting his second shot.

Other Meds: I am a physician reporting a possible adverse reaction to a patient who received the Pfizer vaccine first shot on 1/15/21 and the second shot 2/5/21. He was hospitalized for lithium toxicity on 2/12/21 without any recent change in lithium d

Current Illness: Bipolar Disorder.

ID: 1178053
Sex: U
Age:
State:

Vax Date:
Onset Date:
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: BODY ACHE; ALLERGIC REACTION; FEVER; FATIGUE; HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. 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. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the subject experienced body ache, allergic reaction, fever, fatigue, and headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever, fatigue, headache, body ache and allergic reaction was not reported. This report was non-serious.

Other Meds:

Current Illness:

ID: 1178054
Sex: F
Age: 36
State: NY

Vax Date: 03/31/2021
Onset Date: 04/01/2021
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: Low fever (100 deg F), alternating chills and hot spells, drowsiness, light headedness for approx 12 hours. I had to take the day off work because I was too sick to work. Spent most of the day sleeping, didn?t want to eat anything.

Other Meds: Wellbutrin XL 150mg

Current Illness:

ID: 1178055
Sex: M
Age: 36
State: FL

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:

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

Symptoms: Patient administered 2.5mL

Other Meds:

Current Illness:

ID: 1178056
Sex: F
Age: 34
State: KY

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: None known

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

Symptoms: Had first covid shot 3/17/21 at 7:15. Got home started period around 2:00 pm. Period was two weeks early. Very heavy flow with awful cramps. Had second Covid 19 vaccine today 4/7/21 at 7:25 and around 2:00-3:00 started period again. 1 week early.

Other Meds: None

Current Illness: None

ID: 1178057
Sex: F
Age: 41
State: CA

Vax Date: 03/29/2021
Onset Date: 03/30/2021
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: NA

Symptom List: Unevaluable event

Symptoms: 03/30--- chills, headache, febrile symptoms, and pain in the covid arm 03/31--- pain in covid arm and axillary swell (left), tenderness and itchiness in area of the shot. 04/01--pain in covid arm and axillary swell (left), tenderness and itchiness in area of the shot. 04/02--pain in covid arm and axillary swell (left), tenderness and itchiness in area of the shot. 04/03-- Redness and itchiness in area of the shot.

Other Meds: NA

Current Illness: NA

ID: 1178058
Sex: F
Age: 26
State: PA

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: no known allergies

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

Symptoms: A few minutes after being vaccinated patient was sitting for her 15 minute observation period and walked over to the pharmacy counter stating "I just got my vaccine and I really don't feel well" the pharmacist approached the patient and caught her under both arms from behind her back as the patient fainted. Patient did not hit the ground or injure herself-she did not lose consciousness she was flushed and sweating. Pharmacist sat on floor with patient for 2-3 minutes and gave her water, patient was then able to stand up with little assistance and brought to sit down. Patient stated she felt nauseous and may vomit she was given a trash can but did not vomit she was able to drink a bottle of water and was given a soft pretzel. After about 10 minutes she stated she was feeling much better was no longer flushed or sweating she called her boyfriend for a ride home.

Other Meds: none reported

Current Illness: none reported

ID: 1178059
Sex: F
Age: 52
State: PA

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: sulfa

Symptom List: Injection site pain, Pain

Symptoms: arrived at obs 1510 with complaints of lightheadedness, heavy breathing, lips quivering, teeth chattering. 1715 bp 221/110 hr 76 rr 20 sao2 100% ra, placed in tredelenberg. 1722 bp 205/100 hr 87 rr 20 sao2 100% ra. denies pain or sob. 1732 bp 176/86 hr 82 sao2 100% ra. spouse called to excort patient home. 1740 bp 178/96 hr 79 sao2 100% ra rr 20. denies any new s/s, other s/s resolving, resting calmly on stretcher. 1755 bp 188/106, patient advised to f/u with pcp regarding hx of undiagnosed bp, spouse escorting patient out to personal vehicle and stable at time of departure.

Other Meds: none

Current Illness: na

ID: 1178060
Sex: F
Age: 33
State: FL

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

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

Lab Data:

Allergies: Peanuts Cats

Symptom List: Injection site pain, Menorrhagia

Symptoms: Later on that evening of the vaccine date my arm was swollen on the vaccine site. During all my pregnancy I never had any complications, the expected delivery date was 04/17/2021. I was induced for hypertension my doctor noticed it on 03/29/2021 and I got induced on 04/01/2021. The baby was born on 4/3/2021 & the weight was 5lbs 13oz.

Other Meds: Loratadine Claritin Prenatal vitamins

Current Illness:

ID: 1178061
Sex: F
Age: 60
State: MD

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: Penicillin

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

Symptoms: generalized flushing of both arms and neck 30 mins post vaccine (similar to past reaction to PCN)

Other Meds: Aspirin, bupropion, claritin, clobetasol and HCTZ

Current Illness: None

ID: 1178062
Sex: M
Age:
State: MN

Vax Date:
Onset Date: 03/01/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: PAIN ON THE INJECTION SITE; DIARRHEA; FATIGUE; NAUSEA; This spontaneous report received from a patient concerned a 51-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: 1808978,and expiry: 13-JUN-2021) dose was not reported, administered on 25-MAR-2021 in right deltoid for prophylactic vaccination. No concomitant medications were reported. On MAR-2021, the subject experienced diarrhea. On MAR-2021, the subject experienced fatigue. On MAR-2021, the subject experienced nausea. Treatment medications included: Ibuprofen. On 25-MAR-2021, the subject experienced pain on the injection site. The action taken with COVID-19 VACCINE AD26.COV2.S was not applicable. The patient recovered from pain on the injection site on 26-MAR-2021, and had not recovered from fatigue, diarrhea, and nausea. This report was non-serious.; Sender's Comments: V0: Medical Assessment comment not required as per standard procedure as the case assessed as non-serious.

Other Meds:

Current Illness:

ID: 1178063
Sex: F
Age: 65
State: CA

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: RA

Lab Data:

Allergies: sulphur

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Felt cold, and chilled after going to bed, and feverish. took temperature and it was 101.8. couldn't sleep tossed and turned most of the night until I took Tylenol PM

Other Meds: Hydroclorothaide , 81mg asprin

Current Illness: None

ID: 1178064
Sex: F
Age: 59
State: VA

Vax Date: 01/16/2021
Onset Date: 01/20/2021
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: Tetanus vaccine

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

Symptoms: I exp 103 fever for 3 days after Dose 1. My normal body temp is 99.8 and left arm had swollen (size of little tennis ball, hard,hot). I had to continue to turn the lights off due to headaches. I started to have involuntary gasps and blood oxygen level was going down at night. After the fever was gone I felt 3-4 days later. I followed up with Pulmonologist and scheduled for MRI.

Other Meds: Advair inhaler, Zyrtec

Current Illness: No

ID: 1178065
Sex: F
Age: 66
State: LA

Vax Date: 03/31/2021
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: Nausea

Symptoms: Woke up from nap today. Fatigue, headache, back of neck hurting, muscle aches all over

Other Meds: Tylenol

Current Illness:

ID: 1178066
Sex: M
Age: 23
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Patient received vaccine and moved to observation chair. Within about 5 minutes, patient proceded to experience a syncope episode. Total episode lasted about 30 seconds, and patient spontaneously awoke. Upon awakening, patient requested water, and we also offered crackers and he accepted both. Patient waited in observatory for a total of 30 minutes. At time of departure, skin color was normal and patient was not experiencing weakness or confusion.

Other Meds:

Current Illness: None

ID: 1178067
Sex: F
Age: 0
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known

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

Symptoms: Within 5 to 10minutes of receiving vaccine, pt was visibly red, reported feeling hot all over with scratchy throat. Over the next few minutes mouth became numb. Medics evaluated pt, and after 30-40 minutes, pt left pharmacy with a family member. (medics came to pharmacy)

Other Meds: Not known, likely has albuterol inhaler

Current Illness: None

ID: 1178068
Sex: F
Age: 67
State: FL

Vax Date: 04/01/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: urticaria of trunk and redness and bruising of injected arm

Other Meds:

Current Illness:

ID: 1178069
Sex: M
Age: 60
State: CA

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: SOB, nausea, headache. Felt chest heaviness. Vital signs wnl, O2 sat 97%. Given albuterol 2 puffs. Went to ED.

Other Meds:

Current Illness:

ID: 1178070
Sex: F
Age:
State: NJ

Vax Date:
Onset Date: 03/28/2021
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: DIARRHEA; NAUSEA/VOMITING; NOT FEEL WELL; This spontaneous report received from a consumer concerned a 48 year old female. 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: 1808978 expiry: UNKNOWN) dose was not reported, administered on 25-MAR-2021 19:00 for prophylactic vaccination. No concomitant medications were reported. On 28-MAR-2021, the subject experienced diarrhea. On 28-MAR-2021, the subject experienced nausea/vomiting. On 28-MAR-2021, the subject experienced not feel well. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the diarrhea, nausea/vomiting and not feel well was not reported. This report was non-serious.

Other Meds:

Current Illness:

Date Died: 02/24/2021

ID: 1178071
Sex: M
Age: 53
State: TX

Vax Date: 02/24/2021
Onset Date: 02/24/2021
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: Bee venom protein

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

Symptoms: Patient found expired at home about 12 hours after administration of vaccine

Other Meds: Lantus, Humalog, omeprazole, furosemide, loratadine, metoprolol, ASA 325mg, atorvastatin, benzonatate, metolazone, Hydrochlorothiazide, hydralazine, montelukast

Current Illness: None

ID: 1178072
Sex: F
Age: 62
State: NM

Vax Date: 03/24/2021
Onset Date: 03/25/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: (Pfizer-BioNTech COVID-19 Vaccine EUA given March 24,2021); reactions started March 25, 2021; sluggish, slight headache, little to no appetite, feeling cold, sore arm. March 26, 2021 red rash at injection site, still a little sluggish, sore arm, appetite coming back, not feeling as cold, headache gone.

Other Meds: Hydrochlorothiazide 12.5mg 1x daily; Lisinopril 20mg 1x daily; Levothyroxine 50mg 1x daily; Vitamin D3 5000iu 1x daily; Apple Cider Vinegar 450mg 2x daily.

Current Illness: none

ID: 1178073
Sex: M
Age: 32
State: NM

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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient recieved vaccine and was moved to observation area. Patient suddenly lost conciousness and fell from chair to the ground. Pt regained conciousness within 30 seconds. Patient was alert and orient upon regaining conciousness. Patient verbalized he was having no trouble breathing and vitals were taken. Patient vital signs were within normal ranges. Patient verbalized that his left arm hurt and fingers were numb on that side. Patient was taken to urgent care clinic and evaluated by physician. Patient signed an AMA form and was released from hospital. Patient encouraged to follow up with primary care doctor.

Other Meds: none

Current Illness: none

ID: 1178074
Sex: M
Age: 48
State: AZ

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

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

Lab Data:

Allergies: Vicodin

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

Symptoms: Fever the following morning (which broke later in the day), along with a lot of pain throughout arm and shoulder (continuing after 3 days). A lot of swelling in armpit (continuing after 3 days). Fatigue.

Other Meds: Valcyclovir

Current Illness: None

ID: 1178075
Sex: F
Age: 36
State: PA

Vax Date: 03/14/2021
Onset Date: 03/25/2021
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: none

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

Symptoms: Rash (Pityriasis Rosea)

Other Meds: none

Current Illness: none

ID: 1178076
Sex: M
Age: 38
State: OR

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: None

Symptom List: Pain in extremity

Symptoms: Fever, chills, nausea, and fatigue. Kept waking up during the night being hot or cold. The next day mild fever and chills, but still feeling fatigued.

Other Meds: Levothyroxine Sodium

Current Illness: None

ID: 1178077
Sex: F
Age: 62
State:

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Migraine headache at front of head and around eyes and upper jaws.

Other Meds:

Current Illness:

ID: 1178078
Sex: M
Age: 43
State: KY

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

Lab Data:

Allergies: NA

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

Symptoms: Fever, Chills, headache, major fatigue

Other Meds: Lipitor, Tricor, Montelukast, Multi-vitamin, Vitamin D

Current Illness: Sinus infection due to seasonal allergies. One month prior

ID: 1178079
Sex: F
Age:
State:

Vax Date:
Onset Date: 03/01/2021
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: This spontaneous report received from a consumer via a company representative concerned a female 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: Unknown) dose was not reported, administered on 27-MAR-2021 for prophylactic vaccination. The batch number was not reported. We are unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On MAR-2021, the subject experienced debilitating migraines. On MAR-2021, the subject experienced aches. On MAR-2021, the subject experienced chills. On MAR-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever, debilitating migraines, aches, and chills. This report was non-serious.

Other Meds:

Current Illness:

ID: 1178080
Sex: M
Age: 34
State: MO

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: Seasonal allergies

Symptom List: Vomiting

Symptoms: The patient developed a sensation of seeing bright sparkly spots in his vision that lasted a brief moment. He said that this typically happens after he gets a shot or is exposed to needles. He then asked if he could lay himself down because he says that is what usually helps him feel better. His SBP was measured to be in the 80s initially with a heart rate in the low 50s. His oxygen saturation was normal. He was given some water to drink. After a few minutes, his heart rate and blood pressure returned to normal. We discussed having him go to the hospital. After our evaluation, the patient preferred to go home. We asked that he go to the hospital if his symptoms returned.

Other Meds: None

Current Illness: None reported

ID: 1178081
Sex: M
Age: 39
State: CA

Vax Date: 02/03/2021
Onset Date: 02/04/2021
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: SEVERE AND PROLONGED RASH, WITH HIVES AND BURNING SENSATION. I HAVE TO TAKE A ZYRTEC EERY TWO DAYS NOW TO AVOID THE RASH

Other Meds: Symtuza

Current Illness: HIV

ID: 1178082
Sex: M
Age: 47
State: IL

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

Lab Data:

Allergies:

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

Symptoms: Approx 5-10 minutes after receiving vaccine, Medical Member was called over to patient in chair who was found to be verbally unresponsive with eyes closed. Noxious stimuli applied without response. Eyes closed, when manually opened, noted to have dysconjugate gaze with 5mm sluggish pupils. Patient then exhibited upper/lower extremity tonic/clonic movements <10 seconds. After, patient spontaneously opened eyes, became verbal and answered all questions appropriately with clear speech. Moved all extremities spontaneously without focal deficit. BP: 98/61 HR 41 RR 16 EMS call to evaluate patient. Patient left building with EMS.

Other Meds:

Current Illness:

ID: 1178083
Sex: F
Age: 24
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none reported

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient had just received covid vaccine. She was still seated in immunization room and said she felt dizzy and then passed out. She then started having a seizure a few seconds later. She seized for about 2 minutes. Patient was breathing but unconscious.

Other Meds: none reported

Current Illness: none reported

ID: 1178084
Sex: F
Age: 30
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: oxycodone, chocolate, tree pollen

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

Symptoms: patient had a syncopal episode in the observation area post vaccination. she has POTS syndrome and states that she losses consciousness about twice per week. She had no extremity weakness, no bowel or bladder incontinence.

Other Meds: none

Current Illness: none

ID: 1178085
Sex: F
Age: 53
State: RI

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

Lab Data:

Allergies: Opiates and Opioids, Ibuprofen, Eggs, Lactose, Avocado, Shell Fish

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

Symptoms: On Saturday April 4, I had intense itching is the left arm where I received injection about 25 min after injection and started to get a migraine about 1 hour after the injection. I went home and took Benadryl and Ubrely, slept for about 10 hours, then there was no more itching and no more Migraine. On Sunday April 4, I felt achy, took two Extra Strength Tylenol on onset and right before bed, and I was fine for work on Monday April 5, 2021.

Other Meds: Breo: Asthma Medicine, Singular, Hydroxyzine

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm