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: 1186448
Sex: F
Age: 43
State: CA

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

Lab Data:

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: 43 Y female with chief complaint of ALLERGIC REACTION (pt had covid vaccine shot around 1430, pt started feeling like her throat was closing up and urticaria in torso. pt was given epinephrine 0.15mg IM on scene and benadryl 50mg IV by EMS upon arrival. symptoms greatly improved upon arrival to ED.)

Other Meds: None known

Current Illness: None known

ID: 1186449
Sex: F
Age: 69
State: NJ

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Overnight - chills Next three days - muscle aches, headache, fatigue

Other Meds: Synthroid, Femara, multivitamin, calcium, fish oil

Current Illness:

ID: 1186450
Sex: F
Age: 47
State: CA

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

Lab Data:

Allergies: Aspirin

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

Symptoms: Pt reports 10 minutes after injection, tightness in throat. Pt speaking in clear and full sentences, able to swallow water but continues to clear throat.

Other Meds: NA

Current Illness: NA

ID: 1186451
Sex: F
Age: 50
State: NY

Vax Date: 03/26/2021
Onset Date: 04/02/2021
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: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Seven days after injection of first dose, had itchiness and white spots around the injection site. The next day, the white dots had become scabs (I did NOT scratch then to make cuts; happened on its own, almost like poison ivy can). Scabs remained for about a week. No other adverse events or symptoms that I know of.

Other Meds: None

Current Illness: None

ID: 1186452
Sex: M
Age: 44
State: NJ

Vax Date: 03/20/2021
Onset Date: 03/23/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Received first Moderna shot on 3/20. Experienced severe vertigo episodes on 3/23, 3/24, and then again on 4/8 (all with spinning, dizziness, vomiting, sweating, chills). Visited an ENT doctor. Did an ENG showing weakness in the right ear. Have had ringing in the right ear for several weeks. Have a hearing test scheduled for 4/20 and am currently on dizziness medication. Also have an MRI scheduled. Have the 2nd shot scheduled for 4/17 and need guidance on whether to take it.

Other Meds: Rosuvastatin 10mg

Current Illness: none

ID: 1186453
Sex: M
Age: 23
State: NJ

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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: n/a

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

Symptoms: Pt fell faint. Anxious about vaccine. Did not hurt his head. Landed on his buttocks. No complaint of headache, dizziness, chest pain or shortness of breath. Patient alert, awake, oriented. Vital signs were taken, 11:20 blood pressure 113/82, heart rate 76, spO2 98%.

Other Meds: n/a

Current Illness: n/a

ID: 1186454
Sex: M
Age: 48
State: NY

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 04/09/2021
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: dust mold pollen and penilicin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: After second dose, tired, very fatigued, whole body was sore, chest rash, injection site pain, this was the day after the shot and last for about 4 days. Felt bad for weeks after 2nd dose. On 3/23/21, Syncope and collapse, 3 days in hospital. Dr's could not find the cause of syncope and collapse, they ran many tests. On 3/23/21, woke up with severe chest pains and collapsed, large gash on my head, taken to hospital by ambulance. Dr's did not think it was from 2nd dose, but they could not find another reason for Syncope and collapse.

Other Meds: Lorsartan 25 mg, Atorvastatin 20mg, Fish Oil 300 mg, Vitamin D3 25 mcg, Probiotic, Tumeric 538 mg, Centrum Mens Multi Vitamin, Qurol CoQ10 mg

Current Illness:

ID: 1186455
Sex: F
Age: 37
State: KY

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: allergic to Cipro (medication, RX)

Symptom List: Pharyngeal swelling

Symptoms: slight headache, body chills, muscle aches, low grade fever 100.6. symptoms started approx 10-11 hours after the injection, and are still occuring at present (4:00 pm)

Other Meds: women's multi-vitamin, vitamin C

Current Illness: none

ID: 1186456
Sex: F
Age: 19
State: NC

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: IM
Vax Site: LA

Lab Data:

Allergies: Amoxicillin, citrus fruits

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Janssen COVID-19 Vaccine EUA Immediately after getting the vaccine, I experienced severe nausea for 10-20 minutes. I experienced no symptoms for 3-4 hours afterward, but then began to develop a low-grade fever, muscle aches, a headache, and became nauseous again. Around 12 hours after getting the vaccine, I developed a fever of 102 F, I began to experience severe muscle aches and cramps in my calves and abdomen. I also began to develop a much worse headache and lost partial vision in my right eye for a few hours. This is when I became violently nauseous, but I was unable to throw up, or defecate. I was unable to sleep during this time, and at 2 am, my nausea peaked, and I threw up incredibly violently and incredibly suddenly. It was so violent, it caused me to pop a blood vessel in my eye, and gave me a sore throat. However, after throwing up, most of nausea subsided. At this point, the vision began to return to my eye. 20-40 minutes after throwing up, I began to experience chills that lasted for up to an hour. Eventually, I slept at 4 am, but slept fitfully, and woke every 40 minutes to 2 hours. At 7 am on the 9th, the nausea was completely gone the day after my vaccination, but the muscle aches and headaches were back. My fever was down to 101, and I took some Tylenol and slept fitfully until 2 pm when I woke up feeling significantly better.

Other Meds: Pristiq 150 mg, Trazodone 100mg, Tri-Estarylla birth control

Current Illness: none

ID: 1186457
Sex: F
Age: 47
State: AZ

Vax Date: 04/03/2021
Onset Date: 04/03/2021
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: Contrast Dye

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Instant, horrible Tinnitus. Very red, thick, vein-like mark in appreance, but not a vein, down forearm down from injection site. Hot to touch.

Other Meds: Elderberry, Hair Skin & Nails, Vitamin D, Stool Softener

Current Illness: None

ID: 1186458
Sex: F
Age: 22
State: PA

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: SYR
Vax Site: LA

Lab Data:

Allergies: NA

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

Symptoms: Reading reaction signs and symptoms sign after vaccine. Felt short of breathe and dizzy. Resolved as soon as she arrived at med observation at 14:52. BP at 14:53, HR 61, Resp 16, BP 125/69, SaO2 98%. Kept patient until 15:08. All symptoms still resolved, vitals at 13:08, HR 61, resp 16, BP 115/57, SaO2 99%. Patient released at 15:08 and left via her own vehicle.

Other Meds: NA

Current Illness: NA

ID: 1186459
Sex: F
Age: 16
State: MN

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Pt was vaccinated. She said she felt fine. Pt walked 15 feet then fainted. Her mom was able to catch her. We moved her to a cot. She slowly regained consciousness. She had no signs of anaphylaxis. She was breathing fine. Her mother states she has fainted during blood draws in the past and her daughter hadn't eaten this morning. We monitored pt for 30 minutes. Her color and smile came back. Pt was able to walk out on her own. Her mother will monitor her today.

Other Meds:

Current Illness:

ID: 1186460
Sex: F
Age: 52
State: VA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
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:

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

Symptoms: Patient reported feeling itchy within 15 minutes of vaccination. Given Benedryl; patient improved and was released to home.

Other Meds:

Current Illness:

ID: 1186461
Sex: F
Age: 45
State: NC

Vax Date: 04/01/2021
Onset Date: 04/08/2021
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: N/K

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

Symptoms: Red rash on arm at injection site. Raised / firm. Hot to touch.

Other Meds: BCP, unisom.

Current Illness: None

ID: 1186462
Sex: F
Age: 42
State: IN

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: Tetracycline, latex, neosporin, and seasonal allergies

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

Symptoms: SEVERE headache Uncontrollable shaking and chills 103 temp Body aches Weak joints and body Felt like the flu x?s 600

Other Meds: Taking singular, levothyroxine, Benadryl, estradiol, requip, nasacort,

Current Illness: Weight loss Loss of appetite Hypothyroidism 1kidney from donation

ID: 1186463
Sex: F
Age: 33
State: KY

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:

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

Symptoms: Vomiting 20 minutes after injection, brain fog, migraine headache, 102 degree fever with sweats and chills, injection site was initially red, then purple and now brownish. pt has swollen lymph nodes, a swollen left breast and is not growing hair in her left armpit.

Other Meds:

Current Illness:

ID: 1186464
Sex: F
Age: 40
State: CO

Vax Date: 02/16/2021
Onset Date: 02/17/2021
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: No Known Allergies

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

Symptoms: Patient presents to ED one day after receiving Pfizer COVID-19 vaccine at outside facility with tachycardia. Seen earlier that day at an outside facility ED. Denies chest pain, shortness of breath, nausea, vomiting, abdominal pain. Breathing comfortably. Only other symptom is body aches. Has not needed any medications prior to arrival. Adminsitered acetaminophen and ibuprofen and discharged home medically stable. No escalation of care.

Other Meds:

Current Illness:

ID: 1186465
Sex: M
Age: 22
State: CA

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: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Upon removing cap of needle, re tightened needle to barrel, injected dose into pts. arm and noted a significant amount on injectors hand and pts. arm. Conferred with staff who consulted with pharmacy and other individuals. Second dose administered completing pts 2nd dose.

Other Meds: N/A

Current Illness: N/A

ID: 1186466
Sex: M
Age: 61
State: CA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Known systemic reaction to Grass, Trees and Weeds.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient was monitored for 30 minutes without complaint. Patient returned approximately 45 minutes after vaccine complaining of lips and mouth tingling that transitioned to numbness. Patient received 25mg of Benadryl PO approximately 50 minutes after vaccine. 30 minutes after Benadryl patient continued to complain of lip numbness and tingling on both palms. Patient was transferred to ED for further examination/treatment.

Other Meds: Crestor 40mg, Singulair 10mg, Albuterol 90mcg, Atenolol 25mg, Alvesco 160mcg, Flonase, 50mcg, Flexeril 5mg, Ibuprofen 600mg.

Current Illness: Asthma and rhinitis.

ID: 1186468
Sex: F
Age: 48
State: NC

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: INSECT VENOM, POISON IVY, SULFA

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

Symptoms: 48yr old female with history of anxiety, previous episodes of arm and leg weakness currently undergoing work-up for intermittent neurologic symptoms x 2yrs (on , allergies (insect venom: hives, shortness of breath; poison ivy: hives, shortness of breath; sulfa: hives) presented for COVID-19 J&J vaccine on 4/8/21. RN administered JANSSEN COVID19 VACC (LOT # 207A21A, exp 6/23/21) IM in patient's left deltoid at 1410. Approximately 5 minutes after receiving vaccine, patient complained of dizziness which later manifested as increased fatigue, malaise, weakness of the extremities with eventual report of tingling in the face. Patient unable to ambulate. Patient transported to exam room via wheelchair and transferred

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1186469
Sex: M
Age: 21
State: IN

Vax Date: 03/29/2021
Onset Date: 04/05/2021
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:

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

Symptoms: Increased resting heart rate from 60 to 80 1-2 weeks after second dose.

Other Meds:

Current Illness:

ID: 1186470
Sex: F
Age: 64
State: NC

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: IM
Vax Site: LA

Lab Data:

Allergies: Morphine, Penicillin allergy, Sulfa

Symptom List: Unevaluable event

Symptoms: 63 yo female patient complaining of a "tightness in her throat" Pt states she had multiple allergies. Pt given benadryl. No swelling to mouth or tongue noted. Pt denies any shortness of breath. Vital signs wnl. Pt stated she would sit and wait for awhile to see if she began feeling better. Pt advised she did not want to go to the hospital.

Other Meds: ASA, Albuterol, Plavix

Current Illness:

Date Died: 04/09/2021

ID: 1186471
Sex: M
Age: 45
State: PA

Vax Date: 04/07/2021
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: VANCOMYCIN RELATED

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

Symptoms: Complaints of diarrhea, sweating, weakness suffered sudden cardiac arrest. CPR, AED, Lucas device applied ACLS protocol initiated by EMS. Efforts terminated. Patient pronounced deceased at 1003am.

Other Meds: AMLODIPINE 10MG TABLET -- [TAKE 1 TABLET(S) ORALLY ONCE DAILY] -- 2021-02-23--2021-09-20 ATORVASTATIN 40MG TABLET -- [TAKE 1 TABLET(S) ORALLY ONCE DAILY] -- 2021-02-23--2021-09-20 LACTULOSE 10GM/15ML SOL -- [TAKE 30 MILLILITER(S) ORALLY TWI

Current Illness: D-4 - POST-OPERATIVE ANALGESIA, MILD-TO-MODERATE - 2020-09-03 E78.5 - HYPERLIPIDEMIA, UNSPECIFIED - 2021-02-23 I10 - HYPERTENSION, UNSPEC. - 2019-02-04 F10.20 - **[F10.20A]** ALCOHOL USE DISORDER, MODERATE - 2019-02-11 F14.20 - **[F14.20A]** COCAINE USE DISORDER, MODERATE - 2019-02-11 D-19 - FRACTURED TOOTH - 2020-08-24

ID: 1186472
Sex: M
Age: 53
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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Fever 102. Generally. Very tired

Other Meds: Carbamazepine Briviact lamotrigine depekote

Current Illness:

ID: 1186473
Sex: F
Age: 16
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: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: 16 Y/O PATIENT RECEIVED THE COVID19 (JANSSEN) VACCINE AT OUR WALK-IN CLINIC ON 4/8/21

Other Meds: N/A

Current Illness: N/A

ID: 1186474
Sex: F
Age: 65
State: VT

Vax Date: 04/05/2021
Onset Date: 04/07/2021
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 drugs and amoxycillin

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

Symptoms: I noticed increased pain, swelling and redness at the base of my right hand baby finger into the hand (palm side up)- very painful to the touch, can't bend' can't use.

Other Meds: none

Current Illness: none

ID: 1186475
Sex: M
Age: 20
State: MD

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Dizziness shortly after receiving the shot. Dizziness resolved after a few minutes.

Other Meds:

Current Illness:

ID: 1186476
Sex: M
Age: 36
State: CO

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 2nd Vaccine was given early. First dose given on 3/19/21 second does was due on 4/16/21 but was not due until 4/16/21

Other Meds: None

Current Illness: None noted

ID: 1186477
Sex: M
Age: 51
State: IL

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:
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: Patient received second shot Moderna 4/9/21 and first shot was Pfizer 3/19/21.

Other Meds: n/a

Current Illness: None

ID: 1186478
Sex: M
Age: 36
State: PA

Vax Date: 02/16/2021
Onset Date: 03/02/2021
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: Nausea

Symptoms: two weeks after i was given the moderna vaccine i had very intense mental fog, fatigue, trouble sleeping, and joint pain. I have been taking prednisone for three weeks now and am starting to get better.

Other Meds:

Current Illness:

ID: 1186479
Sex: F
Age: 46
State: MD

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bee Pollen, Sulfa

Symptom List: Injection site pain

Symptoms: Pt c/o difficulty swallowing, tongue tingling, and feeling "fuzzy overall" 25 min post vaccination. EMS called. Transferred to local hospital.

Other Meds:

Current Illness:

ID: 1186480
Sex: F
Age: 83
State: TN

Vax Date: 03/31/2021
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: nka

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

Symptoms: A lump has formed under her right arm and breast. Her physician has scheduled her for a scan and says the lump needs to be removed.

Other Meds: Alprazolam 0.25 mg; Eliquis 5 mg; Fish Oil 1000 mg; Protonix 40 mg.; furosemide 20 mg.; Vitamin D3, 5000 units

Current Illness: none noted

ID: 1186481
Sex: F
Age: 85
State: NJ

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

Lab Data:

Allergies: Shellfish

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

Symptoms: Patient was in store to receive the second Moderna vaccination and the pharmacist gave the J&J vaccine instead

Other Meds:

Current Illness:

ID: 1186482
Sex: F
Age: 64
State: IN

Vax Date: 03/11/2021
Onset Date: 03/11/2021
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: Pt received 1st dose Moderna at a different location 2/11/2021. On 3/11/2021 pt present to facility with appointment for 2nd dose appointment. Patient received 2nd dose Pfizer vaccine at this time.

Other Meds: lexapro 20 mg tab po daily risperdal 1 mg tab po BID trazodone 50mg tab po q hs calcium 500mg tab po daily zinc 50 mg 1 tab po daily multivitamin daily CBD gummies BID cetirizine 10mg tab po daily albulterol hfa 90 mcg 2 puffs q 6 hours prn

Current Illness: None

ID: 1186483
Sex: F
Age: 63
State: WA

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

Lab Data:

Allergies: adhesives, sulfa, fluticasone

Symptom List: Erythema, Pruritus

Symptoms: We didn't adminster the vaccine at our location, however, she alerted us of her reaction that started immediately after getting vaccine: Per patient:"I had a generalized reaction. My face swelled, turned red, got hot; my throat had some swelling; I had to remove my mask to breathe. I had to stay an hour and a half before they would let me go home. My face swelling diminished over the next 24 hours."

Other Meds:

Current Illness:

ID: 1186484
Sex: M
Age: 13
State: NC

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: None

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

Symptoms: Patient did NOT have a reaction. Patient was given a vaccine that had expired on 03/28/2021

Other Meds: No

Current Illness: None

ID: 1186485
Sex: M
Age: 8
State: NC

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: 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: child given expired polio vaccine by accident. Nurse thought expiration date was 03/31/2021 but it was 03/13/2021. No adverse reaction or side effects noted. Parent informed and child re-vaccinated the next week.

Other Meds: none

Current Illness: none

ID: 1186486
Sex: M
Age: 25
State: MI

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

Lab Data:

Allergies: No known allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: The client experienced mild nausea and anxiety 5 minutes after receiving his first Pfizer covid vaccine. He left observation after 15 minutes at 1345 with no treatment, except bottled water. An hour later at 1445 the client returned to Observation c/o increasing nausea and vomiting. At this time, I administered 50 mg IM benadryl to the client. The client waited in observation for 30 additional minutes and left at 1515. At this time of departure, the client had no signs or symptoms of N/V.

Other Meds: N/A

Current Illness: N/A

ID: 1186487
Sex: M
Age: 43
State: CA

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: 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 have a strange pin prick feeling in the top of my head that only exhibits pain when my facial expressions or other movements cause my scalp to be moved or stretched. When I try to feel for something poking the top of my head, there is nothing there and touching the area does not cause pain. But then I may look to the right and frown, and suddenly there is a sharp needle feeling in the top of my head.

Other Meds:

Current Illness:

ID: 1186488
Sex: F
Age: 22
State: NJ

Vax Date: 03/13/2021
Onset Date: 04/05/2021
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: Latex

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

Symptoms: Shingles around the left eye and forehead area, as well as scalp. Itchiness, rash and pain, pain associated with the left eye as well Rash began 4/5/2021 Pain began 4/6/2021

Other Meds: Junel Fe

Current Illness: N/A

ID: 1186489
Sex: M
Age: 37
State: VA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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:

Symptom List: Pain in extremity

Symptoms: Patient felt faint and fell to the floor within 15 minutes of vaccination. Patient was transported to ER by EMS.

Other Meds:

Current Illness:

ID: 1186490
Sex: M
Age: 31
State: WA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: none

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

Symptoms: muscle soreness dizziness weakness nausea

Other Meds: none

Current Illness: none

ID: 1186491
Sex: F
Age: 32
State: OH

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: N/A

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

Symptoms: Whole body aches and fatigue beginning at 7pm day of vaccination lasting til 1pm following day, Severe Chills beginning at 8:30pm lasting til 12pm, Headache starting 12pm relieved with Tylenol, Mild-Moderate Nausea starting at 4am until 5am

Other Meds: TriNessa Birth Control

Current Illness: N/A

ID: 1186492
Sex: F
Age: 51
State: CA

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 allergy

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

Symptoms: Pt feels dizzy on the way to the observation area. EMT provides oxygen. paramedics called and transport to hospital

Other Meds: High blood pressure and cholesterol medication

Current Illness: Stroke, COVID at November 2020

ID: 1186493
Sex: F
Age: 40
State: IN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: None

Symptom List: Vomiting

Symptoms: Extreme pain first day with red swollen injection site. Pain lessened next few days. Pus filled bump on injection site with patchy red hot rash surrounding. Arm still tender to move a week after.

Other Meds: Calcium, Probiotic, Vitamin C

Current Illness: None

ID: 1186494
Sex: F
Age: 74
State: IL

Vax Date: 02/22/2021
Onset Date: 04/08/2021
Rec V Date: 04/09/2021
Hospital: Y

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

Lab Data:

Allergies: Allergen Reactions ? Codeine Rash ? Iodinated Diagnostic Agents "almost went into coma, 1971" ? K-Tab [Potassium Chloride] rash ? Other Tylenol #2 ? Penicillins Rash Rash on arms in 1963 with strep throat/rheumatic fever ? Sulfa Antibiotics Nausea And Vomiting ? Vancomycin Rash "rash on chest"

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 3/8: Admitted to hospital dx chest pain; 3/9 transferred to a different hospital, dx gallbladder necrosis. Hospital course: 74 y.o. female admitted on 4/8/2021 for abdominal pain. Notable PMHx: aortic valve replacement, HTN On morning of admission, patient woke up with severe epigastric pain. Describes pain as a pressure. Has had vomiting. Had bowel movement after pain started. Patient came to the emergency room. Patient received an antiemetic and Demerol. Patient has continued to have pain in got a dose of morphine as well. Pain eased some but was still 7/10. In the ER, blood pressure was very elevated with systolic in 200s. Cardiac enzymes negative. EKG look good with normal sinus rhythm. Patient has aortic valve replacement and is on Coumadin with INR goal of 2.5-3.5. INR was elevated at 4.3. D-dimer was negative. Amylase and lipase negative. Creatinine normal at 0.9. Chest x-ray done which showed no acute disease. On the floor, we ordered a CT abdomen. It did show gallstones, but nonobstructing. It showed kidney stones in the renal pelvis, but none obstructing. No other inflammation or signs of bleeding. Blood pressure came down after medicines in the ER. Did have some lower blood pressures through the afternoon evening which was felt to be a combination of blood pressure low in medicines in the ER and pain medication. From 11:00 p.m. onward blood pressures were controlled. Patient continued to have severe abdominal pain. Hemoglobin down to 9.0 from prior 12.4 yesterday. Creatinine up from 0.9 yesterday to 1.8. White count up from 8.3 yesterday to 14.4. INR from 4.3 yesterday to 4.2. Coumadin was held yesterday. CT abdomen was repeated. CT abdomen was read as worrisome for necrotic gallbladder and small bile leak Contacted transfer line at hospital. Surgery accepted and wanted transfer to go through the ER. Patient has PCN allergy. Surgery said that if reaction was not severe, they wanted Invanz given before she left. Patient says that she had a itching rash in the 70s. No trouble breathing or swallowing. No other reaction. Dose of Invanz ordered. IVF were increased. HPI from hospital: 74 y.o. female who presents with Chief Complaint Patient presents with? Abnormal Scan Patient presents via EMS as a medical transfer from hospital after having gallbladder necrosis seen on CT imaging. She was given IV Invanz there. General surgeon was contacted by that facility and he accepted the patient for transfer to this facility. Apparently, the patient began having abdominal pain yesterday. Timing of onset was gradual. Severity is rated as severe at maximum intensity. Quality is described as aching abdominal pain. Symptoms have been improved after IV pain medicine. Symptoms worsen with nothing, and improve with IV pain medicine. History was provided by patient, EMS, transfer paperwork and EMR, and I spoke with treating doctor in general surgery who accepted the patient for transfer.

Other Meds: Current Outpatient Medications on File Prior to Encounter Medication Sig Dispense Refill ? atorvaSTATin (LIPITOR) 80 MG tablet Take 1 tablet (80 mg) by mouth at bedtime ? CALCIUM CITRATE PO Take by mouth daily as needed ? Cholecalc

Current Illness:

ID: 1186495
Sex: F
Age: 61
State: MI

Vax Date: 04/06/2021
Onset Date: 04/07/2021
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: OAS (most fruits)

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

Symptoms: Received 2nd Covid19 Moderna vaccine on April 6 in left arm. Very hard rock-like lump area appeared within a couple hrs. By next day large red area around injection site. Painful to touch, and very itchy. Could not sleep on left side. FYI received first Covid19 Moderna vaccine on March 9. Arm slightly sore for couple days, but no other reaction, no redness or itching.

Other Meds: Lisinopril 10 mg/daily Atenolol 25 mg/daily Multivitamin 1/day

Current Illness: N/A

ID: 1186496
Sex: F
Age: 45
State: IN

Vax Date: 04/01/2021
Onset Date: 04/09/2021
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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Injection site is itching, red, and hard one week and one day after receding vaccine.

Other Meds: None

Current Illness: None

ID: 1186497
Sex: F
Age: 67
State: NJ

Vax Date: 03/23/2021
Onset Date: 03/23/2021
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 light headed, patient takes many meds. Had not eaten since 1:00pm, was given orange juice during visit, patient claimed to feel better. Patient spoke to primary care physician and put him on speaker phone, he noted blood pressure that was taken at 5:05pm which was 212/119, heart rate 80, spO2 98%. Blood pressure trended downward to 190/108, doctor felt comfortable with patient going home.

Other Meds:

Current Illness:

ID: 1186498
Sex: F
Age: 52
State: CA

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

Lab Data:

Allergies: None

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

Symptoms: On day 1 injection day, sore arm; day 2 sore body and throat; day 2-3 blisters at the edge of my mouth which is very unusual as I don?t get cold sores.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm