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: 1199167
Sex: F
Age: 41
State: TX

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 04/12/2021
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: Patient stated she had a swollen arm, that felt like a knot, the area was painful to the touch and hot, patient couldn't move arm for 2 weeks

Other Meds:

Current Illness:

ID: 1199168
Sex: U
Age: 20
State: CO

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/12/2021
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: not sure

Symptom List: Anxiety, Dyspnoea

Symptoms: I had the J&J injection in the late afternoon. By evening, I began spiking a fever. I had a fever and chills - sweating, aches and pains all over body, throbbing leg, and a massive headache/migraine for almost 3 days. By the 3rd day, I began feeling better. My head hurt on and off through out the day. By the 4th day, I felt much better.

Other Meds: none

Current Illness: none

ID: 1199169
Sex: F
Age: 28
State: TX

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: none

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

Symptoms: Patient began to experience a slight headache immediately after vaccine administration. She was observed for 15 minutes, after observation she said she felt fine but still had a slight headache. She works with us here at Sams (front end) so she remained in the building for a while. I checked up on her at end of day and she said she felt a lot better and headache was gone.

Other Meds: none

Current Illness: none

ID: 1199170
Sex: F
Age: 22
State: MA

Vax Date: 04/02/2021
Onset Date: 04/09/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Moderna COVID-19 Vaccine EUA I had swollen lymph nodes in my arm for the week after my vaccination. A week after my first dose (4/9/21) I started getting a rash at the injection site. It travelled around my arm from the spot where the needle injected me, towards the inside of my arm and down toward my elbow. I have been taking a typical antihistamine from drug store and applying hydrocortisone to the area. It provides a little relief but my arm is still swollen, hot, and itchy.

Other Meds:

Current Illness:

ID: 1199171
Sex: M
Age: 17
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
Rec V Date: 04/12/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Underage, at 17 years old, received Moderna vaccine.

Other Meds:

Current Illness:

ID: 1199172
Sex: F
Age: 17
State: WA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: Patient received 1st dose of vaccine 1 month ago, at the age of 17 and 10 months. Dose should not have been given until age 18. Upon discussion, it was determined that patient should receive 2nd dose as appropriately recommended, 28 days, which required the patient to receive 2nd dose at 17 years and 11 months.

Other Meds: N/A

Current Illness: N/A

ID: 1199173
Sex: F
Age: 48
State: SC

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: Gluten, Sulfa drugs, percocet, compazine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Red rash and heat in large area around vaccination site and on left elbow for 3 days. Hives and rash on chest and left side of neck - still a few left that are red, itchy, swollen and painful. Using benadryl and pain relievers to treat.

Other Meds:

Current Illness:

ID: 1199174
Sex: F
Age: 23
State: NY

Vax Date: 04/09/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: Significantly heavier than usual menstrual cycle that started on Sunday night/Morning morning

Other Meds: N/A

Current Illness: N/A

ID: 1199175
Sex: F
Age: 57
State: TX

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: Only to toxic mold

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Friday night through Sunday afternoon had spiking fevers up to 102.1 degrees, chills, nauseas, headaches. Sunday afternoon through Monday afternoon fevers spiking to 99.4 , tired and body aches. Monday afternoon through Tuesday very tired and very nauseas.

Other Meds: High blood pressure dyeretic, Effixor, Vitamin D, E, A ,D3,B12, Black Cohash, Ginko Biloba

Current Illness: None

ID: 1199176
Sex: M
Age: 17
State: AL

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: No adverse event but given 17 yo in error.

Other Meds: None

Current Illness: None

ID: 1199177
Sex: F
Age: 40
State: TX

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient in observation and complains of experiencing difficulty swallowing. Redness to the face, and swelling of the lips noted. Patient also complained of feeling flushed and having a rapid heartbeat. Patient AOx3 and GCS of 15. PMS present in all extremities. Lungs clear bilaterally. No hives present. No injuries. Airway clear and patent. Some redness around the cheeks noted. Vital signs BP-122/8-, HR-108, RR-17, SpO2-99% on room air. Benadryl 50 mg given orally at 10:22. Patient monitored. Patient verbalizes feeling better. Redness in the face decreases and lip swelling decreases. Fire Department arrived on scene. Patient refused transport. Patient educated and instructed to call 911 if symptoms persist or worsen. Patient released with a driver at 1043.

Other Meds:

Current Illness:

ID: 1199178
Sex: F
Age: 55
State: OR

Vax Date: 04/01/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
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: Environmental

Symptom List: Rash, Urticaria

Symptoms: Covid Arm - red rash, itchiness. Shot was 12 days ago, rash developed on day 11 in the afternoon and became itchy later in the evening. Remains itchy and red today.

Other Meds: Sertraline, Metformin, Estrogen, Progesterone, Vit C, Vit B6, Calcium

Current Illness: None

ID: 1199179
Sex: M
Age: 41
State: IN

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient was feeling warm and light-headed at 15 minute mark, so we kept for further observation and gave water to hydrate. At about the 17 minute mark patiently suddenly fainted in his chair for 15-30 seconds. He then began to vomit and woke up in the process. Once he fully came back to, he said he felt remarkedly better and no longer felt light-headed or clammy. Following this episode he reported feeling back to normal and that he had just ate a large breakfast before coming in for the shot, but did not feel bad in any way anymore. We observed for another 30 minutes and patient showed no further sign of issues. He was released with his wife.

Other Meds: unknown

Current Illness: none

ID: 1199180
Sex: F
Age: 80
State: SC

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: Codeine Sulfonamides Uncoated Aspirin- gastritis

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

Symptoms: Patient noticed swelling in neck (lymphadenopathy) around 10:30 PM (4-5-21). She said there was no pain or discomfort in left arm, but noticed a "small amount of swelling" at the injection site (left deltoid). She went to bed shortly after. Woke up following morning (4-6-21) at 7:15 AM & had generalized aching at the following body sites: back of head, neck, both legs, & both feet. She compared the aches to a case of "bad flu." Also reports malaise (tiredness, lethargy) and spent the entire day "laying around." On 4-7-21, the aches had resolved but she still felt tired & lethargic. On 4-8-21, all symptoms resolved & patient "felt fine." She did contact her primary care provider, & on 4-8-21 she filled a prescription for celecoxib 100 mg: 1 cap once a day, #30 capsules, which she began later that day.

Other Meds: Alprazolam 1 mg: 1 tab up to 3 times a day Aspirin 81 mg enteric-coated: 1 tab once a day Famotidine 20 mg: 1 tab once an evening Metoprolol succinate 25mg ER (generic Toprol-XL): 1 tab once a morning Mirtazapine 15 mg: 1 tab once a night

Current Illness: Back pain

ID: 1199181
Sex: M
Age: 28
State: PA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: NO ALLERGIES LISTED

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

Symptoms: PATIENT BROKE OUT IN A SWEAT IMMEDIATELY AFTER GETTING THE SHOT. ONLY LASTED A FEW MINUTES. PATIENT STAYED FOR OBSERVATION FOR ABOUT 30 MINUTES AND SEEMED OK TO LEAVE.

Other Meds: PATIENT STATED PROZAC DAILY AND PROPRANOLOL PRN (DID NOT SPECIFY SPECIFIC DOSES)

Current Illness: N/A

ID: 1199182
Sex: M
Age: 34
State: FL

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/12/2021
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

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

Symptoms: 3 minutes after vaccination was given patient stood up and requested juice then fell down and fainted. About 15 seconds later the patient came to. EMS was contacted. Patient had his vitals checked, blood sugar taken. Patient reported to EMS that he was feeling anxious. Patient was asked by EMS questions in relation to time and place. Patient refused to have EMS take him in to the hospital for further tests. Patient was instructed to have a family member come in to take him home and advised him not to drive. Upon a follow up call 30 hours later patient reported he was bruised on his left shoulder, left hip and he had a puncture wound to his Jaw due to his fall. He reported he went to urgent care for follow up. they told him stitches would not be necessary for the puncture wound to his Jaw.

Other Meds: Unknown

Current Illness: Unknown

ID: 1199183
Sex: F
Age: 60
State: GA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 04/12/2021
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: Patient reports the evening of the vaccine she experienced pain in her lymph nodes, body aches, a headache, and general malaise.

Other Meds: Unknown

Current Illness: Unknown

ID: 1199184
Sex: F
Age: 24
State: NC

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: Motrin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Lightheaded, nausea, tunnel vision, shortness of breath.

Other Meds: None

Current Illness: None

ID: 1199185
Sex: F
Age: 33
State: OH

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Cranberries

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: At 1 H post administration, the patient reported a sensation of numbness and tingling in the lips and nose. At 2 H post administration, the patient experienced hives, and a sensation of airway obstruction which resulted in an ER visit.

Other Meds: Vitamin D 25mcg, Duloxetine 20, Protonix 40mg, and Metoprolol Succinate 25mg

Current Illness:

ID: 1199186
Sex: M
Age: 37
State: AZ

Vax Date: 03/26/2021
Onset Date: 04/06/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: None that I was aware of.

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

Symptoms: Went to urgent care on the 9th said it was EDT, decided to go to an ENT as hearing reduced significantly and was not getting better. Tinnitus and sudden sensorineural hearing loss in right ear.

Other Meds: Cymbalta

Current Illness: None that I was aware of.

ID: 1199187
Sex: F
Age: 36
State: NJ

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/12/2021
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: Latex

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

Symptoms: Fever, chills, aches, headache, fatigue, muscle spasms that threw back out, now can?t walk easily or stand straight lots of muscle pain

Other Meds: None

Current Illness: None

ID: 1199188
Sex: M
Age: 54
State: MN

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: tetracycline

Symptom List: Unevaluable event

Symptoms: Arm pain and swelling began immediately. Later in the evening on same day of shot, I began to experience nausea. Next morning pain, swelling and nausea persisted. Medium intensity body aches and headache began late morning. By mid afternoon body pain increased to the point that I was no longer able to function and needed to lie down. Took a 4 hour nap. Side effects persisted after waking up. At time of writing, 28hrs after vaccine, I am still feeling the side effect although less severe. Ibuprofen and Tylenol do seem to help.

Other Meds: multivitamin, steel libido red, steel libido black

Current Illness: none

ID: 1199189
Sex: F
Age: 61
State: WA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/12/2021
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: Bactrim, sulphur, aspirin

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

Symptoms: Site pain and swelling, body pain, dizziness, chills, slight fever, headache, nausea, vomiting, diarrhea, fatigue, disoriented, cannot work. On third day of this.

Other Meds: Venlafaxine, finasteride, gabapentin, cyclobenzaprine, levothyroxine, metformin, quetiapine, centrum, chlorpheniramine, Benadryl.

Current Illness: None

ID: 1199190
Sex: F
Age: 33
State: NY

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/12/2021
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: I had a high fever for 2 days, at times going up to 103.5 degrees Fahrenheit and after takingTylenol and using ice packs on the back if my neck and forehead and underarms, was able to come down to between 101 and 102 on Monday and Tuesday. After those initial days, my temperature ranged between 100 degrees Fahrenheit and 102 degrees Fahrenheit for another 3 days. After receiving the vaccine on a Sunday, I was finally close to my normal temperature by the following Saturday. I normally run about 97.6 degrees Fahrenheit.

Other Meds: Sertraline 100 mg

Current Illness: Had had a mild virus the week before, which cleared itself before I was vaccinated.

ID: 1199191
Sex: M
Age: 17
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Underage, at 17 years old, received Moderna vaccine.

Other Meds:

Current Illness:

ID: 1199192
Sex: M
Age: 38
State: IL

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: PATIENT FELT LIGHTHEADEDNESS AFTER RECEIVING VACCINE. PT GIVEN COLD WATER TO DRINK AND ICE PACK TO PLACE BEHIND NECK AND TURNED ON FAN TO HELP HIM COOL OFF. PATIENT DRANK WATER AND SAT FOR ABOUT 5MINUTES IN IMMUNIZATION ROOM. THEN FELT FINE. HE WAITED FOR 10 MORE MINUTES IN GENERAL WAITING AREA AND THEN LEFT PHARMACY AREA.

Other Meds: NONE

Current Illness: NONE

ID: 1199193
Sex: F
Age: 16
State: VA

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient Vaccinated under 18 years old, No side effects, observed for 30 mins. Accompanied by parents (mother). Advised Mother to call PCP for further advice and evaluation. Seek medical help or call 911 if needed or symptoms like SOB etc).

Other Meds: None

Current Illness: Environmental and food allergies

ID: 1199194
Sex: F
Age: 27
State:

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: lactose

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: dyspnea, chest tightness, anxiety

Other Meds: budesonide, prazosin, quetiapine, metformin, carbamazepine, lithium,oxybutynin, methotrexate, fluticasone

Current Illness:

ID: 1199195
Sex: M
Age: 66
State: FL

Vax Date: 01/06/2021
Onset Date: 01/01/2021
Rec V Date: 04/12/2021
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: Sometime in January but more pronounced in February I developed what I believe is Peyronie's Disease. My penis has always been completely straight with no curve. After the first dose I noticed a slight upward curvature which after the second dose has become quite noticeable and not pronounced. I'm 66 years old and I have never had even an inkling of this symptom. I can't imagine what else it could be other than that it happened after the first dose and became more pronounced after the second dose.

Other Meds: None

Current Illness: None

ID: 1199196
Sex: F
Age: 42
State: AZ

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/12/2021
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: Nausea

Symptoms: fever and chills for <24 hours. Low back pain and muscle pain that started 1 day after vaccine, has persisted for 5 days. Patient had similar symptoms with prior COVID infection in November 2020. Patient has muscle spasms in low back with no associated injury or heavy lifting.

Other Meds: plaquenil, gabapentin

Current Illness: none

ID: 1199197
Sex: F
Age: 42
State: IL

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient presented to pharmacy to received covid-19 vaccine after her doctor asked her to received vaccine due to HTN, DM chronic diseases. Patient received vaccine around 1:05pm and proceed to waiting area within less than 5 minutes patient started to feel sick and experienced nausea, cold sweats, and palpitations. Assisted patient taking BP, 1st reading 195/72 HR:124, 2nd reading 106/67 HR 96. EMS arrived to pharmacy and patient was taken to hospital.

Other Meds:

Current Illness: PULMONARY EMBOLISM

ID: 1199198
Sex: F
Age: 38
State: NH

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: Ceftin (hives and itching), Bees (anaphylaxis)

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

Symptoms: Hives, then decrease in blood pressure: 110/72 (HR 66) at 6:28pm, 102/72 (HR 56, SpO2 100%) at 6:40pm, 98/66 (HR 58, SpO2 100%) at 6:52pm; 2 tabs benadryl 25mg at 6:25 pm; 125mg IM solumedrol at 6:30pm; 0.3mg IM epinephrine at 6:59pm. Called EMS, who arrived at 7:07pm and transported to ED.

Other Meds: Flovent, Singulair, Zyrtec yesterday

Current Illness:

ID: 1199199
Sex: M
Age: 52
State: TN

Vax Date: 04/07/2021
Onset Date: 04/10/2021
Rec V Date: 04/12/2021
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: Non

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

Symptoms: A mole appeared in my lower left abdomen. The mole has a shiny silver spots. This mole has never been there

Other Meds: Non

Current Illness: Non

ID: 1199200
Sex: F
Age: 41
State: MN

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/12/2021
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: Tremor

Symptoms: Following symptoms were experienced about 7 minutes aster receiving the vaccine: Feeling of warmth in abdomen followed by increased heart rate and palpitations. HR 148/min (normal resting heart rate 50-60/min). Blood measure 150/100 (baseline around 115/80). Also feeling of dry mouth. Observation prolonged - BP dropped to 130/90 after about 30 minutes, HR dropped to 80. Episdoes of increased HR kept re-occurring for about 2 hours after the shot. No respitatory distress or cutaneous symptoms. After about 90 minutes after the vaccine, feeling tingling in lips and scratchy throat. Administered Benadryl 25mg per mouth, lip tingling and scratchy throat resolved within 30 minutes thereafter. All of the above symptoms resolved about 4 hours after the vaccine, HR at 60. Following symptoms developed within 12 hours of the vaccine: Chills, fever (100F), myalgia, artralgia, fatigue, nausea. Treated with ibuprofen and acetaminophen, resolved about 48 hours after the vaccine. Note: No known history of Covid.

Other Meds: Multivitamin

Current Illness: None

ID: 1199201
Sex: M
Age: 24
State: CA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: denied

Symptom List: Erythema, Pruritus

Symptoms: 04/12/2021 03:00 pm Responded to a 24-year-old male found sitting on a chair in the 30-minute observation section with c/c anxiety/heart palpitations. Patient was a/o x 3 with GCS 15. As per patient, he had sudden onset heart palpitations and stated that he felt 'anxious.' Patient stated that he felt nervous to for the second vaccination and that he felt 'more nervous when placed in the 30-minute observation section.' Patient was taken into tent for further evaluation by HCP. Patient had history of anxiety. (-) allergies. (-) medications. (-) dizzy. (-) n/v. (-) MLAPSS. All vitals were normal. 13:15 -- 152/86 HR:75 RR:22 SpO2: 98 13:19 -- 138/82 HR:65 RR:20 SpO2: 97 13:24 -- 151/74 HR:66 RR:20 SpO2: 98 Patient was given water and food and stated that symptoms had resolved. Patient was escorted back to seat and left w/o incident. Entered medical area after being notified of patient in medical area by EMT. Upon arrival patient was sitting on cot with BP and Pulse oximeter on. No visual signs of distress. Could see patient pinching inside of upper arm and reported feeling anxious. His vital signs WNL EMT was chatting with the patient and patient was responding to all questions. Informed patient I wanted to check to see how he was feeling then excused myself outside of the area.

Other Meds: denied

Current Illness: denied

ID: 1199202
Sex: M
Age: 17
State: AL

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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: Seasonal allergy / allergy eggs

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

Symptoms: No adverse event / age error in adminsitration

Other Meds: None

Current Illness: None

ID: 1199203
Sex: M
Age: 51
State: MA

Vax Date: 03/19/2021
Onset Date: 04/09/2021
Rec V Date: 04/12/2021
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: Benzocaine, Aspirin

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

Symptoms: Patient had a large pulmonary embolism 3 weeks after receiving the vaccine. Unclear if vaccination was the cause, but giving the timing we are reporting it. The health care proxy also noted some palpable masses on distal L extremity, unclear if related to vaccine or what these are.

Other Meds: Clindamycin lotion topical TID

Current Illness:

ID: 1199204
Sex: M
Age: 51
State: OH

Vax Date: 04/01/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swollen right eyelid. Soreness

Other Meds: Esomerprazole , Lisinopril/Hydrochlorizide, Acetaminophen/Codene, Metoprolo, Asprin, Testostorone

Current Illness: NA

ID: 1199205
Sex: F
Age: 59
State: MD

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/12/2021
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 known

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

Symptoms: Very painful shot 8 hours after shot started chills, fatigue, achy, nerve pain, sensitive skin, headache lasting 2 days

Other Meds: Omeprazole Bupropion hcl Alpha lipoid acid CoQ10 Collagen D3 Bcomplex

Current Illness: None

ID: 1199206
Sex: M
Age: 41
State: WI

Vax Date: 04/01/2021
Onset Date: 04/07/2021
Rec V Date: 04/12/2021
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:

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

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1199207
Sex: F
Age: 27
State: WA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: Dairy

Symptom List: Pain in extremity

Symptoms: A few hours after the first dose of the Pfizer shot, I started to have the same reaction (puffy eyes, nose and lips) as I do when I consume dairy (I did not have any dairy products this day). Immediately after, I had terrible abdominal pain and diarrhea. I had bloody stool and still continue to have bloody stools until today (3 days after the first dose).

Other Meds: N/A

Current Illness: N/A

ID: 1199208
Sex: F
Age: 49
State: CA

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

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

Lab Data:

Allergies: Amoxicillin Not Specified Ceftin [cefuroxime] Not Specified Eggs Or Egg-derived Products Not Specified Levothyroxine Not Specified Nitrofurantoin Not Specified Shellfish Allergy Not Specified Sulfa Antibiotics Not Specified

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

Symptoms: Situation: Patient at the Covid vaccine clinic receiving her first Moderna vaccination. Background: Hx of allergies, has epi pen. Assessment: At the end of the 30 min monitoring period the patient complains of a slight scratch in her throat to MD. Patient is in no acute distress. MD offered Benadryl but the patient states she has a long drive ahead of her, she denies the Benadryl. Patient positioned supine with head elevated 40 degrees on gurney for further assessment and observation with MD. Vital signs: 1517: 128/83, P 57, regular, O2 sat 98% on RA. 1527: 134/87, P 63, O2 sat 98% on Ra. The patient states she is feeling better. Recommendation: MD is releasing the patient. The patient will go to the pharmacy to pick up some Claritin, per MD recommendation.

Other Meds:

Current Illness:

ID: 1199209
Sex: F
Age: 38
State: AL

Vax Date: 04/09/2021
Onset Date: 04/11/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: 48 hours after shot, my arm became swollen, red, fevered, and extremely sore, radiating from injection site to the front of my arm. Also fingers were swollen and numb, with pain in the elbow and shoulder.

Other Meds: Lexapro, singulair

Current Illness: NA

ID: 1199210
Sex: F
Age: 62
State: SC

Vax Date: 02/26/2021
Onset Date: 03/18/2021
Rec V Date: 04/12/2021
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: Codeine levoquin ambien

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

Symptoms: Menstrual ovulation and menstruation

Other Meds: Citalopram losartan fish oil probiotic 81 mg aspirin dulera singulair vit d losartan oneprazole coq10 mg tyl nil arthritis

Current Illness: None

ID: 1199211
Sex: F
Age: 53
State: WA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 04/12/2021
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: Aimovig, erythromycin

Symptom List: Vomiting

Symptoms: Increased severity of migraine following Pfizer shot #1. Dramatically increased severity of migraine pain and nausea following Pfizer shot #2 (beginning April 7). Severe migraine pain still persisting as of April 12. Usual medications are not managing pain adequately.

Other Meds: tramadol, trazodone, gabapentin, sertraline, adapalene (topical), sulfacetamide lotion (topical), T3, levothyroxine, calcium, vitamin D, fish oil capsules

Current Illness: Chronic migraine

ID: 1199212
Sex: M
Age: 17
State: AL

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: No adverse even / reporting age administration error

Other Meds: None

Current Illness: None

ID: 1199213
Sex: F
Age: 40
State: PA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: At time of injection, dizziness, pain at injection site, pain in right arm fingers, inability to grip with fingers on right arm. Next day swelling of hands and feet. Veins large and visible thru skin more than usual. Continued dizziness. Tylenol taken to deal with pain. 7 days later still minor dizziness. Swelling of feet and hands continues. Pain in right arm. Pain in right hand and unable to grip with right hand.

Other Meds: None

Current Illness: None

ID: 1199214
Sex: M
Age: 71
State: NJ

Vax Date: 03/19/2021
Onset Date: 03/21/2021
Rec V Date: 04/12/2021
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: Weak leg muscles which started 2 days after vaccine. Extreme fatigue which began 2 - 3 days after receiving vaccine and lasted for 2 - 3 days. Took Advil and felt much better.

Other Meds: Trelegy, Levemir, Novolog, and Omeprazole

Current Illness: None

ID: 1199215
Sex: F
Age: 58
State: KS

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/12/2021
Hospital:

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

Lab Data:

Allergies: NA

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

Symptoms: slight nausea for 18 hours, stiffness is all muscles

Other Meds: Synthroid .88 MCG Vitamin D 1000 MC

Current Illness: NA

ID: 1199216
Sex: F
Age: 32
State: TX

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/12/2021
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:

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

Symptoms: Body aches, chills, nausea, vomiting, tiredness.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm