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: 1187868
Sex: M
Age: 19
State: IL

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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Extreme fatigue, body aches / pains, severe headache, slight fever, nausea. Became noticeable around 10 hours after vaccine. 24 hours later symptoms mostly gone. After taking advil symptoms alleviated.

Other Meds:

Current Illness:

ID: 1187869
Sex: F
Age: 43
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Left ear is pinging with slight pain- tinnitus.

Other Meds: Synthroid for hypothyroidism Mesalamine for ulcerative colitis

Current Illness: None

ID: 1187870
Sex: M
Age: 73
State: PA

Vax Date: 03/01/2021
Onset Date: 03/25/2021
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: ?

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

Symptoms: On 3/25/21, he went to Hospital because of a high fever. One 3/28/21, he had a moderate stroke in his frontal lobe and can no longer talk, understand basic things or take care of himself.

Other Meds:

Current Illness: pancreatic cancer diabetes

ID: 1187871
Sex: F
Age: 60
State: PA

Vax Date: 04/02/2021
Onset Date: 04/04/2021
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: Eggs, Crab, Penicillin, Statins , Advil liquid Gel

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Sunday 04/04/2021 started itching on right side next to breast, no redness or rash. itch got more severe over nigh. 04/05/2021 morning lips dry and burni,g throat and back tongue scratchy. 04/06/2021 severe itching from head to toe still no rash or redness. took benedryl called fam. doctor, told me to continue benedryl till itch subsides. evening severe pain in upper stomach near breast, felt like big bubble /knot, started vomiting and diarhea all night . 04/07/2021 entire body rash and hives, went to ER. said it was severe alergic reaction. gave me prednisone shot, and told me to contact allergist. taking prednisone for 4 days also pepcid and benedryl. it is now 04/09/2021 still itching all over , and diarhea

Other Meds: montelukast sodium, neurontin, Zetia, Percocet

Current Illness: Infected tooth Oral surgery 03/02/2021

ID: 1187872
Sex: F
Age: 31
State: FL

Vax Date: 04/04/2021
Onset Date: 04/04/2021
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: Nickel, pineapple

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

Symptoms: Joints on the left side began to throb/have a deep ache (left scapula-to-clavicle shoulder join, left wrist, left hip, left knee, and left ankle) around 1:30 in the afternoon. At 1:45am temperature spiked to 102.4 and began to have the shakes where couldn't hold anything in my hands. Shakes dissipated at 4:30am, but fever remained at a steady 102 from Monday-Tuesday night. Monday, left arm developed redness and swelling 2 inches beneath the injection site, along with itching. Redness and swelling wrapped around the front of the left arm to the outside of the left arm. The band was about three inches wide. Wednesday 4/7 temperature dropped to 99.8 and neck was stiff with the feeling of pressure along the base of the skull. Jawline became itchy and red. The swelling and redness in the arm reduced to mild pinkness and occasional itching. Thursday 4/8 - stiffness of the neck and slight pressure along the base of the skull. Easily fatigued.

Other Meds: n/a

Current Illness: n/a

ID: 1187873
Sex: F
Age: 50
State: HI

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:

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

Symptoms: At 12:20 PM the patient complained of itchiness of the lips tongue and throat. She had no shortness of breath no swelling of the face and no hives. She is diagnosed with asthma currently she is on oxygen 3 L per minute she uses when she has a face mask she takes Singulair, albuterol and receives allergy shots Zolair every two weeks at doctors for allergies to bees cats grass and trees. Her blood pressure at 12:20 was 112/70 pulse 60 respirations 18 and she had wheezing. Her temperature was 97 . 5 and she was alert and oriented at 12:28 her blood pressure was 108/60 pulse 63 respirations 18 and she was alert and oriented at 12:22 Patient gave herself her Abiquiu in the right thigh which she carries on her own at 12:30 the fire department personnel came who are on site her oxygen was 97% pulse 64 patient was coughing a tight at 12:30 to patient was taken to the hospital via ambulance by EMT paramedic patient still was complaining of itchy throat lips tongue and some facial swelling was noted.

Other Meds:

Current Illness:

ID: 1187874
Sex: F
Age: 35
State:

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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fatigue, muscle ache, sore injection site, diarrhea, fever

Other Meds:

Current Illness:

ID: 1187875
Sex: F
Age: 23
State: MN

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

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

Lab Data:

Allergies: none acknowledged

Symptom List: Pharyngeal swelling

Symptoms: patient reported nausea to staff, lead RN was called. Diaphoresis was immediately noted patient was tachypneic and anxious, denied throat swelling reported "heavy chest" has a couple "tics" tremors reported this to be someone normal. HR elevated to 130, ems called with patients permission. 2 minutes later patient lost consciousness and epi was administered. EMS updated. Patient brought to hospital via EMS

Other Meds: unknown med for tremors

Current Illness: unknown

ID: 1187876
Sex: U
Age: 37
State: CT

Vax Date: 04/01/2021
Onset Date: 04/15/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever

Other Meds: None

Current Illness: None

ID: 1187877
Sex: F
Age: 28
State: CA

Vax Date: 04/02/2021
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: N/a

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dizziness, headaches, nausea, arm soreness

Other Meds: N/a

Current Illness: N/a

ID: 1187878
Sex: F
Age: 51
State: VA

Vax Date: 03/31/2021
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: Penicillin, sulfa drugs.

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

Symptoms: Redness, swelling, heat, pain and itching at the injection site nine days after injection. Approximately 2 inches wide and 1 inch tall.

Other Meds: None.

Current Illness: None.

ID: 1187879
Sex: F
Age: 57
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: certain topical soap products

Symptom List: Rash, Urticaria

Symptoms: Artery inside of elbow is leaky per patient report. looks like a bruise on the left elbow. No pain, increasing in area. Advised patient if it worsens to reach out to her primary care provider. As of report time it was 4.5 cm in length and 2 cm in with.

Other Meds: naproxen prn, b 12 shot, iron pill, Prozac, Wellbutrin, estradiol, acyclovir prn.

Current Illness: tinnitus, patient believes its stress related

ID: 1187880
Sex: F
Age: 56
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: Body aches, chills, joint pain, fever between 100.4 and 101.8; headache, fatigue, eye burning/watering; stayed home in bed, hydrating, still not feeling well today; fever down to 99.8

Other Meds: N/A

Current Illness: N/A

ID: 1187881
Sex: F
Age: 81
State: PA

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

Lab Data:

Allergies: iodides

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

Symptoms: The patient said that she experienced hot/cold symptoms. She also stated that she had an upset stomach( said it felt like a burning feeling). She said that she experienced it on 4-8-21, she said that she will give it another day and follow up with her physician if not feeling better.

Other Meds: not sure

Current Illness: not known

ID: 1187882
Sex: F
Age: 36
State: VA

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

Symptoms: Swollen entire left leg to the point I can?t pull my left pant leg all the way up

Other Meds: Lamictal Probiotic

Current Illness:

ID: 1187883
Sex: M
Age: 60
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: 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: Swollen glands under the arm pit. Little discomfort

Other Meds: Lisinopril

Current Illness: None

ID: 1187884
Sex: M
Age: 41
State: CA

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: none

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

Symptoms: Pt was sitting in chair for recovery. Fell out of chair from sitting to lying position face down on floor. Pt immeditaly sat up on his own. A/Ox3. Sat up in a daze for a few seconds. V/S obtained with b/p 98/56 HR 47 O2 98%. EMS notified. Upon EMS arrival pt was lying back down but a/ox3. Pt refused EMS for further care. Monitored pt for extra 30 min and sent home with wife at side.

Other Meds: none

Current Illness: none

ID: 1187885
Sex: M
Age: 42
State: FL

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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: morphine contrast dye penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had a strange feeling in the left side of my face that I wasn't sure if it was a reaction or not. It happened within the first 15 minutes but did not last more than 30 minutes. I did not experience anything else until the first evening when my arm was very sore. The next day my arm was more sore and I had a mild circular red mark around the injection site and the arm was much harder on that side. I also felt a little in my back and neck. By the second day in the evening the only thing I felt was pain in the arm which eventually traveled into my armpit by day 3. It wasn't until day 5 that all the pain was completely gone. I may have experienced fatigue the first two days also.

Other Meds: Spark multi vitamin

Current Illness: none

ID: 1187886
Sex: F
Age: 38
State: NC

Vax Date: 03/19/2021
Onset Date: 03/19/2021
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: Na

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Severely swollen lymph nodes in arm pit

Other Meds: Na

Current Illness: Na

ID: 1187887
Sex: F
Age: 55
State: OR

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

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

Symptoms: 1.5 hrs after 1st dose of covid19 pfizer vaccine, pt developed pruritic rash on neck and upper back, swelling beneath eyes bilaterally and SOB noticed as increased use of rescue inhaler. States is "not having that hard a time of breathing".

Other Meds:

Current Illness:

ID: 1187888
Sex: F
Age: 33
State: MN

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: 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: Chills 8 hours after dose, then Severe headache and then sweats

Other Meds:

Current Illness:

ID: 1187889
Sex: F
Age: 40
State: WA

Vax Date: 12/21/2020
Onset Date: 03/09/2021
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: NKDA

Symptom List: Unevaluable event

Symptoms: pulmonary embolism, symptomatic

Other Meds: combined oral contraceptive

Current Illness: none

ID: 1187890
Sex: M
Age: 44
State: AK

Vax Date: 02/25/2021
Onset Date: 03/02/2021
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: environmental allergies

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

Symptoms: peeling skin of palmar aspect of both hands, no pain, no itching, no other skin reaction

Other Meds: Flonase nasal spray, loratadine

Current Illness: sleep apnea

ID: 1187891
Sex: M
Age: 48
State: AZ

Vax Date: 02/04/2021
Onset Date: 02/06/2021
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: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: Swollen lymph nodes under left armpit were severely inflamed when I woke up on Saturday 2/06/2021. 1-2 days later I had severe pain on my Left back- ended up being my brachial plexus nerve. Few days after that I developed numbness and weakness on my left side and pins and needles in my Left index finger. I saw my primary care doctor twice that week. He started me on low dose Prednisone and gabapentin for the pain while sleeping. When the nerve pain/numbness did not subside, I asked for a neurology referral. Two doctors saw me for brachial plexus neuritis. I have had 2 ultrasound guided and one fluoro guided cortisone shots along the nerve. I have also been going to PT 2-3 x/week to regain my strength on the Left side & calm nerve.

Other Meds: Androgel Levothyroxine Atovastatin

Current Illness: None

ID: 1187892
Sex: F
Age: 60
State: VA

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: correctol, penicillin, vibramycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: pt start feeling lightheaded and dizzy ,she lie down on floor and could stay up , no difficulty of breathing we contact 911 and paramedic took her to hospital for observation.

Other Meds: none

Current Illness: pt had sever allergy reaction to PNC and correctol

ID: 1187893
Sex: F
Age: 49
State: GA

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: SYR
Vax Site: LA

Lab Data:

Allergies: shellfish

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

Symptoms: 0213A21A -(The lot number is hard to read and it could be this number or the one above.) Wednesday, Thursday and Friday - I had headaches and I had extra fatigue (I already do have fatigue because I have insomnia). My arm soreness was on the other arm not on the one that I had an injection. Friday and up until yesterday, I had nausea. Saturday, I had headache and being tired. Sunday, I had chest pain (woke up with it) like a burning in my chest. My left arm, I felt a tingling down my arm to my legs - it almost felt like a blood clot was there in my arm. I had to put heat on and then ice. I couldn't extend arm because it hurt. Midnight on Monday, the burning and the chest pain was too much and I was getting worried. The only thing I have is asthma, otherwise I'm healthy. I went to ER - they gave a Cocktail of Lidocaine; Malex and something else to see if it would help with the burning in my chest. Monday, I took Tylenol. Tuesday, the chest pains were more intense. 03:00 on Wednesday am - I went back to ER. They brought me to a full chest x-ray - front, side and back and a CAT SCAN and gave me another Cocktail and also put something in my IV. This time, they sent me home with four different medicines. The meds are: Generic of Nexium; Aspirin low dose of 81 mg - bayers children - one a day; Generic version of Bentil Triacetin - I take this when I want to be still; Generic version of Valium - they gave me four of these - and I have one left that I will take tonight so I can sleep. I am taking Vit D. I haven't taken Tylenol since getting on these. I try to stay hydrated. I still have a really really funny feeling inside me. Last night, I was very restless and couldn't sleep. It makes me on borderline and dizzy and my heart starts palpitating. It's a scary feeling in my chest.

Other Meds: Vit D; Albuterol when needed (not at the time)

Current Illness: no

ID: 1187894
Sex: F
Age: 45
State: NV

Vax Date: 03/10/2021
Onset Date: 03/27/2021
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: Clindamycin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On 3-27-21 patient returned to clinic for routine appointment for wound care. At this visit patient reported that she had diffuse pain along the right side of her chest, midaxillary area, as well as a painful rash to her right upper back.

Other Meds: Artovastatin Insulin Aspart Metformin Insulin Glargine

Current Illness: Wound care (abcess). 80 % healed.

ID: 1187895
Sex: F
Age: 57
State: PR

Vax Date: 01/27/2021
Onset Date: 02/26/2021
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: Not before. After the vaccine allergy to advil, fish, ham, chop, shellfish.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Allergic reaction, swollen eye, swollen lips, closed windpipe. In an emergency they administered decadron with benadryl and solumedrol. After about 2 hours he was able to swallow and speak but with difficulty. The symptoms diminished for the next 4 days. Prior to that. And days after the first dose one eye swelled. And a week the lips too. Reactions that I had never had, nor allergies to medications or foods had appeared before, but after doses together with chronic inflammation throughout the body.

Other Meds: Coreg 25mg, Procardia XL 60mg, Catapres 2mg

Current Illness: None

ID: 1187896
Sex: M
Age: 29
State: CA

Vax Date: 04/07/2021
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: none

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

Symptoms: Reported seizure, Heart rate at 40 bpm. For 15 mins.

Other Meds: none

Current Illness: none

ID: 1187897
Sex: F
Age: 42
State: MN

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: RA

Lab Data:

Allergies: No

Symptom List: Nausea

Symptoms: Pain at injection site post 4 hours of shot. Muscle pain with chills and sweating about 12 hours later, but short lived. Treated with Tylenol. General fatigue

Other Meds: Lexapro and multi vitamins

Current Illness: No

ID: 1187898
Sex: F
Age: 39
State: CA

Vax Date: 04/02/2021
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: Amoxicillin

Symptom List: Injection site pain

Symptoms: Diagnosed with COVID arm. Unable to move arm or complete daily tasks. Excruciating pain for 7 days now

Other Meds: Multivitamin, iron, D3, Vitamin E, fish oil, calcium, biotin, K12, B12 and allegra

Current Illness: No

ID: 1187899
Sex: M
Age: 31
State: NY

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: Unknown

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

Symptoms: Fever greater than 103 Dry heaving Diarrhea Extreme headache Chills Sweats Extreme fatigue Dizziness Blurred vision Lethargic

Other Meds: Adderall

Current Illness: None

ID: 1187900
Sex: M
Age: 81
State:

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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: pt discovered blurry vision/vision loss 1 hour after getting the immunization. Has not resolved as of 04-9-21

Other Meds:

Current Illness: past history of covid infection

ID: 1187901
Sex: M
Age: 18
State: SC

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:

Symptom List: Tremor

Symptoms: Patient received the COVID-19 vaccine (first dose Pfizer). He reported no previous adverse reactions to vaccines. During the 15 minute monitoring period, the patient fainted. He appeared pale and sweaty, and he reported dizziness, lightheadness, and blacking out. He laid down for several minutes and sat up in the chair with assistance when he was no longer lightheaded. His blood pressure was 108/71 with heart rate 76. EMS checked the patient and cleared him approximately 20-25 minutes after receiving the vaccine.

Other Meds:

Current Illness:

ID: 1187902
Sex: F
Age: 47
State: VA

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: seasonal, hx: anaphylaxis unknown trigger

Symptom List: Erythema, Pruritus

Symptoms: 15:35: c/o flushing, palpitation, numbness and tingling, itching, lightheaded and dizzy received vaccine at 15:30. 47 y.o female began feeling flushed, dizzy and lightheaded. pt began feeling more flushed and jittery. she was taken to the EMS tent. She appeared to be flushed on her chest and neck. she was still complaining of being dizzy. she stated that she has had multiple allergic reactions and anaphylactic reactions in the past. pt said that she typically gets the same symptoms she has now. 25mg of oral benedryl was given. pt was evaluated and monitored. she said that she began to feel better. she mentioned at that point she felt like her tongue stopped tingling. 30 mins later she began to feel dizzy and flushed again. 25mg of benedryl was given again (totally 50mg) transport unit was called. pt was transported to MRMC by medic 404-

Other Meds: allegra, zyrtec

Current Illness: unknown

ID: 1187903
Sex: F
Age: 32
State: IN

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: not known

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

Symptoms: About one minute after the woman sat down from getting her COVID shot she told our cashier she was feeling ill and was going to the bathroom. I went in the bathroom and found her sitting on the floor with her head between her legs. She said she started feeling ill and hot and sweaty. Her palms were sweaty as well. She was dizzy and she was starting to black out and then got tunnel vision. I tried twice to take her blood pressure and could not get a reading from the machine. We got her a glass of water that she wanted. She said she did not eat that morning. During our conversation she started feeling worse and laid down. She felt that 911 did not need to be called. After a few minutes she started feeling better and was able to stand. She said she has previously passed out after getting a shot. She answered no on the questionairre and to the direct question of have you ever fainted afer getting a vaccine before the shot. She went back out to sit in the waiting room for 15 more minutes. Before she left she came to me and said she felt better. We went to the HIGI machine to get her BP. It was 116/79

Other Meds: Not known

Current Illness: none that was made aware to us

ID: 1187904
Sex: F
Age: 55
State: GA

Vax Date: 03/31/2021
Onset Date: 04/01/2021
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: Pt experienced >102 Fever, Fatigue, nausea, vomiting, diziness, achiness for 24 hours when waking up the morning after receiving her shot the previous day. Pt stayed in bed all day, too ill to drive kids to school.

Other Meds: None

Current Illness: None

ID: 1187905
Sex: F
Age: 50
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nka

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: patient had complain of numbness that started in her arms and numbness on the right side of her neck. Provider onsite was called to assess the patient. Vital signs were taken and random blood sugar was taken. Patient was closely monitored for additional 15 mins. Prior to discharged, Provider on site was called to assess patient again prior to discharged. 1:46pm Blood Pressure: 148/84 Pulse: 101 O2 Sat: 100% 2:05pm Blood Pressure: 134/74 Pulse: 88 O2 Sat: 100% Blood Sugar: 134 2:25pm Blood Pressure: 117/80 Pulse: 74 O2 Sat: 100% Discharge Time: 2:30 pm Patient was given ER precautions and if the numbness still persist, she is to contact her PCP to schedule a follow up appointment. Patient is aware.

Other Meds: unknown

Current Illness:

ID: 1187906
Sex: F
Age: 62
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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Patient received her first Pfizer vaccine on 4/1/21. Due to a miscommunication, patient received her second vaccine on 4/9/21 without any side effects. Notified Dr. of incident and he contacted CDC. Reported via VAERS. Notified patient of process and expected outcomes as per CDC website. Patient verbalized understanding.

Other Meds: None

Current Illness: none

ID: 1187907
Sex: F
Age: 55
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

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

Symptoms: Dizziness and shortness of breath, Lasted approximately 10 minutes

Other Meds: Lisinopril

Current Illness: none

ID: 1187908
Sex: F
Age: 59
State: GA

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: Oranges

Symptom List: Pain in extremity

Symptoms: Injection site pain and hardness, headache, fever, full body chills, fatigue

Other Meds: losartan 12.5mg, Vitamin B6, Vitamin B12

Current Illness: None

ID: 1187909
Sex: M
Age: 26
State: TX

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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: Fever, shaking, muscle spasms, inability to control my body. Stomach aches

Other Meds: Albuterol for asthma

Current Illness: None

ID: 1187910
Sex: F
Age: 56
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Upper left arm pain, temperature spike to almost 102 F, Dizziness, Body aches, upper leg pain. Taking OTC med for fever reducer and mild pain reliever

Other Meds:

Current Illness: None

ID: 1187911
Sex: F
Age: 27
State: MA

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: Antibiotics

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

Symptoms: Tight throat

Other Meds:

Current Illness:

ID: 1187912
Sex: M
Age: 35
State:

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

Symptom List: Vomiting

Symptoms: Rash at injection site on left arm 7 days after receiving the shot.

Other Meds:

Current Illness:

ID: 1187913
Sex: M
Age: 51
State: WY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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: stomach cramps, diarrhea, body aches, swollen lymph nodes under the L armpit .

Other Meds: amlodipine hctz

Current Illness: none

ID: 1187914
Sex: F
Age: 24
State: TX

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: RA

Lab Data:

Allergies: sulfa drugs

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

Symptoms: Shot administered at 2:30pm. Felt fine all afternoon, until 8:30. Chills and mild headache for about 30 mins, then immediately deteriorated around 9pm into body aches, fatigue, and more severe chills. Patient began taking temperature sublingually, with the same device for each reading Sublingual temperature at 11:01pm: 99.4 degrees fahrenheit Sublingual temperature at 11:10pm: 100.2 degrees fahrenheit Sublingual temperature at 11:22pm: 100.7 degrees fahrenheit Sublingual temperature at 11:43pm: 101.2 degrees fahrenheit Sublingual temperature at 11:56pm: 101.6 degrees fahrenheit Sublingual temperature at 12:37am: 102.5 degrees fahrenheit at this point, patient took 800mg of Ibuprofen. Temperature at 9:30am the following day was 99.5, and remained constant all day. Chills, body aches, head ache, fatigue. Sublingual temperature taken again at 9:37pm (the day after injection) and temp was 100.2 600mg Ibuprofen, patient felt fine the next morning except for lingering lower back aches

Other Meds: synthroid, lo loestrine fe, zertec

Current Illness: n/a

ID: 1187915
Sex: M
Age: 34
State: OH

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Past severe reaction to remicaid

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sedation of tongue swelling approx 10 minutes after injection. VSS. Recommend transport to local ED for evaluation NAD at vaccine site prior to transport

Other Meds: N/a

Current Illness:

ID: 1187916
Sex: F
Age: 61
State: CA

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: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Extreme bidy and joint aches. Headache. Fever.

Other Meds: Estrogen patch Progesterone

Current Illness: None

ID: 1187917
Sex: F
Age: 58
State: NV

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: none

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

Symptoms: Patient developed a rash on forearms most likely related to a cleaning agent used on the chairs to disinfected between patient use

Other Meds: Benadryl

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm