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: 1185468
Sex: F
Age: 63
State:

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: Rash on both lower legs. Rash extends from ankles to top of calf, it was somewhat itchy that night, but next day itch was gone and redness had diminished. As of this report, I still have the rash.

Other Meds:

Current Illness:

ID: 1185469
Sex: M
Age: 36
State: CO

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 04/09/2021
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: Penicillin, erythromycin, eggs, nuts, shellfish, legumes

Symptom List: Anxiety, Dyspnoea

Symptoms: Asthma reaction (coughing, shortness of breath), fever, body aches, sensitive skin

Other Meds: Ciclesonide (inhaled), Budesonide (oral), Ketotifen droplets, nasacort spray, zyrtec, omeprazole

Current Illness: none

ID: 1185470
Sex: F
Age: 56
State: NY

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
Hospital: Y

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: Sulfa, Albuterol, PCN

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

Symptoms: 57 y/o with Past Medical History of Rheumatoid Arthritis on Methotrexate and a biologic medication completed her 15 minute observation period post administration of her 2nd Pfizer COVID vaccination. As she walked out and she began listing to the right side. She sat down, confused, and complaining of chest pain. She also noted pruritus over her face and scalp. No c/o Shortness of Breath, wheezing or nausea. She was immediately evaluated by me and EMT's . Vital signs demonstrated a HR of 74 in sinus rhythm, O2 Sat of 98% and BP was 192/104. She did not have a rash but was scratching at pruritic areas on scalp and face. See continuation page...

Other Meds: Methotrexate and Biologic product for Rheumatoid Arthritis

Current Illness: none

ID: 1185471
Sex: F
Age: 37
State: FL

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Possibly Metronidazole

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Chills, hot flashes, brief knee pain twinges, face flushed, headache. These effects lasted for two hours, then I had anxiety and trouble sleeping for rest of night. The headache carried on into the morning and became severe. Upon taking Advil, the pain drastically decreased. I had a mild headache, along with fatigue, a little queasy after eating and an unpleasant spacey/dizzy/heady feeling for the rest of the day. By morning of the 9th, all effects ceased.

Other Meds: Lo LoEstrol (birth control)

Current Illness:

ID: 1185472
Sex: M
Age: 52
State: IN

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Hay fever

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

Symptoms: Began with tiredness and mild headache Progressed to intense diarrhea and vomiting

Other Meds: Escitalopram 10mg Generic Flonase

Current Illness: None

ID: 1185473
Sex: F
Age: 54
State: MO

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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: tingles all over

Other Meds: trulicity, novalog, lantis, amlodiapine

Current Illness: unknown

ID: 1185474
Sex: M
Age: 50
State: MN

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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: Injection 4/8/21 12:40pm. 4/9/21 3:00am: Severe headache , while first dose did not generate side effects, 4/9/21 6am: Chills, backaches. Aches and chills persisting thru early afternoon 4/9/21

Other Meds: Warfarin

Current Illness:

ID: 1185475
Sex: F
Age: 21
State: OH

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: Full body rash across the trunk of the body (stomach, chest, back, neck). Itchy red spots about half a centimeter in size. Began to show up the morning after receiving the vaccine and have gotten worse since. It is now 8 days since the vaccination. It is not spreading to any new areas, but more spots may be showing up and it is increasing in itchiness.

Other Meds: N/A

Current Illness: N/A

ID: 1185476
Sex: F
Age: 42
State: IN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Headache, fatigue, achy

Other Meds: Alora Patch Progesterone Probiotics Benedryl

Current Illness: None

ID: 1185477
Sex: F
Age: 52
State: KY

Vax Date: 03/04/2021
Onset Date: 03/11/2021
Rec V Date: 04/09/2021
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: Penicillins, tetracyclines

Symptom List: Diarrhoea, Nasal congestion

Symptoms: After the second Moderna Covid-19 immunization on 3/4/21 she developed swelling and significant soreness in the left arm which she felt was improving but then around 1 week later developed a very deep ache/tired feeling in the left arm from shoulder to elbow with stabbing needle sensation. Pain is constant and is worse at night which causes sleep disturbances.

Other Meds: Celexa, estradiol, Flonase, Claritin, Provera

Current Illness: none

ID: 1185478
Sex: M
Age: 22
State: MI

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: Approximately 10 minutes into his 15 minute monitoring period, the patient became syncopal and rolled onto the floor from his chair. He was responsive within 10 seconds. Patient was monitored for a longer period of time and fully recovered.

Other Meds:

Current Illness:

ID: 1185479
Sex: F
Age: 29
State: CA

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: Slight fever, night if vaccination. Body rash, two nights after vaccination. Relieved by allergy medication

Other Meds:

Current Illness:

ID: 1185480
Sex: M
Age: 35
State: TX

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Tomatoes, Rice, Wheat, Peanuts

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

Symptoms: Flu

Other Meds: Levothyroxine

Current Illness: Allergies - hives, not related to vaccine

ID: 1185481
Sex: F
Age: 55
State: WI

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/09/2021
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: Sulfa and decongestants.

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

Symptoms: At 8:47 the patient complained of congestion in the back of her throat after receiving the vaccine. 8:47...Pulse 56 Resp 14...Fells congested "like constantly wants to clear throat" Did not have when she came in to the clinic. Lungs clear, no stridor 8:48...BP 138/86...Denies SOB, able to inhale and exhale completely. Reports symptoms diminishing. 8:51...Pulse 60 Resp 14. Ate breakfast this morning. Somewhat diaphoretic. No stridor, lungs clear. 9:00...Plan...monitor 15 minutes, recheck vitals. 9:15...BP 146/86 Pulse 56 Resp 14...Diaphoresis better. Slight facial flushing. Lungs clear. No stridor. No hives. Feels "throat gunk" is dissipating. Denies lightheadedness, dizziness. Discharged home. VSS. No further intervention required. 4/6 call placed for follow up. On 4/7 the patient returned call stating the congestion continued through late morning. She then "became completely exhausted" and rested for a while. She reports felt better after and has had no further issues

Other Meds: None

Current Illness: None

ID: 1185482
Sex: F
Age: 40
State: FL

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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 and dairy

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

Symptoms: Extended burning sensation during injection, body aches, sweats and headache all night and today

Other Meds: Coreg, Methotrexate, Nifidipene, Hydrochlorothiazide, CBD tincture 1000 mg

Current Illness: Scleroderma and RA

ID: 1185483
Sex: F
Age: 55
State: CA

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/09/2021
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: Amoxicillan

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

Symptoms: Shortly after the shot I felt a little odd. I felt like I had a fast heartbeat or extremely high anxiety. Felt like I had 20 cups of coffee. I was really hyper the night of the shot. Only got (4) hours of sleep. The symptoms continued for approx 24 hours. I had shortness of breath at times which could be from my heartbeat flucuating or I had anxiety. I am also very irritable. No other reactions. Other than that I feel back to normal after about 48+ hours. Praying I don't have any heart damage or lunch damage from what was injected into my body.

Other Meds: (1) Tylenol 500mg take by mouth at approx. 4pm.

Current Illness: None

ID: 1185484
Sex: F
Age: 31
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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:

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

Symptoms: Patient had two syncopal episodes post-vaccination. History of anxiety with needles. Symptoms resolved after 15 minutes and patient was released home

Other Meds:

Current Illness:

ID: 1185485
Sex: M
Age: 20
State: WA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Possible old reaction to shell fish

Symptom List: Ear pain, Hypoaesthesia

Symptoms: dizzy, light-headed, near syncope

Other Meds: None

Current Illness: None

ID: 1185486
Sex: M
Age: 41
State:

Vax Date: 04/08/2021
Onset Date: 04/16/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Woke up with cold sweat, nausea and vomiting, fatigue.

Other Meds: None

Current Illness: None

ID: 1185487
Sex: M
Age: 65
State: FL

Vax Date: 03/02/2021
Onset Date: 03/01/2021
Rec V Date: 04/09/2021
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: Tinnitus

Other Meds: CBD oil zoloft

Current Illness: none

ID: 1185488
Sex: M
Age: 62
State: MO

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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

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

Symptoms: Light headed

Other Meds: None

Current Illness: None

ID: 1185489
Sex: F
Age: 32
State: NY

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Unevaluable event

Symptoms: patient became pale and stated she was not feeling well and fainted immediately after receiving the vaccine. Patient regained consciousness immediately and was alert and oriented x 3. Recovered and was well enough to leave the clinic on her own.

Other Meds: n/a

Current Illness: n/a

ID: 1185490
Sex: F
Age: 32
State: CA

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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: Vicodin

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

Symptoms: Vaccinate at 2pm, by midnight I had fevers and intense chills. I was able to sleep from 2:30-3am. At 4:10am I started vomiting, emptying my stomach of all food, and again at 6:20am I started vomiting bile. I had a pounding headache from 4-10, when I had enough food back in my system to take ibuprofen.

Other Meds: Aleve

Current Illness: Inflamed arms and wrists, work related.

ID: 1185491
Sex: F
Age: 57
State: MA

Vax Date: 12/16/2020
Onset Date: 01/08/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1185492
Sex: F
Age: 58
State: FL

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Codine

Symptom List: Injection site pain, Menorrhagia

Symptoms: Covid arm with rash and feeling sick with fever 5 days after first shot. Received second shot and had covid arm and feeling ill again within 12- hours

Other Meds: Vit D, multi vitamin Zyrtec ( allergy)

Current Illness: N/a

ID: 1185493
Sex: F
Age: 73
State: AZ

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 04/09/2021
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: sulfa

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

Symptoms: Two days of strong neuropathy... felt like walking on broken glass, everything I touched felt like numerous razor blades.

Other Meds: calcium pill, fish oil pill

Current Illness: none

ID: 1185494
Sex: M
Age: 26
State: FL

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: Site: Pain at Injection Site-Mild, Systemic: Chills-Mild, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Medium, Additional Details: Patient experience Syncope

Other Meds:

Current Illness:

ID: 1185495
Sex: M
Age: 39
State: PR

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: NONE REPORTED AT THE TIME OF ADMINISTRATION

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: PATIENT WAS VERY ANXIOUS AT THE TIME OF THE INJECTION. INMEDIATELY AFTER THE FACT PATIENT FELT STINGING PAIN AT THE INJECTION AREA AND FELT LIKE A BRACHIAL PLEXUS LESION . HE was unable to fully close his hand for a few hours. WE CONTACTED HIM THE DAY AFTER AND HE IS FEELING WELL. PATIENT PUT ICE ON THE HAND.

Other Meds: ALLOPURINOL AND COLCHICINE

Current Illness: NONE

ID: 1185496
Sex: F
Age: 53
State: AZ

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: none

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

Symptoms: Hives from scalp to bottom of feet, eyes itched nonstop for hours. Took (2) antihistamine tablets, Eyes still itched the next day until noon.

Other Meds: Biostatic, Levothyroxine, Lexapro.

Current Illness: none

ID: 1185497
Sex: M
Age: 43
State: TX

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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

Symptom List: Nausea

Symptoms: Administered incomplete dose less than 0.3 mL of Pfizer. Dose repeated in opposite arm.

Other Meds: n/a

Current Illness: n/a

ID: 1185498
Sex: F
Age: 50
State: CA

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Sulfa allergy, multiple food and environmental allergies.

Symptom List: Injection site pain

Symptoms: Delayed cutaneous hypersensitivity. Red, itchy, swollen and painful red rash on upper arm that appeared day after injection. The area affected is approximately 4" wide by 6" long, most of upper arm. Rash progressed from 4/6 through 4/8. 4/9 is starting to see improvement.

Other Meds:

Current Illness:

ID: 1185499
Sex: F
Age: 54
State: MN

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: 18 hours of fever 101.5, muscle aches, headache, nausea, chills. Next 12 milder symptoms of achy. Note that patient tested positive for covid n 11/10/2020

Other Meds: Duloxetine

Current Illness: None

ID: 1185500
Sex: F
Age: 72
State: CA

Vax Date: 03/23/2021
Onset Date: 03/25/2021
Rec V Date: 04/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none known

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

Symptoms: rash right upper chest without pain, itching, swelling, blisters, scabs

Other Meds: aspirin, Lipitor, Celebrex, flexeril, Neurontin, hydrochlorothiazide

Current Illness: none

ID: 1185501
Sex: M
Age: 51
State: IN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Diarrhea about 6 hours after vaccination. Feeling off much of the rest of the day. Fever started about 15 hours after vaccination with chills and shaking followed by sweating. Used Ibuprofen to bring fever down and it would break after a couple hours. Then took Tylenol hours later in the morning to try to ward off the fever. Fever returned when these wore off. Had fever again yesterday afternoon and last night - again taking Ibuprofen to break the fever both times and Tylenol in the morning to try to head off the fevers. Sluggish feeling and lots of body aches. Not as bad as the actual COVID disease probably but reminiscent of those symptoms except not getting the coughing I had when I had COVID in October (I was sick for 3 weeks when I had it with fever over 2 weeks solid).

Other Meds: Metformin, Men's Multivitamin, B12

Current Illness: None

ID: 1185502
Sex: M
Age: 34
State: NE

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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: No Known Allergies

Symptom List: Erythema, Pruritus

Symptoms: -Pt fainted ~ 10 minutes after receiving vaccine while sitting in designated post vaccine waiting area -He became alert almost immediately and laid on his back for ~ 15 minutes -A cold pack was placed on this head and a pillow was supplied -He drank apple juice per his request and started feeling better -He stated he faints when he gives blood occasionally -He felt fine after ~ 30 minutes and got a ride home with a friend

Other Meds: Not Available

Current Illness: No Known Illness

ID: 1185503
Sex: F
Age: 63
State: IN

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 04/09/2021
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: pollen, dust, fragrances

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

Symptoms: 1st injection on evening of Feb. 18, 2021, resulted only in sore arm for maybe 36 hours and feeling fairly tired the next fully day. 2nd vaccine, 2 p.m. on March 12, 2021, resulted initially in mildly sore arm. By end of next day or possibly day after that, I had developed tender, slightly itchy swelling around injection site on left arm. Swelling was a few inches long and a couple of inches wide. At the same time, I started experiencing pain in various parts of that arm and hand ranging from discomfort to fairly sharp pain, with location and amount of pain varying from day to day. This lasted for two full weeks. I can't explain why, but rather than being only a direct result of the vaccine, my perception was that somehow the injection had triggered the fibromyalgia in that arm and only that arm. Whether it was the physical process of the shot or the medication, I can't say. It wasn't debilitating, but it was definitely unpleasant.

Other Meds: esomeprazole, atomoxetine, lamotrigine, cetirizine, NeevoDHA, L-methylfolate, vitamin D, diazepam, flaxseed oil, magnesium

Current Illness: none

ID: 1185504
Sex: F
Age: 26
State: DE

Vax Date: 01/24/2021
Onset Date: 01/25/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: On the next day my left arm was sore, I developed a rash ,hot to touch and itchy. I had a Televisit told it might be Cellulitis take Benadryl and prescribed a antibiotic. They recommended a steroid explained to me it would counteractive the vaccine I declined. My symptoms lasted in total 2 weeks.

Other Meds: No

Current Illness: No

ID: 1185505
Sex: M
Age: 40
State: MI

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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 we are aware of

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Approximately 5 minutes after the patient received his vaccination, he rested his head on the wall behind him in the chair he was being observed in and passed out and turned white. His wife began slapping his face and screaming his name and the observer called for me. I arrived within seconds and assisted his wife in moving him from the floor to the chair. Within seconds of getting his head to the ground safely, he came back to and was very sweaty, red in the face. He stayed on the ground laying down, and then sitting for approximately 25 minutes. During that time, he told us that he had previously passed out during 3 procedures done at doctors offices. We got him an ice pack and a orange pop as he was complaining of being hot and having only eaten a granola bar all day. He was able to get up to a chair and sat there for an additional 5 minutes, before he was able to walk out on his own accord. I have spoken with the patient twice since, once last evening and once today and he reports he feels great now besides the expected body aches from the vaccination.

Other Meds: None we are aware of

Current Illness: None

ID: 1185506
Sex: F
Age: 39
State: VA

Vax Date: 03/27/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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:

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

Symptoms: I received my COVID 19 vaccine (1st dose) on March 27th, 2021. My cycle was then due on March 31st, 2021. I am never late with my cycle, but due to the vaccine, I was 10 days late. I think it is extremely important to advise and inform women of the possibility of this side effect. If you are trying to conceive, it can be very misleading.

Other Meds:

Current Illness:

ID: 1185507
Sex: M
Age: 34
State: FL

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: Client stated PCN and was told by parents, reaction as a child.

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

Symptoms: Two min. post vaccine given client became pale, sweaty with eyes looking dazed. Vaccination nurse attended to client stated he was feeling dizzy for a minute. Client was escorted to DOH observation site for further observation by paramedics on standby.

Other Meds: Client stated none

Current Illness: none

ID: 1185508
Sex: F
Age: 31
State: MI

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Medication allergies: Miconazole, Clindamycin, Benadryl, Depakote, Nitrous oxide. Also has lactose intolerance and is severely allergic to cats and somewhat allergic to dogs.

Symptom List: Pain in extremity

Symptoms: Received vaccine at Covid-19 pop-up clinic on 4/5/21 at 2:30pm. Was fine during the vaccine administration. Waited 30 minutes after vaccination and left the clinic and felt fine. About 15-30 minutes later she was driving around running errands and was drinking water in the car and she noticed that it was becoming hard to swallow. Felt dizzy and disoriented and called her allergist. She carries epi pen because she gets allergy shots due to dog and cat allergies. Epi pen is for potential reaction to allergy shot. Allergist advised her to call EMS. She called EMS and they told her to administer the epi pen. She administered epi pen and began to feel symptoms improve. EMS arrived and she felt better and was not transported to the hospital. She drove herself home and was fine the rest of the day. She also had a topical reaction to the band-aid on her arm, with blisters and ripping off her skin. She generally has allergy issues with adhesives.

Other Meds: Latuda, Wellbutrin, Lamictal, Singulair, Allegra, Gabapentin, Topamax, Riboflavin (Vitamin B2), Magnesium, Prenatal vitamins, Immunotherapy (For allergy to cats and dogs - gets shots every 3 weeks. Last shot was 3/24/21.)

Current Illness: No illnesses at time of vaccination or the month prior.

ID: 1185509
Sex: F
Age: 95
State: NY

Vax Date: 03/25/2021
Onset Date: 04/04/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies: Timolol, brimonidine (both decrease heart rate), Flomax (dizziness)

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

Symptoms: Resident has developed new episodes of confusion, behavioral changes, and visual hallucinations as of 4/4/21

Other Meds: ACETAMINOPHEN 325 MG TABLET (TYLENOL 325 MG TABLET) TWO TAB by mouth every 6 hours as needed fever maximum amout for 24hrs= 3gm ACETAMINOPHEN 500 MG TABLET (TYLENOL 500 MG TABLET) - STOCK TWO TAB by mouth twice daily (08:00, 20

Current Illness: Admitted on 3/3/2021 after admission to hospital/rehab for recurrent falls and uncontrolled pain.

ID: 1185510
Sex: F
Age: 30
State: TX

Vax Date: 03/28/2021
Onset Date: 04/06/2021
Rec V Date: 04/09/2021
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 to food. Maybe allergy to tramadol or experienced bad side effects in the past.

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

Symptoms: Day 1 had no symptoms. day 2 had arm soreness and internal swelling. day 3-5 soreness began to subside. day 5-7 soreness was gone but the internal swelling was still there. day 9-11 arm started to get itchy and experienced large hives and inflammation. arm was hot to the touch. Day 13 arm is still hot to touch and swollen. not experiencing hives as i am typing this.

Other Meds: none

Current Illness: none

ID: 1185511
Sex: F
Age: 22
State: KS

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Mild, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Weakness-Mild

Other Meds:

Current Illness:

ID: 1185512
Sex: M
Age: 49
State: CA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
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: not reported

Symptom List: Vomiting

Symptoms: back pain. could be do to regular work because patient went back to work right away and performed regular lifting duties.

Other Meds: not reported

Current Illness: not reported

ID: 1185513
Sex: M
Age: 31
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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: Patient complained of feeling dizzy and became syncopal. Patient was lowered to the ground and regained consciousness quickly. Gave patient juice while laying in stretcher. Became dizzy again while sitting up. Evaluated by EMS. BP 124/60 and HR 65. Declined transport and released home.

Other Meds:

Current Illness:

ID: 1185514
Sex: F
Age: 71
State: MD

Vax Date: 03/08/2021
Onset Date: 04/01/2021
Rec V Date: 04/09/2021
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: None

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

Symptoms: My primary doctor did know what cause my vein going to my middle finger, left hand to roll to the left and there is swelling. She suggested I see a surgeon.

Other Meds: Premarin 0.625 MG tablet Klor-con M20 tablet Vitamin D2 1.25MG(50,000 unit) Triamterene-HCTZ 37.5-25 MG TB

Current Illness: None

ID: 1185515
Sex: F
Age: 45
State: TN

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/09/2021
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: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Around 135pm patient was sitting in chair in a stiff position, bilateral arms to her side with wrist flexed out. 5 mins prior to incident patient just received her first shot of Moderna lot #031A21A , received in left arm. Stiff position lasted less the 1 min. nurse called out to staff to help and to call 911. Patient started to come back to her self and stated that she has had this happen before. Patients was oriented x3 to person place and thing. She denies and shortness of breath or difficulty breathing. Patient stated her husband was in the car and ask for him to come in. Husband stated she has had seizure activity in the past. Upon retrieving her vitals BP- 93/62 Temp- 98.4 Pules 60 Respirations- 16. Patient also stated her having a history of low blood pressure as well. Around 145 EMS arrived and patient was able to communicate feelings of incident. Patient and husband then walked outside with EMS. Doctor informed of incident and was gave the report of patients activity.

Other Meds:

Current Illness:

ID: 1185516
Sex: M
Age: 37
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt felt cold and clammy after the Covid vaccination for about 2 min. We took care of him.We were with him all the time and was checking on him. He was with us until he was doing great.

Other Meds:

Current Illness:

ID: 1185517
Sex: M
Age: 23
State: MT

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/09/2021
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: unknown

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

Symptoms: Patient is reporting tingling/numb feet about 5-10 minutes after vaccination. After about 30 minutes he said he was feeling fine, and walked around the store for a bit to make sure he was ok. Than he left.

Other Meds: unknown

Current Illness: unknown

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm