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: 1193301
Sex: F
Age: 41
State: IN

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/11/2021
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: Sulfa, Lidocaine, Soy

Symptom List: Dysphagia, Epiglottitis

Symptoms: Arm pain, headache, diarrhea, dizziness, fatigue (2 days). Started period 2 day early and had very heavy period with bad cramps.

Other Meds:

Current Illness:

ID: 1193302
Sex: F
Age: 26
State: NY

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/11/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Needle malfunction during vaccine administration. Small amount of vaccine exuded from vaccine site when needle was withdrawn. It was determined that patient received greater than half a dose, therefore, per Guidelines, no further vaccine was administered .

Other Meds:

Current Illness:

ID: 1193303
Sex: F
Age: 53
State: GA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: penicillin

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

Symptoms: pain, redness, heat at injection site. applied ice several times throughout the day for 20 minutes, ongoing at this point but improving. Fever ranging up to 100.3 degrees, chills, headache, general weakness. drank plenty of fluids, ate chicken soup with garlic, rested. Symptoms mostly resolved after 24 hours.

Other Meds: zoloft 100 mg PO q 24 hrs, mulit-vitamin 1 PO q 24 hrs, 2000 IU vitamin D3 PO q 24 hrs

Current Illness: none

ID: 1193304
Sex: F
Age: 30
State: OH

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever, chills, severe nausea, vomiting, fatigue, moderate/severe body aches

Other Meds: BCP

Current Illness: None

ID: 1193305
Sex: F
Age: 64
State: TN

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: Sensitive to vanvomycib, Cipro, epinephrine Titanium allergy, medical grade plastic allergy

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

Symptoms: Tasted vaccine in throat, throat closed briefly, ringing in ears began immediately, hearing loss/stuffiness in right ear occurred immediately, foggy brain occurred immediately. The tinnitus is constant and persists along with the hearing loss .

Other Meds: Metropolol, amlodopine, Losartan, liothyronine , levothyroxine

Current Illness:

ID: 1193306
Sex: F
Age: 65
State: CT

Vax Date: 03/21/2021
Onset Date: 03/22/2021
Rec V Date: 04/11/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: Vaccine given on 3/21/2021 - Chills, headaches , weakness and fatigue started on 3/22/2021- no fever. Weakness,chills and fatigue and headaches progressed until 4/01/2021 when patient experienced complete weakness in left arm and leg and unable to stand or walk. Prior to 2nd dose, patient was recovering from a stroke and was beginning to walk with assistance and a cane. After April 1, 2021, patient is unable to stand or walk. Chills, headaches weakness and fatigue continue as of April 11, 2021

Other Meds: Lithium Carbonate 300mg, Amlodipine 5mg, Lamotigine 25mg, Magnisium Oxide 400 mg, Vitamin D 2000 units, Multivitamin, Miralax, diazapan 2mg PRN, Depakote 125 mg - 2 pills per day, Tylenol PRN, Aleve PRN, Azo go-less bladder control 1 pill p

Current Illness: recovering from stroke from Aug 31, 2020

ID: 1193307
Sex: M
Age: 25
State: MI

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: Penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I experienced all of the listed side effects (except, I didn't have an actual fever, I felt like I had a fever, but my temperature was normal). The chills and muscle pain were extremely intense 6 hours after I received my vaccine. I could not stop shivering, or get warm enough. That would be followed by a feeling that I was too warm and I would begin sweating profusely. I also experienced a few additional side effects I could not find listed: I felt especially sensitive to stimuli as if normal sensations were heightened (e.g. hot water in a shower felt painful, running fingers through my hair felt like I was having my hair pulled, I kept my eyes squinted because the sunlight through the windows felt too bright.) I was extremely irritable and became extremely frustrated easily. I mean frustrated to an embarrassing degree over small things that didn't matter. It was inconsistent with my day-to-day temperament. It felt like an adrenaline rush came in response to the most minor of inconveniences.

Other Meds: Adderall 10mg

Current Illness: None

ID: 1193308
Sex: F
Age: 41
State: NY

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Tachycardia, Hypertension, feels flushed,

Other Meds: N/A

Current Illness: N/A

ID: 1193309
Sex: F
Age: 47
State: MN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/11/2021
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: Approx. 9 hours after the vaccination, I began to feel achy in my neck, shoulders, and upper back. Within approx. 30 minutes, I was having extreme chills, some slight stomach cramping, and the neck/upper back aches became very intense. It felt like a case of the flu, but worse. I did not experience vomiting. I took 600mg of Ibuprofin at about 10:00pm Those symptoms ended at approx. 12:30am on 4/8/2021. I was quite exhausted all day on 4/8/2021. Throughout the day on 4/8/2021, I felt lightheaded and a bit dizzy. That symptom lasted for just that day only. I continued to feel tired through 4/9/2021. I now feel completely recovered.

Other Meds: Omeprazole for acid reflux

Current Illness: None

ID: 1193310
Sex: F
Age: 64
State: MI

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 04/11/2021
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: Univasc, sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extremely sore arm, swelling of injection site about size of baseball in circumstance, extreme redness, hot feeling at injection site, small lump still at injection site, body aches, fatigue

Other Meds: Tecfidera, baclofen, cymbalta, diltiazem, modafinal, aldactone, tamsulosin, omeprazole, pravastatin, vitamin D3, vitamin C, calcium

Current Illness: Pneumonia

ID: 1193311
Sex: F
Age: 32
State: TN

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Sharp chest pain came on suddenly about 27 hours after second vaccine does. Sharp pain caused shortness of breath due to discomfort. Unable to sit/stand up straight due to discomfort. Continued for 3 hours until laid down to rest/go to bed. Symptoms returned shortly after waking up around 8:30am the next day (4/8) and continued all day long until bed around 10pm.

Other Meds: Eluryng; Slow release iron; Vitamin D; Biotin; Prenatal gummy vitamins

Current Illness: None

ID: 1193312
Sex: F
Age: 61
State: FL

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/11/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Full-blown flu-like symptoms: fever, muscle pain, swollen lymph nodes, chills, tiredness, fatigue, sensitive skin, sensitive eyes, headache started in the evening of the vaccination date; acetaminophen caplets and liquid NyQuill were taken, to alleviate the symptoms; the symptoms took three days to subside On the third-fourth day ?Moderna Arm? appeared: red hot fist-size area on the shoulder of injection; resolved itself in two days On the fifth day severe skin itch all over body (back, legs, arms, scalp); and severe itch in both eyes appeared; Benadryl and cortisone cream were used on skin, which helped slightly;Visine was used in eyes, with no positive effect; The itch on skin and in eyes is still present at the time of filling this form

Other Meds: Levothyroxine 88 mcg

Current Illness:

ID: 1193313
Sex: F
Age: 57
State: MA

Vax Date: 03/27/2021
Onset Date: 04/02/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: Cat dander, dust mites

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

Symptoms: Shooting pains like needle jabs in my neck proximal to skull attachment sites, along SCMs and in ligaments. Lasted for a week. Was intermittent during the daytime.

Other Meds: Atenolol, Felodipine, Lamyctal, Clonidine, Hydrochlorothiazide, Albuterol

Current Illness: None

ID: 1193314
Sex: F
Age: 55
State: VA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/11/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: 1st day, dark spot at injection site with redness around it about softball size and very sore for about 1 week. Red and hot at injection site continues 11 days after 1st injection. Is this normal.

Other Meds: Cymbalta, Armour Thyroid, vitamin C, D3, Super B complex, Zinc

Current Illness: None

ID: 1193315
Sex: M
Age: 71
State: OH

Vax Date: 03/31/2021
Onset Date: 04/02/2021
Rec V Date: 04/11/2021
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: Approximately 2 days after shot, got a rash in upper arm. At 11 days out rash is worsening, itching noted, hard bump and redness. Rash extends 12*13.5cm

Other Meds:

Current Illness:

ID: 1193316
Sex: F
Age: 57
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: Sore, tender rash at injection site, chills, sweats, body aches, insomnia, major fatigue After 28 hours took ibuprofen and felt much better

Other Meds: Zyrtec,trazodone, singulair, Prilosec, multi vitamin, fish oil, glucosamine

Current Illness: No illnesses

ID: 1193317
Sex: F
Age: 16
State: MO

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/11/2021
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: PCN and Cephalosporin

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

Symptoms: The patient started feeling anxious when she got out of her car to come up to the clinic. After she received her vaccination, she started to feel anxious, felt like her heart was going fast, and sat down. We checked her blood pressure and HR which were normal.

Other Meds: Lexapro 40mg

Current Illness: N/A

ID: 1193318
Sex: F
Age: 62
State: CA

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Sore arm at injection site. Bruising and swelling at injection site. Purple and blue bruises about 3 inches in length. 1 week post vaccine, swelling is gone but bruises are still visible. Anticipating it will take a few more days for bruises to disappear.

Other Meds: Blood pressure meds, ARB and BETA blocker

Current Illness: None

ID: 1193319
Sex: F
Age: 62
State: IN

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: Opioids, Soma, Anti-depressants, Statins

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1st reaction - Day 1 As I was walking to my vehicle, after waiting my 15 minutes, I had an awful metallic taste in my mouth. I had to spit out the saliva, which helped, but it still lingered for a few minutes. 2nd reaction -Day 1 After several hours, I experienced swelling in my right arm, and diarrhea. I also had insomnia, and slept very little the night of the shot. Day 2 I had loose stools, slight nauseous feeling most of the day. My body odor smelled like onions. I also had bad muscle aches and fatigue. That night, I had insomnia again and slight chills. Day 3 Still had loose stools, fatigue and muscle aches. The onion smell comes and goes. I experienced excessive urination throughout the day (about once an hour, which is not usual for me). Day 4 Muscle aches and fatigue are gone, Day 5 Excessive urination again. Onion smell comes and goes.

Other Meds: None

Current Illness: None

ID: 1193320
Sex: F
Age:
State: MD

Vax Date:
Onset Date: 04/11/2021
Rec V Date: 04/11/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: No

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

Symptoms: Fever fatigue up to 48h after injection, arm swelling at receiving site showing redness and hardness from today( day10 after injection), about size of my hand , feeling itch and a little pain too.

Other Meds: No

Current Illness: No

ID: 1193321
Sex: F
Age: 56
State: IN

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Red food dye; Caffeine; Bilota; Morphine

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

Symptoms: High Fever 104-105; Vomiting; Aches; Weakness; Lightheaded; Nausea; Fatigue; Injection site extremely sore.

Other Meds: Fluoxentine; Linsinopril; Nexium; Busiperone; B12; Iron

Current Illness: Mild sore throat

ID: 1193322
Sex: F
Age: 34
State: NY

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: Codeine (I get itchy)

Symptom List: Unevaluable event

Symptoms: Debilitating migraine as well as throwing up (still having it started at 3am)

Other Meds: Zoloft, wellbutrin, lorazepam, singular

Current Illness: N/A

ID: 1193323
Sex: F
Age: 59
State: MD

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 04/11/2021
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: None

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

Symptoms: I broke out in hives on my shins, neck, scalp, upper back and forearms. They started after the first dose and got much worse with the second dose.

Other Meds: Activella

Current Illness: None

ID: 1193324
Sex: F
Age: 47
State: IN

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Extreme soreness at injection site, headache all day, body aches

Other Meds: Paxil, Zyrtec, fish oil, vitamin D

Current Illness: None

ID: 1193325
Sex: F
Age: 73
State: TX

Vax Date: 03/29/2021
Onset Date: 04/05/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Loss of breath after working for a very short time.

Other Meds: Atorvastatin, Losartan/HCTZ, Fluoxetine, Diazepam, Metformin, Acarbose, Glimepiride, Ozempic.

Current Illness: None

ID: 1193326
Sex: F
Age: 64
State: IL

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: None

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

Symptoms: Chills, body aches, severe headache, vomiting, nausea, pain at injection spot

Other Meds: One a day- women 50+ Vitamin D 5000 Vitamin C Calcium 600 No prescription medication

Current Illness: None

ID: 1193327
Sex: F
Age: 57
State:

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/11/2021
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: meloxicam; seasonal/environmental

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: difficulty breathing (history of asthma)

Other Meds: antihypertensives, insulin, antiepileptics, statin; discontinued anticoagulant recently

Current Illness:

ID: 1193328
Sex: F
Age: 49
State: TX

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Extreme fatigue, feeling cold, headache, total body muscle aches, extreme pain in all my joints. Started the evening I received the shot. I stayed home from work for 2 days and slept most of the time. Took ibuprofen for the pain. Pain left after 2 days, fatigue has lasted a few more days.

Other Meds: Bupropion XL, Trintellix, Hydrochlorothiazide, Losartan, Loratadine,

Current Illness:

ID: 1193329
Sex: F
Age: 30
State: NV

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Penicillin

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

Symptoms: Migraine

Other Meds:

Current Illness:

ID: 1193330
Sex: F
Age: 56
State: FL

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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 known

Symptom List: Nausea

Symptoms: Patient stated she had flu like symptoms beginning the evening of administration. ...fever, chills, headache. She then stated that last night 4/10 her fever broke but she broke out in a rash from chest to jaw area.

Other Meds: not known

Current Illness:

ID: 1193331
Sex: M
Age: 42
State: AZ

Vax Date: 03/16/2021
Onset Date: 04/07/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Bells Palsy.

Other Meds: None

Current Illness: None

ID: 1193332
Sex: F
Age: 40
State: PA

Vax Date: 03/18/2021
Onset Date: 03/22/2021
Rec V Date: 04/11/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Lymph node swelling and tenderness in armpit, breast area - lasted about 5 days. Started about 5-7 days after shot.

Other Meds: None

Current Illness: None

ID: 1193333
Sex: F
Age: 41
State: FL

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/11/2021
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: Had Covid arm after the first shot. Received my second shot in the alternate arm. Also allergic to Macrobid and surgical glue.

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

Symptoms: Temperature of up to 102.6, chills, aches, headache, very stiff and painful neck with shooting pains through head, Covid arm on day 2, fatigue, no appetite, some nausea.

Other Meds: None

Current Illness: None

ID: 1193334
Sex: F
Age: 54
State: TN

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Penicillin

Symptom List: Tremor

Symptoms: Tinnitus, blocked hearing in right ear.

Other Meds: Met form in, hydrochlorothyazide, Potassium Citrate, multivitamin, melatonin, Aimovig, Qudexy

Current Illness: None

ID: 1193335
Sex: M
Age: 43
State: OH

Vax Date: 04/08/2021
Onset Date: 04/11/2021
Rec V Date: 04/11/2021
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: Artificial sweeteners.

Symptom List: Erythema, Pruritus

Symptoms: Severe muscle spasms from muscle scarring from an accident 20 years ago. See earlier accident history for more details.

Other Meds: Lamotrigone, Ropernoile, Quentapolone, Valium

Current Illness: None

ID: 1193336
Sex: F
Age: 67
State: IL

Vax Date: 04/06/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: Fine, itchy rash on upper left arm surrounding injection site. No bumps or blisters. Treated with Benadryl Gel topically applied 2-3 times daily. This is third day since appearance of rash, still itchy, but not as red in appearance.

Other Meds: Propanalol 40, Multi-vitamin, b-1, b-12, Calcium, flax seed oil

Current Illness: none

ID: 1193337
Sex: F
Age: 23
State: GA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Avocado, cats, pollen, penicillin, Biaxin.

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

Symptoms: Woke up at midnight with intense chills, sweating, and body aches. Body pain rated about a 6. Panic attack ensued until about 12:30am. Body aches relieved by advil. Chills/sweats continued until about 10am, Body aches continued past 11:30am.

Other Meds: Prozac, buspirone, vitamin C 250mg.

Current Illness: Ear infection (Left).

ID: 1193338
Sex: F
Age: 60
State: MI

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I began having a fever around 6:30 the day of the injection. I was having muscle pain, joint pain amd chills also. Symptoms were not relieved with Tylenol. The symptoms remained for approximately 36 hours

Other Meds: No meds that day. I typically take Super B vitamin complex, zinc 50 mg amd Vitamin D3 5000u

Current Illness: None

ID: 1193339
Sex: F
Age: 60
State: WA

Vax Date: 04/02/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: One week after receiving my first dose of the Moderna vaccine the injection site became swollen again and fever set in. The fever peaked 12 hours later at 100.4. Within the next 12 hours the fever broke and the swelling and soreness at the injection site subsided.

Other Meds: Lisinopril - Hctz 10 - 12.5 Mg Tab Levothyroxine Sodium 75 Mcg Tab

Current Illness: None

ID: 1193340
Sex: M
Age: 20
State: IN

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Slight Headache and Sore throat

Other Meds: None

Current Illness: None

ID: 1193341
Sex: F
Age: 36
State: NC

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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 known

Symptom List: Pain in extremity

Symptoms: Exactly one week following my first dose, I had a rash appear at the injection site. Red, hot swollen and painful, similar to a bee sting. Within about 6-7 hours following my second dose,, Istarted getting some itchy bumps around my ankles and thighs which turned into a dull blown rash all over my body by day two, covering legs, arms, torso and back. I also had intense lethargy and nausea on the day following, sleeping off and on from 10pm until 3pm the following day. I messaged my primary care provider who advised me to take a regimen of antihistamines and Tagamet.

Other Meds: Took 2 Ibuprofen for arm pain (one the evening of and second day after) Multivitamin Mushroom immunity supplement Anti-inflammatory supplement

Current Illness: None

ID: 1193342
Sex: F
Age: 40
State: PA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/11/2021
Hospital:

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

Lab Data:

Allergies: sulfa drugs

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

Symptoms: muscle aches, total body soreness, tenderness at injection site, chills/low grade fever, armpit/breast area soreness. Headache. Fatigue. Lasted over 24 hours without improvement. 4 days later - feeling almost better

Other Meds: none

Current Illness:

ID: 1193343
Sex: M
Age: 60
State:

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/11/2021
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: 1. Hydrocodone (prescribed after oral surgery and pinched nerve pain, but causes itchiness after 1-2 doses) 2. Compazine (prescribed for childhood diarrhea while on a family vacation, but caused jaws to move laterally in opposite directions)

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

Symptoms: Overview of symptoms in order of occurrence: Pain in the arm; Dry eyes; Fatigue; Nausea; Headache; Chills; Joint pain; Muscle aches; Dizziness; Measured Fever; and Arm rash. Symptoms of greatest concern: Nausea, Headache, Chills for 1-2 days; and the ongoing Fatigue is now in its 4th day. Details of symptoms with time of onset, duration and severity are provided below (Note: Injection with 2nd dose of Moderna vaccine took place at 9:24AM on 07APR21): 07APR21, 10:30AM ? Arm Pain: Onset of mild pain in arm that was noticed when not touching the arm; Level of pain was a ?1? out of 10). An annoying level of pain where the pain ramped up to 3 or 4 on a scale of 10 when the arm was moved about began at 7:00PM on 07APR21 and lasted 12 hours until 7:00AM on 08APR21. The pain diminished to a mild ache for another 33 hours until it became insignificant by 4:00PM on 09APR21. 07APR21, 1:00PM ? Dry Eyes: Onset of an intermittent feeling of very dry eyes that lasted approximately 1-2 hours at a time and continued over a period of 9 hours until 10PM on 07APR21. 07APR21, 3:30PM - Fatigue: Onset of mild fatigue that steadily increased until bedtime at 10:00PM on 07APR21; and was significantly more pronounced at 1:00AM on 08APR21 (was difficult to stand and walk 20? to closet to obtain a thermometer; could not walk straight and bumped into hallway on left 4-5 times). Fatigue was rather frightening and severe from 3:00AM to 3:30AM on 08APR21 when I crawled to the bathroom, but could not get off my knees and collapsed on the floor until I could return to bed by crawling on the floor. Was able to stand again at 7:00AM on 08APR21 and walked (slowly) 30? to a sofa. Slept from 10PM on 07APR21 to 1:00AM on 08APR21; 4:00-7:30AM on 08APR21; 8:30-10:30AM on 08APR21; 11:00AM to 3:00PM on 08APR21; 7:00PM on 08APR21 to 3:00AM on 09APR21; 3:30AM to 7:30AM on 09APR21; 9:30PM on 09APR21 to 9:15AM on 10APR21; 6:40PM on 10APR21 to 7:00AM on 11APR21. Ongoing weariness continues as I write this at 11:00AM on 11APR21. 07APR21, 7:10PM - Nausea: Onset of continuous nausea that lasted 13 hours and 20 minutes until 08APR21, 8:30AM. Nausea was particularly bad with intermittent dry heaves for the 7.5 hours lasting from 1:00AM to 8:30AM on 08APR21; Nausea then came in waves for 23 more hours until 09Apr21, 7:30AM when it was finally gone. 07APR21, 7:10PM - Headache: Onset of headache that has lasted 4 days (as of 11APR21, 10:30AM). Finally gave in and took one extended release tablet of 650mg Acetaminophen tablet about 25 hours after the vaccination (i.e., took painkiller at 10:30AM on 08APR21). Took two Ibuprofen at 9:00AM on 11APR21. 07APR21, 7:15PM ? Chills: Onset of chills that increased to intermittent shivering by bedtime at 10PM on 07APR21. Awoke at 1:00AM on 08APR21 and could not get warm. Two hours later, at 3:00AM, I felt completely opposite and could not feel cool. These symptoms gradually subsided and were gone by 7:30AM on 09Apr21. 07APR21, 7:15PM ? Joint Pain and Muscle Aches: Onset of joint pain and muscle aches that occasionally became annoying with twinges of pain. These symptoms subsided by 7:30AM on 09Apr21. 07APR21, 7:15PM ? Dizziness: Onset of mild dizziness that lasted 12 hours until 7:15AM on 08APR21. 08APR21, 1:00AM ? Measured Fever: Decided to measure temperature due to significant chills and shivering and found temperature was 101.0 at 1:00AM on 08APR21. At 3:00PM on 08APR21, my temperature was 100.2 (this was 4.5 hours after taking one extended release tablet of 650mg acetaminophen). At 3:00AM on 09APR21, my temperature measured 98.6 degrees and has remained near there ever since. 09APR21, 4:00PM ? Arm Rash: First noticed presence of a rash measuring about 2? x 3? on upper arm near the area that received the injection. Mild itchiness was present about an hour later and a topical 2% diphenhydramine gel was applied. The rash had dissipated by 5PM on 10APR21.

Other Meds: 1. Centrum Silver, Quantity 1 tablet/day 2. Vitamin D3, Qty 3 tablets of 1000 IU/day 3. Vitamin C, Qty 1 tablet of 1000mg/day 4. Saw Palmetto, Qty 1 softgel of 160mg/day 5. Turmeric Curcumin Complex, Qty 1 capsule of 500mg/day 6. Elderberry

Current Illness: April 2-4, 2021: Mild cold symptoms

ID: 1193345
Sex: F
Age: 19
State: CT

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: The day after the vaccine, I started to experience severe uterine cramps and bleeding heavier than my usual menstrual period. What is unusual about it is that, according to my birth control pill schedule, I was not expecting to get my period until at least six days later. This may or may not have been a direct effect of the vaccine, but I though that I should report it just in case.

Other Meds: Sprintec norgestimate and ethinyl estradiol tablets

Current Illness: none

ID: 1193346
Sex: M
Age: 38
State: CO

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/11/2021
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: Severe cramping in right abdominal area. Couldn?t lay down. Severe muscle soreness. Kidney punch providing reaction. Neck and shoulder soreness and cramping.

Other Meds: None

Current Illness: Covid prior. 3/12

ID: 1193347
Sex: F
Age: 52
State: IN

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: Morphine Sulfa drugs Tape sensitivity

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: APPROX. 6 HOURS FROM INJECTION, BEGAN EXPERIENCING ALL-OVER BODY ITCHING SIMILAR TO REACTION TO MORPHINE. INTENSITY MUCH LOWER THAN MORPHINE REACTION. TOOK A SECOND CLARITIN FOR THE DAY. ITCHING SUBSIDED AT APPROX. 2:30 AM ET. TOOK DAILY DOSE OF CLARITIN AT APPROX. 7:00 AM ET. MILD ITCHING BEGAN AGAIN AT APPROX. 7:00 PM ET. TOOK ANOTHER DOSE OF CLARITIN. NO ADDITIONAL ITCHING HAS OCCURRED SINCE APPROX. 9:00 PM ET.

Other Meds: Wellbutrin XL Estradiol patch Claritin Biotin Vitamin C Calcium/Magnesium/Zinc/Vitamin D

Current Illness: None

ID: 1193348
Sex: M
Age: 22
State: NY

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/11/2021
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: Nothing

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

Symptoms: Jannsen COVID-19 Vaccine EUA Had a high fever, worst pain I?ve ever felt. Was up until 5 am shaking and in serious pain. Lower back hurt really bad and my legs were sore. Hurt so bad it motivated me to fill out this form.

Other Meds: Nothing

Current Illness: Nothing

ID: 1193349
Sex: F
Age: 30
State: IN

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Chills, Body Ache, Nausea, Tiredness At the injection site: bruising, soreness, bleeding

Other Meds: No

Current Illness: No

ID: 1193350
Sex: F
Age: 40
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/11/2021
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: Severe headache, loss of balance, malaise, fever (between 101-103.2 for about 24 hours), nausea, chills, body pain

Other Meds:

Current Illness:

ID: 1193351
Sex: F
Age: 19
State: OK

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/11/2021
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: Thursday I got extremely nauseous, muscle weakness as well as muscle pains, started vomiting throughout the night. Friday, I was still extremely weak and had muscle pains and nauseousness, struggling to get up for very long because I felt like I was going to pass out. Still have been nauseous through the weekend and very weak.

Other Meds: Non

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm