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: 0944053
Sex: F
Age: 45
State: CA

Vax Date: 01/04/2021
Onset Date: 01/13/2021
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: NONE

Symptom List: Dysphagia, Epiglottitis

Symptoms: 5.25cm x 5.25cm RASH AT INJECTION SITE. RASH IS ITCHY, SWOLLEN, AND WARM TO TOUCH.

Other Meds: LEXAPRO; ABILIFY; SINGULAIR; ALLEGRA; OZEMPIC

Current Illness: COMMON COLD

ID: 0944054
Sex: F
Age: 26
State: NY

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine administered 1/11 at Bushwick vaccine hub. Nurse administering vaccine noted injection was "difficult to push." Five hours post vaccine began to feel severe pain in left arm. Pain worsened overnight. 36 hours later unable to use arm due to pain and numbness noted in fingertips of left hand. Went to emergency room, both nurse and doctor assessed area and could see injection site and noted it was inappropriate - not into the deltoid rather into my shoulder joint. Discharged with pain medication. This AM (1/14) left shoulder pain still significant.

Other Meds:

Current Illness:

ID: 0944056
Sex: M
Age: 20
State: MO

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Systemic: Vomiting, Systemic: Panic Attack; symptoms lasted 0 days

Other Meds:

Current Illness:

ID: 0944059
Sex: F
Age: 47
State: CA

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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: Cipro - lose hearing; demurral and morphine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: About 4 hours after vaccine - started to have a headache: 3 out of 10; took a couple of Motrin (200 mg) and rest; 4 hours later - headache worsened (not migraine though); hot flashes- took blood pressure : 137/85 (my usual is 110/80 - normal) and took another motrin and hydrated. 21:00 pm QR Code - CDC Info number - 800 number called them(doctor was out of town)-called again the next day, as I was concerned about @hypertension. Blood pressure second day: (150/90 went up to) ; CDC couldn't give medical advice - if it gets worse go see DR; on second day got up to 160/100 - took another Motrin and rested. Stayed in bed for two days. Third day at 4:00 am - no headache that third morning - blood pressure was back to normal. Headache came and went for next five days on different side of head.

Other Meds: antibiotic for UTI - (citrotran? ); vitamins - Probiotic for GI; vit C 1000mg Vit D and Zyrtec for allergies.

Current Illness: UTI - acute

ID: 0944063
Sex: M
Age: 66
State: TX

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: iodine

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

Symptoms: After vaccination, pt. returned home and later had nausea and vomiting. The next evening he also had diarrhea. Pt. reported to hospital today and is currently being treated for n/v and diarrhea.

Other Meds: ezetimibe 10 mg. daily lisinopril 20 mg. daily Nasonex spray prn rosuvastatin 10 mg. @ HS Zoloft 50 mg. 1/2 tab to 1 tab daily

Current Illness: Hypertension hyperlipidemia

ID: 0944065
Sex: M
Age: 74
State: MS

Vax Date: 01/12/2021
Onset Date: 01/13/2021
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: PN, Vancomyicin, Silicone, Linorspil

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

Symptoms: Chills, low grade fever 32 hours post vaccine. This lasted 4-5 hours. Sore muscles, flu like feeling.

Other Meds: Aspirin 80mg daily Meloxicam 15mg daily Trulicity 0.75mg once a week TERAZOSIN HCL 2MG CAP/PM ?Prostate Health OMEPRAZOLE 20MG EC CAP 2 CAP DAILY?Acid Reflux LYRICA 50MG 3X A DAY?Neuropathy ATENOLOL 50MG TAB AM--BP FUROSEMIDE 20MG TAB AM--

Current Illness: None

ID: 0944068
Sex: F
Age: 29
State: MD

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient reported itchy hive rash on chest that went on the back of neck

Other Meds:

Current Illness:

ID: 0944070
Sex: M
Age: 51
State: CA

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Morphine and demerol

Symptom List: Pharyngeal swelling

Symptoms: At approximately 0906 staff immediately began to cough and c/o itchy throat, and itching throughout the body. O2 given at 3 L via nasal cannula. 0910 Cetirizine 10 mg PO. 0915 Benadryl 50 mg given PO.

Other Meds: Benadryl 50 mg PO and Cetirizine 10 mg PO

Current Illness:

ID: 0944072
Sex: F
Age: 31
State: TN

Vax Date: 01/13/2021
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: LA

Lab Data:

Allergies: No

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Nausea, upset stomach body aches and soreness

Other Meds: Iron, magnesium, vitamin d, calcium, fish oil

Current Illness: No

ID: 0944075
Sex: F
Age: 25
State: AR

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: head ache and muscle aches

Other Meds:

Current Illness:

ID: 0944081
Sex: F
Age: 44
State: AL

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:
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: The day after recieving the shot I woke up with chills, Ache , fever. Temp. was 101.0, took tylenol. The next morning I felt a heaviness in my chest. Patient continue to experience aches, chills and fever.

Other Meds: Tylenol

Current Illness: none

ID: 0944083
Sex: F
Age: 47
State: CA

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:

Symptom List: Rash, Urticaria

Symptoms: Chills, nausea, vomiting, headache, neck pain. Improving.

Other Meds:

Current Illness:

ID: 0944084
Sex: F
Age: 36
State: DE

Vax Date: 01/07/2021
Onset Date: 01/07/2021
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: Vaccinated Thursday morning, later in the evening felt achy and had a fever. Headache for 2 days. Sat morning 1/9/21 woke up with left arm weakness and numbness which went up to her face. Had an MRI completed which showed a new small right paritial ischemic stroke.

Other Meds:

Current Illness:

ID: 0944085
Sex: F
Age: 27
State: MT

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Body Aches, Headaches

Other Meds:

Current Illness:

ID: 0944086
Sex: M
Age: 60
State: CA

Vax Date: 12/29/2020
Onset Date: 01/05/2021
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:

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

Symptoms: On 01/05/21: Numbness, pins and needles, tingling to the right side of body: arm, legs, torso, hands, feet, face, tongue, lips. Arms felt like it was going to explode. If standing on two feet, cannot feel right foot on ground. On 01/13/21: - Cannot feel texture or sense of touch from elbow to fingers and from knee down to toes.

Other Meds: Multivitamins for men, probiotics, Vitamin C, Vitamin D, glucosamine

Current Illness:

ID: 0944089
Sex: F
Age: 44
State: VA

Vax Date: 01/05/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: quarter-sized area of redness, pain, and swelling at the injection site

Other Meds:

Current Illness:

ID: 0944092
Sex: F
Age: 40
State: PR

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: Medications: Penicillin, Aspirin

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

Symptoms: In the early morning around 3:00 a.m. presented swelling in the eyes, numbness of the tongue, swollen mouth and tingling in the face. where it took a Benadryl at the time.

Other Meds: Benadryl Zyrtec

Current Illness: No disease

ID: 0944094
Sex: F
Age: 60
State: KY

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Systemic: Fainting-Medium; symptoms lasted 0 days

Other Meds:

Current Illness:

ID: 0944134
Sex: F
Age: 56
State: HI

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 56 yo female from pharmacy presented to the observation room at ~1116 after receiving COVID vaccine. She reports feeling weakness and dizziness. She states she fellt sensation to her neck immediately after she got the vaccine. Pt appears very anxious. Provided cold pack behind her neck and vital signs taken 152/90 with HR 98 O2 SAT 98%. Pt then taken to the gurney to lay down. Pt continued to feel weak with short of breath, tingling finger tips. 100% NR mask provided, Dr notified and arrived immediately. vital signs taken every 5-10 min with b/p trending down within 20 minutes. Pt states felt better around 1150. Attempted to sit up but states felt weak again. Pt felt anxious and wanted to speak to her husband, Medic, called husband and was able to speak to him. Pt continues to feel weak. Continue to monitor and comfort provided. Discussed with medical team that patient need to be sent to the ER for further observation. 911 called at 1215 and arrived within few minutes, report given to EMS. Patient transferred to ER at 1230 via gurney. 1117: 152/90,HR 103, O2 sat 98% 1121: 144/72, HR 89, O2 SAT 99%-applied O2 100% non rebreather mask 1126: 153/88, HR 80 1142: 160/92, HR 85, O2 SAT 100% 1147: 147/85, HR 77, O2 SAT 100% 1152: 136/85, HR 70, 02 SAT 100% 1202: 133/81, HR 68, 02 SAT 99%

Other Meds:

Current Illness:

ID: 0944163
Sex: F
Age:
State: PR

Vax Date: 01/07/2021
Onset Date: 01/08/2021
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: uncontrolled chills that lasted for an hour; This is a spontaneous report from a contactable healthcare professional. A 40-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number E5168/expiration date unknown), dose number 2 intramuscularly on 07Jan2021 10:30 at a single dose on the left arm for COVID-19 immunization. The vaccine was administered in a Public Health Clinic facility. No other vaccine was received within 4 weeks. The patient was not diagnosed with COVID-19 prior to vaccination, and was not tested for COVID-19 since the vaccination. Medical history included diabetic and high blood pressure. Historical vaccine included dose 1 of BNT162B2 (lot number EK5730) on 17Dec2020 for immunisation. Concomitant medications included unspecified routine diabetic care meds. On 08Jan2021 03:50, the patient experienced uncontrolled chills that lasted for an hour. She received 2 Advil liquid gels for the event. The outcome of the event was Recovered/Resolved With Sequel. The event was assessed as non-serious.

Other Meds:

Current Illness:

ID: 0944165
Sex: F
Age: 30
State: AR

Vax Date: 01/13/2021
Onset Date: 01/14/2021
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: Sulfa drugs

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

Symptoms: Temp of 101.5, nauseous, fatigue, body aches, dry heaving

Other Meds: 200mg vaginal suppository progesterone nightly

Current Illness: None

ID: 0944166
Sex: F
Age: 17
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: IM
Vax Site: LA

Lab Data:

Allergies: nkda

Symptom List: Unevaluable event

Symptoms: Booster Given Too Early

Other Meds:

Current Illness:

ID: 0944167
Sex: F
Age: 45
State: LA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Redness noted to site within 12 hours; over 2 days time developed into cellulitis (diagnosed per ultrasound on 1/13/21). No treatment required at this time, MD office will continue to monitor.

Other Meds:

Current Illness:

ID: 0944169
Sex: M
Age: 59
State: DE

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/14/2021
Hospital: Y

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

Lab Data:

Allergies: lisinopril seasonal allergies

Symptom List: Injection site pain, Pain

Symptoms: altered mental status, hypoxic, fever 39.3, agitated

Other Meds: metoprolol amlodipine hydralazine omeprazole

Current Illness: hx CKD, DM, HTN lymphedema, bipolar d/o, previous covid infection dx 11/21 now admitted 12/29 with altered mental status, hyopxemic resp failure

ID: 0944171
Sex: F
Age: 37
State: NY

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: 1/11-arm soreness, feeling of warmth in head and neck 1/12 Elevated heart rate, SOB, dizziness, body aches 1/13-elevated heart rate, SOB, dizziness--slightly better than 1/12 1/13-symptoms subsided

Other Meds:

Current Illness:

ID: 0944173
Sex: F
Age: 26
State: WI

Vax Date: 01/05/2021
Onset Date: 01/11/2021
Rec V Date: 01/14/2021
Hospital:

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

Lab Data:

Allergies: SULFA

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

Symptoms: PATIENT NOTICED REDNESS AND A LUMP OVER THE INJECTION SITE, EXPERIENCED SOME PAIN IN UPPER ARM THAT IS IMPROVING, MAIN COMPLAINT IS ITCHINESS. USED NSAID, COLD COMPRESS AND BENDADRYL WITH EFFECTIVENESS IN DECREASING SYMTPOMS. REDNESS BORDERS MARKED ON 1/13/2021, TODAY REDNESS IS SIGNIFICANTLY DECREASED AND PT REPORTS A DECREASE IN ITCHING AND PAIN. PATIENT WAS ADVISED TO CALL HER PHYSICIAN FOR ANY FURTHER INSTRUCTIONS TO WHICH SHE DID, AT THIS TIME WILL CONTINUE TO MONITOR AND WILL CALL PHYSICIAN BACK IF SYMPTOMS GET WORSE.

Other Meds: ADVAIR, GABAPENTIN, LAMICTAL, ALBUTEROL INHALER, NUVA RING

Current Illness: NONE

ID: 0944174
Sex: U
Age: 5
State: KS

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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: No additional adverse events reported; a dose of PROQUAD was given during a temperature excursion; This spontaneous report was received from a medical assistant referring to a 5 year old patient of unknown gender. The patient's concomitant medication, pertinent medical history and drug allergies and reactions were not provided. On 28-DEC-2020, the patient was vaccinated with a dose of improperly stored measles, mumps, rubella and varicella (oka-merck) virus vaccine live (PROQUAD) (strength and route of administration were not provided; lot# was T021638 and expiration date was 21-DEC-2021) 0.5 ml for prophylaxis (product storage error ). No additional adverse events were reported. The vaccine underwent temperature excursion of 5.6 degree Celsius for 16 hours 20 minutes. There were no previous temperature excursions. The digital data logger was not involved.

Other Meds:

Current Illness:

ID: 0944175
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944176
Sex: F
Age: 50
State: CA

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:

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

Symptoms: Fever, chills, headache, malaise. Resolved.

Other Meds:

Current Illness:

ID: 0944177
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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:

Symptom List: Nausea

Symptoms: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944178
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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:

Symptom List: Injection site pain

Symptoms: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944179
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944180
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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:

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

Symptoms: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944181
Sex: F
Age: 37
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: IM
Vax Site: LA

Lab Data:

Allergies: Losartan, olmesartan

Symptom List: Tremor

Symptoms: At approximately 1405, nursing reported that the patient stated that she had "confusion/disorientation, headache, difficulty speaking, dizziness, right arm briefly going numb. Soreness at her joint. Vitals: T 99.4 temporal, R 16, P 102, SpO2 99% RA, BP right wrist 184/129 BP left wrist 153/106. Monitored by the facility medical director. No treatment required. Symptoms resolved.

Other Meds: Amlodipine

Current Illness:

ID: 0944182
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous report was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944183
Sex: U
Age:
State: NM

Vax Date:
Onset Date:
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:

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

Symptoms: Vaccine was stored at -20 Degrees F so outside of the Temperature range; A spontaneous was received from a pharmacist concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) that was stored at -20 degrees F, so outside of the temperature range. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. The reporter stated the COVID-19 vaccine was stored at -20 degrees Fahrenheit; outside of the recommended temperature range. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, vaccine that was stored at -20 degrees F so outside of the temperature range, was considered resolved.; Reporter's Comments: This case concerns a patient who received their first of two planned doses of mRNA-1273 (Lot unknown), reporting Product storage error without any associated adverse events.

Other Meds:

Current Illness:

ID: 0944184
Sex: F
Age: 56
State: PA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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: 15 min after injection, site became swollen to size of golf ball and hot to touch. Swelling went down over the next hour. Site was painful and arm had limited mobility for two days. Exactly one week post injection, site became itchy swollen and covered in hives.

Other Meds: None

Current Illness: None

ID: 0944185
Sex: F
Age:
State:

Vax Date: 12/28/2020
Onset Date: 01/03/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Staff member presented to Hospital to inform of probable reaction to COVID-19 Vaccine. Has generalizes red, raised, itchy rash to her body...Employee health nurse observed rash area to exposed skin areas of neck and arms. Denies any SOB/dyspnea/throat or tongue swelling. States rash has been present for about 5 days. States has history of delayed rash response to various meds and vaccines where she needs to take Benadryl and sometimes steroids. Has been completed CDC daily questionnaire since about day 4 post vaccination.

Other Meds:

Current Illness:

ID: 0944186
Sex: F
Age: 40
State: MD

Vax Date: 12/23/2020
Onset Date: 12/31/2020
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:

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

Symptoms: red, itchy swollen and warm at injection site

Other Meds:

Current Illness:

ID: 0944187
Sex: F
Age:
State: GA

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: unknown

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

Symptoms: Anxiety. Observed 30minutes B/P 130/86@ 10:18AM. No worsening of condition.

Other Meds: unknown

Current Illness: unknown

ID: 0944188
Sex: F
Age: 41
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: Dizziness and nausea within 2 mins of the vaccine. Dizziness went away after 10 mins but nausea has remained for over 24hours.

Other Meds: Nuvaring Adderall XR Wellbutrin XL Zyrtec

Current Illness: none

ID: 0944189
Sex: M
Age: 44
State: TN

Vax Date: 12/27/2020
Onset Date: 01/14/2021
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: none

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

Symptoms: I experienced a fast heartbeat at about 10 minutes after the shot. I did a few deep inhale/exhale repetitions to calm it down. I think this lasted less than 1 minute. I did not have other symptoms.

Other Meds: Lisinopril 40MG

Current Illness: no

ID: 0944190
Sex: F
Age: 45
State: TX

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

Lab Data:

Allergies: NKDA

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

Symptoms: Chest pain, anxiety and numbness to right hand x 10 minutes

Other Meds: Lisinopril

Current Illness:

ID: 0944191
Sex: F
Age: 15
State: OH

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Wrong Dose of Vaccine - Too High; symptoms lasted 0 days

Other Meds:

Current Illness:

ID: 0944192
Sex: F
Age: 63
State: MN

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Vomiting

Symptoms: 20 hrs after injection, I started sweating, felt very nauseated, chills and headache. It only lasted 5 minutes

Other Meds: calcium, Vit. E , zinc, Paxil, Lipitor, Estridial, Progesterone cream

Current Illness: none

ID: 0944193
Sex: F
Age: 29
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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin and sulfa drugs

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Shooting chest pains, delirium, dry mouth/throat with mild difficulty swallowing, severe weakness, severe fatigue, sweating.

Other Meds: Cymbalta

Current Illness: None

ID: 0944194
Sex: F
Age: 34
State: AR

Vax Date: 01/08/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: fever

Other Meds:

Current Illness:

ID: 0944195
Sex: M
Age: 55
State: AZ

Vax Date: 11/05/2020
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pain at the injection site, he reports he also has pain radiating into the shoulder. Not clear how these symptoms occurring from injection site in Deltoid region. I make sure the injection is administered in the mid point of Deltoid muscle (at lest 3 fingers width below from the shoulder joint), not too close to the shoulder joint. Not clear why he took this long to report. When asked when the symptoms began, he said the symptoms began post vaccination, He did not see any provider yet, he said he will see his doctor in the near future and will let us know.

Other Meds: Glipizide, Losartan, Amlodipine, Tadalafil,

Current Illness: Diabetes, Hypertension.

ID: 0944196
Sex: F
Age: 40
State: CA

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: IM
Vax Site: RA

Lab Data:

Allergies: no

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

Symptoms: Beginning feeling tingle on the tonged, 10-20 sec. Soreness at the inj site. 2hrs later tired. Little nausea. 1/14/21 bad nausea, cold hot sweats, flu like symptoms. Nasal congestion and fatigue. Symptoms are trickling in not all at once.

Other Meds: no

Current Illness: no

ID: 0944197
Sex: F
Age: 58
State: MT

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

Lab Data:

Allergies:

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

Symptoms: Body Aches, Headache, Sore Arm, Diarrhea

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm