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: 0943338
Sex: F
Age: 45
State: WI

Vax Date: 01/05/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
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: Softball size redden, raise, warm to touch, and itchy around injection site right upper arm

Other Meds:

Current Illness:

ID: 0943339
Sex: M
Age: 33
State: TX

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
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: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Fever, Chills, body aches & skin sensitivity starting 22 hours post second dose of Pfizer's Covid-19 vaccine. Symptoms resolved in 5 hours with continued use of Tylenol. Sore arm persists 3 days later.

Other Meds: Tylenol, Vitamin C, Zinc

Current Illness: N/A

ID: 0943340
Sex: F
Age: 59
State: CA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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:

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

Symptoms: Injection site pain/soreness, body ache.

Other Meds:

Current Illness:

ID: 0943341
Sex: F
Age: 66
State: MO

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
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: Systemic: pt said "room is moving," all vitals fine, inject site fine, no redness normal warmth, no pain discomfort. Dizzness rechecked in 15 minutes and gone.-Mild

Other Meds:

Current Illness:

ID: 0943342
Sex: F
Age: 46
State: PA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/14/2021
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: Systemic: Rash (other than injection site)-Medium, Systemic: Fever-Medium, Systemic: Felt itchy all over body, no visible hives, flushed-Medium; symptoms lasted 0 days

Other Meds:

Current Illness:

ID: 0943343
Sex: F
Age: 46
State: CA

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/14/2021
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: Individual received the vaccine via buttocks

Other Meds:

Current Illness:

ID: 0943344
Sex: F
Age: 80
State: VA

Vax Date: 01/12/2021
Onset Date: 01/14/2021
Rec V Date: 01/14/2021
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: blue potatoes

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Vertigo while in bed early in the morning.

Other Meds: vitamins

Current Illness: none

ID: 0943345
Sex: F
Age: 58
State: MI

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Advair Diskus [fluticasone Propion-salmeterol] Clindamycin Hydrocodone-acetaminophen Penicillin V Potassium . Tetracycline

Symptom List: Pharyngeal swelling

Symptoms: Within minutes of receiving first COVID vaccine, patient experienced a feeling of warmth, lightheadedness and elevated blood pressure of 210/110. BP down to 170/100 at the time of leaving appointment (20 minutes after shot). The next day she felt nausea, Ha, body aches and burning sensation down the arm of the injection.

Other Meds: tramadol, nortriptyline, metformin, loratadine, fluticasone, Clindagel, celexa, albuterol

Current Illness: denies

ID: 0943346
Sex: F
Age: 42
State: CA

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: Mold, strawberries

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Moderna COVID-19 Vaccine EUA. The first day was a sore arm at injection site. Day 2: sore are and myalgia. Day 3: nausea, fatigue, diarrhea. Day 4: nausea, fatigue, diarrhea, voice became raspy and horse needed constant clearing and congestion. Day 5: nausea, fatigue and congestion. Day 6: nausea, fatigue and congestion.

Other Meds: Xanax .5 prn, , Escitalopram 20 mg daily, Buspirone 10 mg 2x a day

Current Illness: None

ID: 0943347
Sex: F
Age: 49
State: PA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: tramadine

Symptom List: Diarrhoea, Nasal congestion

Symptoms: blurry vision 1st day. asthma attack 1st night inhaler worked. next morning. Massive severe headache (almost as bad as the spinal headache from my 1st child) , chills, fatigue, nausea. Called PCP and he gave me Tylenol with codeine for the headache and a prednisone for the asthma even though it was under control.

Other Meds: Tylenol, albuteral

Current Illness: none

ID: 0943348
Sex: F
Age: 32
State: KY

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: Fevers, shortness of breath, chills, exhaustion, cough, headache. Arm soreness at injection site.

Other Meds: Genetic Nuva Ring. Spironolactone. Metformin

Current Illness: Mild Headaches.

ID: 0943349
Sex: F
Age: 64
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: Sulfa, Prednisone, other unknown food products causing extreme diarrhea. Severe allergies to bees and wasps stings - using EPI Pen occasionally

Symptom List: Rash, Urticaria

Symptoms: Due to lack of data for Asian-descent - I hope this data is helpful to Moderna and CDC. Light adverse side effects right after the vaccine was administered. Remained under supervision for 45 minutes longer instead of 15 min. Within 5 mins, heat rose up to my head causing dizziness & head spin. Then loss of smell lasting for 10 min or a bit longer, then tongue tied hard / swollen for 3 hrs and lasting mildly 1 day after. Severe dehydration. Did not monitor heart beat due to severe fatigue. Took blood pressure rising and falling like roller coaster 2x. I stop and learned to relax and sleep throughout the day to calm the nervous system and the slight fever. Other normal aching pains as pre-described side effects. No nausea, vomiting, no rash as of 1 day after and no difficult breathing. Occasional and short loss of smell carried after 1st day.

Other Meds: Taken daily Generic Hypertension prescriptions 100mg(etc), Generic Cholesterol (Atorvastatin 20mg), aspirin-81, Blood thinner Copidogrel 75mg. Vitamins B12,iron, zinc, magnesium, calcium, D and C vitamins.

Current Illness: - Sinus infections

ID: 0943350
Sex: F
Age: 32
State: MD

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Mild tingling on the right side of her mouth and face that started shortly after receiving the vaccination. Symptoms were less intense and lasted for a shorter period of time than after the first injection.

Other Meds:

Current Illness:

ID: 0943351
Sex: M
Age: 68
State: IL

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: 5 minutes after the vaccination was given, patient developed soft swelling periorbital area, mostly under the eye. No other symptoms. Swelling decreased after 1/2 hour. No other adverse effects.

Other Meds: Lisinopril, Norvasc, Metoprolol, HCTZ, Lipitor, Plavix

Current Illness: None

ID: 0943352
Sex: F
Age: 57
State: WI

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Certain fruits will give itchy throat

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

Symptoms: Client formed a blister on lip approximately 1.5 hours after vaccination was given and a second fluid filled blister on the lip the next day. No additional reactions after this point.

Other Meds: None

Current Illness: No

ID: 0943353
Sex: M
Age: 43
State: NY

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
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: very slight allergies to apples, cherry, jackfruit, peach and seasonal allergies

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

Symptoms: Started to have low grade fever on and off, body aches, head aches

Other Meds: Allopurinol

Current Illness: none

ID: 0943354
Sex: M
Age: 51
State: WA

Vax Date: 12/27/2020
Onset Date: 12/28/2020
Rec V Date: 01/14/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Right after the vaccine I just had a slight head ache. I had pretty typical symptoms. Around 8pm my arm got to 8/10 pain. I have waves of Tachycardia and nausea. I had pretty bad diarrhea the first day and second day, this was also a side effect from the Celexa. The Tachycardia was going up to 130-140 . Very much flu like symptoms, heart pounding, head pounding and very light headed. I was having trouble controlling BP when I stood up. I felt feverish, I kept checking my temp but it was normal. This went on for two day, I wasn't able to eat or drink liquids. I ended up going and getting a Covid test on Tuesday morning, I was feeling somewhat ok. Then in the evening all my same symptoms came back. I spoke with a Dr. who informed me I was probably dehydrated. I almost went into the Emergency Room because my high heart rate and thought I was having a heart attack. I didn't due to high volume of Covid in the ER. I have a follow up meeting with my PA before my second dose to come up with a strategy. The left side of my face started to get numb and the left side of neck. My neck started to get still and went to my jaw.

Other Meds: Celexa ( week prior to vaccine)

Current Illness: Low grade sinus irritation Oral thrush

ID: 0943355
Sex: F
Age: 47
State: NY

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: felt light headed and clammy, has had this happen when having injections in the past

Other Meds:

Current Illness:

ID: 0943356
Sex: M
Age: 33
State: NY

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: TREMORS

Other Meds: NO

Current Illness: NONE

ID: 0943357
Sex: M
Age: 35
State: FL

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: swollen lymph nodes in armpit on right arm

Other Meds: omeprazol 40mg clomiphene 25mg

Current Illness:

ID: 0943358
Sex: F
Age: 54
State: MO

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/14/2021
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: Morphine, Ceclor, sulfa

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

Symptoms: 48 hours of fever up to 102 degrees. Severe headache, fatigue and bodyaches. Nausea and severe arm pain radiating to neck. Took tylenol and tramadol for 36 hours and then symptoms began to subside. By the third day post vaccine, all symptoms except for fatigue resolved.

Other Meds: Tramadol 100mg as needed Duloxetine 60mg daily Multi-vitamin Amytriptylline 100mg at bedtime gabapentin 200mg at bedtime

Current Illness: none

ID: 0943359
Sex: F
Age: 38
State: KS

Vax Date: 12/30/2020
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
Hospital: Y

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

Lab Data:

Allergies: Betadine, citalprozam

Symptom List: Unevaluable event

Symptoms: Unprovoked seizure (clonic tonic) 13 days later, requiring hospitalization and testing

Other Meds: Zoloft, buspirone, multivitamin, protonix

Current Illness: None

ID: 0943360
Sex: F
Age: 60
State: VA

Vax Date: 01/05/2021
Onset Date: 01/09/2021
Rec V Date: 01/14/2021
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: Sulfa, Statins

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

Symptoms: Day 1 Severe headache (tylenol), Day 2 and 3 Sore left arm and general myalgias (ibuprofen), Day 4 Fatigue, headache, chest pain, severe nausea, abdominal pain, lack of appetite, myalgias (rest and fluids) Day 7 Severe watery diarrhea, nausea, low grade temp, headache, abdominal cramping, sore throat, myalgias (fluids, immodium, tylenol)

Other Meds: Sertraline, Zolpidem, Vit D, Probiotic

Current Illness: None

ID: 0943361
Sex: F
Age: 52
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Received 2nd dose Pfizer lot EL0142 on 1-13-2021 on right arm. Has body aches, joint pain, muscle ache, head ache, fatigue, and arm pain.

Other Meds:

Current Illness:

Date Died: 01/13/2021

ID: 0943362
Sex: F
Age: 73
State: MI

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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 reported

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt collapsed at home approx 5:30 pm and died

Other Meds: unknown none reported

Current Illness: none known

ID: 0943363
Sex: F
Age: 93
State: KS

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/14/2021
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: NKDA

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

Symptoms: within 24 hours- Large "golf ball size" lump. Hard, hot to touch, red from injection site down to elbow. after 36 hours swelling had gone down, redness had moved all the way from the injection site to wrist. No pain noted, skin temperature was back to normal.

Other Meds: Aspirin 81mg Calcium + D3 600 Flovent HFA 220 MCG Ipratropium-Albuterol Levothyroxine Sodium 125 MCG Losartan Potassium 50 MG Miralax Tylenol 8 Hour Arthritis Pain 650 MG

Current Illness: Covid Positive 11/27/2020

ID: 0943364
Sex: F
Age: 61
State: AL

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Systemic: Anaphylaxis-Severe, Systemic: Fainting, Systemic: Pharmacist submitting: unable to determine if anaphalaxis or panic attack, patient experienced facial weakness, chest tightening, tremmors, inability to breathe, and fainting within 10 min of administ

Other Meds:

Current Illness:

ID: 0943365
Sex: F
Age: 40
State: IN

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Low grade fever (99.8-100.2), headache, fatigue, and soreness at injection site

Other Meds: Fioricet, Ambien, Xyzal, Flonase

Current Illness: None

ID: 0943366
Sex: F
Age: 46
State: PR

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/14/2021
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: TWO DAYS OF SINTOMES, PAIN INJECION SITE, HEADACHE, MUSCULAR PAIN, SWELLING IN INJECTION SITE, INCHING ON INJECTION SITE AND REDNESS.

Other Meds: PANADOL 2 TAB OF 500MGS

Current Illness: NONE

ID: 0943367
Sex: F
Age: 24
State: PA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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 known

Symptom List: Nausea

Symptoms: Copied from student's chart note on 1/12/2021 from telehealth visit with Doctor, " 24 year old who had varicella vaccination #2 yesterday, last pm she started with itching and swelling, 5 cm of erythema around shot. See picture in messages. She has mild itching after her first shot which she got with Tdap, it was delayed. No fever today, hurts to touch but mostly intensely itchy".

Other Meds: None known

Current Illness: None known

ID: 0943368
Sex: M
Age: 67
State: IL

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain

Symptoms: EXTREME PAIN RADIATING TO THE NECK AND ALL THE WAY DOWN TO THE FINGERS , TINGLING PAIN IN THE FINGERS . PAIN LASTED FOR 4 DAYS . TAKED IBUPROFEN AND ALEVE BUT DIDN'T HELP. TALKED TO THE DOCTOR'S OFFICE ON SATURDAY. EACH DAY IS GETTING BETTER BUT IT WAS TOO MUCH PAIN THE FIRST 4 DAYS .

Other Meds: MULTIVITAMINS

Current Illness: NONE

ID: 0943369
Sex: F
Age: 54
State: OR

Vax Date: 01/03/2021
Onset Date: 01/08/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: SULFZ

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

Symptoms: RED SPOTS ON LEGS. Doesn't itch or hurt. Just there.

Other Meds: LISOPRIL HCTZ PROZAC

Current Illness: NONE

ID: 0943370
Sex: F
Age: 40
State: MD

Vax Date: 12/30/2020
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
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: peptobismol

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

Symptoms: Itchiness in groin and armpit, leading to increased itchiness accompanied by raised and cluster of hives at groin area

Other Meds: LoLoestrin, Fluoxetine (15 mg)/day, daily multi-vitamin

Current Illness: none

ID: 0943371
Sex: F
Age: 38
State: CT

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Reglan

Symptom List: Tremor

Symptoms: Day one, about 6 hours after vaccine, extreme tiredness, slur speech, slow movement, vertigo, sore arm. Day two, extreme tiredness, headache, nausea , sore arm.

Other Meds: glucosamine chondroitin, NewRhythm Probiotics

Current Illness:

ID: 0943372
Sex: M
Age: 28
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: headache, eye pressure, nausea diarrhea, achy, generalized body aches. Treatment include Tylenol with no improvement and Naproxen 220 mg with mild improvement.

Other Meds:

Current Illness:

ID: 0943373
Sex: M
Age: 64
State: GA

Vax Date: 12/30/2020
Onset Date: 01/07/2021
Rec V Date: 01/14/2021
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: cephlosporins

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

Symptoms: Systemic: reported existing cellulitis was exacerbated; symptoms lasted 0 days

Other Meds:

Current Illness:

ID: 0943374
Sex: F
Age: 28
State: MI

Vax Date: 01/07/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: Large, swollen, warm, itchy red patch at injection site.

Other Meds: Sprinted, Zegrid OTC, Wellbutrin XL, Cymbalta, Evekeo

Current Illness: None

ID: 0943375
Sex: F
Age: 28
State: NJ

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Developed soreness and pain at the injection site about 30 minutes after injection. After a couple hours, the pain became unbearable, and she had an ED physician look at her arm. She had limited use of her arm on Monday 1/11 and Tuesday 1/12. Wednesday 1/13 her arm started to feel better and she could lift it. She went to her PCP and he said the injection site looked higher than it should have been. Today 1/14 she still has sharp pain with movement and limited range of motion.

Other Meds: Tylenol and Ibuprofen

Current Illness: none

ID: 0943376
Sex: F
Age: 42
State: KS

Vax Date: 12/29/2020
Onset Date: 01/07/2021
Rec V Date: 01/14/2021
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: NKA

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

Symptoms: Development of petechial rash to lower extremities, abdomen and L arm

Other Meds: Emgality once per month

Current Illness: None

ID: 0943377
Sex: F
Age: 25
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: Experienced fatigue, headache, body chills, body sweats, muscle pain (back and neck), some nausea from 8PM day of administration-current (9:30 AM 1/14/2021); Sore arm at injection site.

Other Meds: Nexplanon (etonogestrel implant)

Current Illness: Previous COVID-19 illness

ID: 0943378
Sex: F
Age: 74
State: LA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Pain in extremity

Symptoms: Rash from knees to chest with itching,.Relieved by taking Benadryl 50 mg; still some itching 12 hours after Benadryl but has improved "75%" according to patient. Rash has resolved.

Other Meds:

Current Illness: none

ID: 0943379
Sex: F
Age: 50
State: MI

Vax Date: 01/04/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: penicillin and sulfa

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

Symptoms: at site of injection, arm has a red patch on the skin

Other Meds: superb complex, multi vitamin, vitamin c

Current Illness: none

ID: 0943380
Sex: M
Age: 50
State: KS

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Reglan, Sulfa, Zocor and Lipitor

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

Symptoms: Anaphylactic reaction - swollen lips, dizziness, flushing, rapid heart rate

Other Meds: pantoprazole, fish oil, MVI, red yeast rice supplement, zinc, vitamin C

Current Illness: none

ID: 0943381
Sex: F
Age: 72
State: MI

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Described as floaties in the eye

Other Meds:

Current Illness:

ID: 0943382
Sex: M
Age: 39
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/14/2021
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: Body aches and general fatigue

Other Meds: None

Current Illness: None

ID: 0943383
Sex: F
Age: 46
State: MD

Vax Date: 12/28/2020
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
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: Starting on 1/11/21 she developed a rash over her entire body with some areas of hives. This got worse the following day. The rash is still present though the itching has improved.

Other Meds:

Current Illness:

ID: 0943384
Sex: F
Age: 68
State: MO

Vax Date: 01/04/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: Top of arm injected is red and warm. Some very slight pain.

Other Meds: Synthroid 175mg ; Estradiol; Flonase

Current Illness: None

ID: 0943385
Sex: F
Age: 41
State: TX

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/14/2021
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: compazine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: sore arm on the same day , fatigue, next day woke up with swollen lymph nodes on my right arm same place where injection was given , still sore and pain full to touch and headaches .

Other Meds: Lasix 20 mg once a day citalopram 20 mg

Current Illness: none

ID: 0943386
Sex: F
Age: 38
State: VA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: sulfa, codeine, Percocet, one injectable RA med that she cannot recall the name to; sesame, all nuts except pistachios and almonds, bees, seasonal

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

Symptoms: Treated by NP attending vaccine event. HPI: Abnormal sensation in throat approx. 15 min after receiving Moderna novel coronavirus vaccine. Denies SOB, wheezes, tongue swelling. No n/v/d, no abdominal cramping, no weakness, no faintness. History of similar reaction to multiple medications. In the past when she has had this throat sensation in reaction to a medication or food, she takes 12.5 mg of oral Benadryl and finds the reaction stops or progresses to hives to posterior knees and thighs, she typically takes more Benadryl and Zantac and the reaction ceases. One episode of anaphylaxis to oral sulfa. Hx hives reaction to one injectable for RA, cannot recall the name. No hx of anaphylaxis to injectable medications. Also reports remote history of severe episodes of hives of unknown origin over a 3 week period about 10-12 years ago; her provider speculated they were stress induced. ROS: otherwise negative. PE: Constitutional - No acute distress. Speaks in full and lengthy sentences without difficulty. ENT: No oropharyngeal edema. Voice clear. No drooling. Airway patent. Neck: Supple, no LAD, no masses, no torticollis. Respiratory: CTAB, no increased WOB. Cardiac: HRRR, no murmur. A/P: Adverse rxn to vaccination, hx multiple food and drug allergies. Administer diphenhydramine 12.5 mg as she usually takes. Continue monitoring for extended period. Further intervention as needed, EM care if condition deteriorates. Report to VAERS. 0918 - diphenydramine 12.5 mg oral administered. 0930 ? reports less fullness sensation in throat. 0935 ? reports abnormal sensation is completely resolved. Lungs CTAB, no increased WOB. No hives, no n/v/d, no faintness. No oropharyngeal edema. 0940 ? patient now questioning if she has reacted to the orange Juicy Juice she drank; she has never had one before. 1020 ? continues to be asymptomatic. Lungs CTAB, no increased WOB. No hives, no n/v/d, no faintness. No oropharyngeal edema. Discussed the importance of PCP follow up to be advised on whether or not a 2nd vaccine is prudent, she plans to seek this guidance. She may opt to rec the 2nd injection at the health department if her PCP advises it is safe, has been information on how to make an appointment there. Encouraged to seek re-evaluation for new symptoms.

Other Meds: Vyvanse 60 mg oral daily, Adderall 5 mg PO BID PRN, fluoxetine 10 mg oral daily, valcyclovir 500 mg oral daily, oral contraceptive

Current Illness:

ID: 0943387
Sex: F
Age: 62
State: MD

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/14/2021
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: Anaphylaxis to Cephalosporins, SJS to Sulfa, PCN

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

Symptoms: Pt developed facial itching 15 minutes after Moderna Covid vaccine injection.. Benadryl 25 mg capsule given po per order Dr. Will be observed x 30 more minutes. 9am C/O oral itching, examined again by Dr. No SOB or difficulty breathing, 9:15am Tx to AUC per DR. Was given Benadryl, Solumedrol and Pepcid. To be discharged home with EpiPen

Other Meds: Hyzaar, Flexeril, Sudafed, citrate magnesium, Mucinex

Current Illness: None per EMR

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm