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: 1213073
Sex: U
Age: 61
State: OH

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/15/2021
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: Tetanus Antitoxin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Usual expected effects that increased in severity as time passed but on 4/13/2021 in the late afternoon/early evening, while resting in recliner, my body had a heaviness as if pressure was pushing me into the recliner. On 4/14/2021 at 4 am, woke, after about 10-15 minutes I felt nauseous, then cold clammy sweat outbreak, then dizziness and thought I would pass out. Sat on the floor so I wouldn't fall, laid on back, had the heavy pressure as if pushing me into the floor. I focused on ceiling and prevented a pass out (I think). After a few minutes, it was over and I was able to get up. Two hours later, severe migraine type headache came back. (all effects in Cont page note)

Other Meds: Levo-thyroxine 112 Mcg, Pravastatin 20 Mg, (see note cont. pg)

Current Illness:

ID: 1213074
Sex: M
Age: 20
State: CA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/15/2021
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: PENICILLIN ALLERGY WHEN HE WAS YOUNG

Symptom List: Anxiety, Dyspnoea

Symptoms: FAINTING. RECOVERED SOON WHEN WE HAD HIM LYING DOWN. CALLED 911, THEY TALKED HIM AND CONFIRMED THAT HE WAS CONCIOUS AND DIDN'T COME. BP CHECKING (80/42)..REALLY LOW. HE STAYED AT OUR LOCATION FOR 1 HOUR AND LEFT. CHECKED ON HIM ON 4/14/21, HE STATES HE IS FINE.

Other Meds: NO

Current Illness: NO

ID: 1213075
Sex: F
Age: 38
State: IL

Vax Date: 04/08/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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: Bandaids

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

Symptoms: Rash at injection site appeared 7 days after vaccination. Lump in left armpit 6 days after vaccination.

Other Meds: Sprintec

Current Illness:

ID: 1213076
Sex: F
Age: 44
State: WA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt received 1/2 dose due to a pulling error.

Other Meds: n/a

Current Illness:

ID: 1213077
Sex: F
Age: 46
State: VA

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: Betablockers, Biaxin, Cipro, Latex, Nickel, PCN, Zofran

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

Symptoms: 30 minutes after first shot had redness on her face. Patient self-medicated with antihistamine and it improved. I then drove home and on the way home - my face swelled up and my right eye was swollen. I arrived home - took additional antihistamine - H1 and H2 blockers and went to sleep. When I woke up i was fine. Pt took second dose on 1/25 and premedicated for that vaccine and had milder episode of hives. Patient is an allergist.

Other Meds:

Current Illness:

ID: 1213078
Sex: M
Age: 63
State: LA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/15/2021
Hospital: Y

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: CLINDAMYCIN; HYDROCODONE-ACETAMINOPHEN; ROFECOXIB

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

Symptoms: Pt received the J&J vaccine on Monday 4/12 around 10 am. Reports onset of diarrhea mon night, frequent episodes. Then Tuesday 4/13 developed dysuria, fever/chills, headache, nausea, vomiting. Presented to ED 4/14 and admitted to hospital medicine with acute kidney injury.

Other Meds:

Current Illness:

ID: 1213079
Sex: F
Age: 43
State:

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/15/2021
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: Sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Extreme muscle aches Fatigue Headache Chills Very sore arm

Other Meds: Wellbutrin Lithium

Current Illness: No

ID: 1213080
Sex: F
Age: 49
State: NC

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: PREDNISONE LISTED IN PROFILE

Symptom List: Pharyngeal swelling

Symptoms: PATIENT SAID SHE HAD TO LEAVE WORK DAY OF THE VACCINE DUE TO BEING IN PAIN. TODAY SHE SAYS SHE IS IN EXTREME PAIN. IT DOES NOT MATTER IF SHE IS LYING DOWN, SITTING, OR STANDING. SHE HAS TO USE A CANE TO WALK (SHE GENERALLY DOES NOT USE A CANE). SHE IS GOING TO AN URGENT CARE TO BE SEEN

Other Meds:

Current Illness:

Date Died: 03/13/2021

ID: 1213081
Sex: M
Age: 76
State: NC

Vax Date: 02/16/2021
Onset Date: 02/17/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: strawberries

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever, Sick on stomach, aches, fatigue, extreme weakness. Symptoms were extreme. Generally felt terrible after being very stable and active. No improvement and condition worsened daily with loss of appetite. Death occurred on March 13, 2021.

Other Meds: Lasix, Lisinoprol, Avorstatin, Cardivirol

Current Illness: heart failure, kidney disease

ID: 1213082
Sex: F
Age: 47
State: CA

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/15/2021
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: Heavy concentration of gluten

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Hives, Swelling, Redness, Pain

Other Meds: Mutli-Vitamins

Current Illness: None

ID: 1213083
Sex: F
Age: 55
State: WV

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/15/2021
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: Woke up next morning very dizzy, running, 101 fever, headache, body aches, nauseous. pain in left arm where injection was administered. Very tired. Stayed home from work. As day progressed symptoms got worse. Headache was very bad and Tylenol would not help. Got very sick and was unable to eat. Fever did not break until Saturday morning. I was dizzy until Sunday morning. Was very tired until Sunday evening. Did not contact my doctor.

Other Meds: Lisinopril - HCTZ 20-25, 1 tablet daily, Vitamin E 180mg - 1 tablet daily, Vitamin B12 - 5000mcg - 1 tablet daily, Vitamin D3 - 50mcg - 1 tablet daily.

Current Illness: Tested Positive for Covid-19 on March 8, 2021

ID: 1213084
Sex: M
Age: 19
State: NJ

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/15/2021
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: amoxicillian

Symptom List: Rash, Urticaria

Symptoms: About 5pm after the vaccine I developed a cramp in my left leg, felt really tired and the fever began. About 10pm the symptoms got worse so I took nyquil because I was feeling horrible. My fever elevted to 101 causing me to have a seizure. EMT transported me to the ER about 12midnight and I was given meds for nausea, pain and monitored and about 3:30am I was released. The next day I was really tired, fatigued and had a really bad headache but by that Wed all symptoms had subsided.

Other Meds: no

Current Illness: no

Date Died: 04/02/2021

ID: 1213085
Sex: F
Age: 87
State: IL

Vax Date: 02/05/2021
Onset Date: 04/02/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: ACE inhibitors, codeine sufate

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

Symptoms: End Stage dementia, overall decline, hospice care, expired

Other Meds: acetaminophen, aspirin, ativan, insulin glargine, gabapentin, divalproex, fluoxetine, ocuvite, metformin, levothyroxine, topiramate, potassium chloride, lasix

Current Illness: anemia, heart failure

ID: 1213086
Sex: M
Age: 37
State: WA

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 04/15/2021
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: In addition to common side effects including fatigue and headache, my arms became covered in rashes, particularly my elbows. The rashes persisted for about 10 days and are starting to vanish.

Other Meds:

Current Illness:

ID: 1213087
Sex: F
Age: 46
State: FL

Vax Date: 03/07/2021
Onset Date: 04/12/2021
Rec V Date: 04/15/2021
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:

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

Symptoms: 1 Extensive left upper extremity venous thromboembolism-nonocclusive in the left subclavian, left axillary, brachial and basilic veins 2 Right lower lobe subsegmental PE 3 Mechanical thrombectomy of the left subclavian and axillary veins 4 Bruising all over body

Other Meds:

Current Illness:

ID: 1213088
Sex: F
Age: 40
State: DE

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 04/15/2021
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: Unknown

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

Symptoms: Patient (driver of vehicle) passed out shortly after leaving the vaccination lane, while proceeding to the post administration area. Patient was involved in a 5 vehicle in the post administration area. Patient was assessed on scene by emergency unit and transported by emergency unit to local ER for further evaluation.

Other Meds: Unknown

Current Illness: Unknown

ID: 1213089
Sex: F
Age: 52
State: UT

Vax Date: 03/12/2021
Onset Date: 04/02/2021
Rec V Date: 04/15/2021
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: 1st shot sore are tire for 2 days 2nd shot tired on the 2nd day 3rd day start getting getting headache, dizzy, nausea, sick to my stomach, tightness of chest, rapid heartbeat on and off, couldn't eat, didn't sleep well, tingling in hands and feet, didn't feel like I was going to make it through though the night. Not bad enough to go to the emergency room. I have been to urgent care and to internal medical to get checked still not feeling good I had covid in December and I feel like this shot has made me sick and I just can't get back to myself

Other Meds: Metformin

Current Illness: None

ID: 1213090
Sex: F
Age: 43
State: PA

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I had multiple side effects, which I will list below, but the one that was most concerning and which I have not seen listed as a typical side effect is that I got very dizzy and fainted, losing consciousness briefly. I got my vaccine around 10am. By 9pm I had severe chills and was achy. Around midnight I got up to use the bathroom and felt dizzy, then I fainted. Thankfully I had called for help beforehand, so my husband caught me and called my name until I regained consciousness. Immediately after coming to I started sweating profusely. My temperature at that time was 100.3. Through the rest of the night and for the following day and night I experienced nausea, chest pains, achy, sore arm, weakness, and fatigue. I felt relief from symptoms by about 48 hours after my vaccination.

Other Meds: Women's One-a-Day multivitamin NatureMade Iron Supplements

Current Illness: none other than anemia

ID: 1213091
Sex: M
Age: 34
State: GA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/15/2021
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: Fever, headache

Other Meds: none

Current Illness: cold

ID: 1213092
Sex: F
Age: 22
State: KY

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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

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

Symptoms: fainted and had decreased HR. has only ever fainted when she was very young. history of only one other episode.

Other Meds: unknown

Current Illness:

ID: 1213093
Sex: F
Age: 31
State: OH

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 04/15/2021
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: Patient experienced a metallic taste in her mouth approximately 15 minutes after receiving vaccine. She was to then be observed longer. Vitals at 4:10pm= BP 142/90mmHg, PO2 96%, and heart rate 88 beats/min. Patient reports she had already been having an asthma exacerbation earlier during the day and walking into the facility from the cold makes her asthma worse. Upon the metallic taste in her mouth and the need to be observed longer she states she had some anxiety and that this contributed to her wheezing. Patient took one puff of her albuterol inhaler and was feeling better. At 4:25pm the nurse noted lungs were clear with no wheezing detected. After approximately 30-45 minutes of observation, she was then walked by a nurse outside and due to the cold bothering her lungs she took a second puff of her inhaler in her car. Her wheezing lessened and the patient felt fine to go home.

Other Meds: Albuterol HFA

Current Illness: Occasional asthma exacerbations

ID: 1213094
Sex: F
Age: 63
State: AL

Vax Date: 03/19/2021
Onset Date: 03/22/2021
Rec V Date: 04/15/2021
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, Amlodipine

Symptom List: Unevaluable event

Symptoms: Dose 1- Left side of face would be real red when I woke up. Would happen every 2-3 days for 6-10 hours duration. Went in about 2 weeks. Did not hurt, no fever. injection site sore around 4 days when lifting my arm. Dose 2- injection site not as sore. Woke up the next morning with left side of face beet red again. Also left neck/collarbone area lymph nodes swollen. Palpable, not sore, no fever or muscle aches. Face red most of the day. On day #6 woke up RIGHT side of face beet red, and right neck/collarbone lymph nodes swollen. So now both sides are swollen. And beet res on both sides of face. No fever, no muscle aches.

Other Meds: Losartan, Zyrtec, Lyrica, Synthroid, Spiriva, Flonase, Omeprazole, Synthroid

Current Illness: Urinary tract infection

ID: 1213095
Sex: F
Age: 38
State: CT

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/15/2021
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: Penicillin, Morphine and Codeine

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

Symptoms: Patient felt nauseous and dizzy after shot

Other Meds: Aptiom 600mg Prozac 40 Dexilant 30

Current Illness:

ID: 1213096
Sex: F
Age: 72
State: NH

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 04/15/2021
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: NEOMYCIN

Symptom List: Injection site pain, Pain

Symptoms: DAY 2, FEVER, CHILLS, ACHES DAY 3 VERTIGO WHILE IN LYING POSITION

Other Meds: AZITHROMYCIN, ETHAMBUTOL,RIFAMPIN,LIPITOR,CALCIUM,VITAMINS

Current Illness:

ID: 1213097
Sex: F
Age: 58
State:

Vax Date: 03/03/2021
Onset Date: 04/02/2021
Rec V Date: 04/15/2021
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: significant HA, head numbness

Other Meds:

Current Illness:

ID: 1213098
Sex: F
Age: 26
State: CA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/15/2021
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: h/o angioedema, unknown specific allergen

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

Symptoms: Pt experienced throat swelling around 10 minutes after vaccination. She described the sensation as "tightness" and "something in the back of my throat." No visible angioedema at first evaluation. PO Claritin administered. Vitals remained stable throughout episode. Throat became visibly edematous around 20 minutes post vaccination. 0.5mg epinephrine was give at this time. (9:20am)

Other Meds: - Abilify - additional psychiatric med, unknown name

Current Illness: none

ID: 1213100
Sex: F
Age: 69
State: VA

Vax Date: 03/09/2021
Onset Date: 03/23/2021
Rec V Date: 04/15/2021
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: Iodine and IVP dye All seafood, coconut,pineapple Bee stings

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Developed pain in arm, up into shoulder, across to neck. Still hurts at shoulder

Other Meds: Ziac,Accupril, fish oil, biotin,calcium, vitamin d, and tumeric

Current Illness: None

ID: 1213101
Sex: F
Age: 50
State: VA

Vax Date: 03/31/2021
Onset Date: 04/13/2021
Rec V Date: 04/15/2021
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: On 4/13/2021 at 11:00 AM pt. began experiencing left leg pain with swelling noted around left knee and extended above knee. By 11:00 PM pt. felt faint and nauseated and left leg was swollen and discolored. Rescue squad was called and took pt. to Hosp where she was told it was sciaticia. After showing the medical professionals her leg and insisting upon an ultrasound of her leg she was told the "machine" was not available and she would be called the next day to be scheduled. Per pt's daughter, she was never called and daughter called hospital to have U/S scheduled. Pt. went back to hospital on 4/14 at 3:15 PM for U/S and she was diagnosed with multi DVT's in left leg which at that time had swelling all the way down to her foot. Pt. was put on Coumadin.

Other Meds:

Current Illness:

ID: 1213102
Sex: F
Age: 16
State: TX

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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: PATIENT WAS GIVEN MODERNA VACCINE EVEN THOUGH SHE IS 16

Other Meds:

Current Illness:

ID: 1213103
Sex: F
Age: 61
State: WI

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/15/2021
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: Within 15 minutes of vaccination, patient became diaphoretic. Shortly after, had syncopal episode and was taken to urgent care for EKG evaluation. No abnormal findings, and patient was discharged in alert, stable condition.

Other Meds:

Current Illness:

ID: 1213104
Sex: M
Age: 57
State: TX

Vax Date: 04/10/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: (14 April 2021) I started experiencing stomach discomfort which resulted in diarrhea . It has been constant for the past 24 hours. (15 Apr 2021) I contacted my healthcare provider at 8:10 am and selected the call-back option. The healthcare provider called me back at 8:17 am. The healthcare provider will start case file contact patient before the day is over. I took Imodium at 8:50 am. Got a call from the doctor's office (10:19 am) with instructions: Take fiber and plenty of liquids. I informed them I took an Imodium, directions changed to drink plenty of liquids and let it run its course. There is nothing they can do because the vaccine was already administered.

Other Meds: None

Current Illness: None

ID: 1213105
Sex: M
Age: 72
State: NC

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: MUSHROOMS

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

Symptoms: CONTACTED GP AFTER SYMPTOMS OF SEVERE TIREDNESS AND DROOPY MOUTH. PERFORMED STROKE SELF-TEST..VISITED OFFICE. DIAGNOSED WITH BELL'S PALSY. PRESCRIBED VALACYCLOVIR 1 GM 3 TIMES DAILY...PRESCRIBED PREDISONE 20MG 3 TABLETS DAILY FOR 4 DAYS, 2 TABLETS DAILY FOR 4 DAYS, AND 1 TABLET DAILY FOR 4 DAYS UNTIL COMPLETE

Other Meds: GABAPENTIN, AMLODOPINE, ATORVASTATIN

Current Illness: DOUBLE BY-PASS 1/29/21 AND CAROTID Endarterectomy 3/29/21

ID: 1213106
Sex: F
Age: 28
State: AZ

Vax Date: 02/01/2021
Onset Date: 04/12/2021
Rec V Date: 04/15/2021
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: NKDA

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

Symptoms: Patient received Pfizer COVID #1 on 2/1/2021 with Lot EL3247. Patient then received Pfizer COVID #2 on 2/25/2021 with Lot EN6202. Patient reports nasal congestion since 4/12/2021 with associated headache. Denies fever, sore throat or cough. Patient has also developed loss of taste and smell. patient reports her boyfriend was positive for COVID earlier in the month. Patient arrived to our facility today and was tested for COVID using PCR.

Other Meds: Zyrtec 10mg Tablet, PO once daily

Current Illness:

ID: 1213107
Sex: F
Age: 63
State: CA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient reports mild facial swelling. No airway impairment, no breathing difficulty. Patient took their own Zyrtec 15ml. No facial swelling noted, no airway impairment. Patient was observed for 30 minutes. Symptoms resolved

Other Meds:

Current Illness:

ID: 1213108
Sex: M
Age: 29
State: WA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/15/2021
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: NA

Symptom List: Erythema, Pruritus

Symptoms: Complete body/muscle lock up - Was rendered useless on hallway floor for 15 minutes while my body locked up with muscle spasms Extreme Migraine morning after - Continues to be an issue as the days go on - Not getting worse, but each day is a headache Extreme Muscle pain from left collar bone area to the left ear Minor/Medium pain behind my eyes every so often Shortness of breath at times with no strenuous activity prior

Other Meds: NA

Current Illness: NA

ID: 1213109
Sex: F
Age: 63
State:

Vax Date: 03/16/2021
Onset Date: 03/18/2021
Rec V Date: 04/15/2021
Hospital: Y

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: N17.0 - Acute kidney injury (AKI) with acute tubular necrosis (ATN) W19.XXXA - Fall, initial encounter N39.0 - UTI (urinary tract infection) R73.9 - Hyperglycemia

Other Meds:

Current Illness:

ID: 1213110
Sex: F
Age: 33
State: FL

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 04/15/2021
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 previously known

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

Symptoms: 103 degree temperature from around 3am until 10am: took Tylenol 500mg at 6am when I woke up for too much body sweats. Slept for the next day only waking up 2-3 times to drink water and took Tylenol again for headache on upper right side of head hurting minimally less the first away from right side.

Other Meds: none

Current Illness: none

ID: 1213111
Sex: M
Age: 50
State: OH

Vax Date: 03/22/2021
Onset Date: 04/02/2021
Rec V Date: 04/15/2021
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: Severe gout in left knee that is not responding to nsaids indomethacin, ibuprofen, aleve or colchicine or cortisone injection. Have been unable to walk for almost 2 weeks now and have not been able to go to work.

Other Meds: Klonopin, rosuvostatin,januvia,meformin,lisinopril

Current Illness: None

ID: 1213112
Sex: F
Age: 60
State: IN

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/15/2021
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: Antivert, Vitamin E, Nickel

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

Symptoms: Chills for over night, slight fever overnight & bodyaches for a couple of days. Tired feeling .

Other Meds:

Current Illness: none

ID: 1213113
Sex: F
Age: 83
State:

Vax Date: 02/22/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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: COVID 19 infection positive

Other Meds:

Current Illness:

ID: 1213114
Sex: F
Age: 62
State: NY

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: N

Symptom List: Pain in extremity

Symptoms: Patient reports arm pain of same arm as injection site since injection

Other Meds: Yes

Current Illness: yes

Date Died: 04/10/2021

ID: 1213115
Sex: M
Age: 77
State: NY

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: Bactrim: itching

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

Symptoms: cardiac arrest at approximately 4:35pm, patient expired.

Other Meds: Ferrous Sulfate 325 (65 Fe) MG Tablet 1 tablet Orally BID-TID Vitamin C 500 mg Tablet 1 tablet Orally Once a day Ozempic 0.5mg , Notes: rx'd by endo Metformin HCl 500 mg Tablet 2 TABS Orally twice a day Metoprolol Succinate ER

Current Illness: None

ID: 1213116
Sex: M
Age: 30
State: CO

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: First day after vaccine: chills, fever, whole body aches, expected soreness at site of injection Second day after vaccine: tightness in back of throat (maybe even already in chest, hard to pinpoint) that felt a little like choking Third day after vaccine: moderate headache and general head discomfort, particularly behind eyes No treatments for any of the symptoms, I've just been letting them each run their course and they've each only lasted about 24 hours so far.

Other Meds: None

Current Illness: None

ID: 1213117
Sex: F
Age: 53
State: MN

Vax Date: 03/17/2021
Onset Date: 03/20/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Developed shingles on the left side of my torso, 3 days following the COVID-19 vaccination.

Other Meds: Multi-vitamin, psyllium, calcium, vitamin B12, vitamin B complex, estroven, fish oil, vitamin C, vitamin D

Current Illness: None

ID: 1213118
Sex: F
Age: 57
State: GA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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: Seafood, mushrooms, drinking alcohol, penicillin, codeine

Symptom List: Vomiting

Symptoms: After 30 mins, my lower lip started tingling and became numb. In 15 mins, my left side of my face was numb and tingling. It then spread to the right side. My throat started itching and then my ears began itching. I then got a headache. I contacted my primary dr office. They would not see me because they didn't give the shot. I text my allergy office. They told me to take Benadryl and keep my epi pen close. I did. After an hour and a half, the symptoms didn't improve so I decided to go to the Urgent Care. By this time, the numbing/ tingling feeling was going down my arms and back. They said my blood pressure was a little high and I had a slight fever, 99,8. I felt awful. The urgent care said there wasn't anything they could do but recommend continual use of benadryl and ibeprophen. I went home and rested. The numbness and tingling lasted until around 5:00. The itchy throat/ears and bad headache continued until I went to sleep around 9:30. I slept through the night. All symptoms were gone except for a sore arm, in the morning.

Other Meds: Dynamist, Hormone Meds, Lasartin, Zertec, allergy shots

Current Illness: None

ID: 1213119
Sex: F
Age: 60
State: IN

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/15/2021
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: nka

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: pt says that her arm was very sore after taking the vax but then she developed a fist size bruise at the injection site. there is no fever or soreness any longer but the bruise has been there for almost 2 weeks. She went to PCP Dr. on 4/12/2021 and she was told it was not a bruise and to contact the vax manufacturer since he wasn't sure what it was.

Other Meds: Levothyroxine 137mg

Current Illness: no

ID: 1213120
Sex: F
Age: 48
State:

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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: post vaccine pt reported funny taste in mouth and began to panic. Pt evaluated in tent and recovered.

Other Meds:

Current Illness:

ID: 1213121
Sex: F
Age: 64
State: IA

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 04/15/2021
Hospital: Y

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 known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Information Provided by Patient's Husband Received vaccine on April 6th. April 7th: nausea and vomiting all day April 8th: fatigue, slept all day, hardly ate, mental fog when awake. April 9th: Slept 22 hours, didn't respond well to attempts to wake her up, mental fog when awake April 10th: ambulance took patient to local hospital where patient was admitted April 13th: Discharged from hospital. Mental fog and fatigue still continuing. Husband states that mental fog seems a little worse this morning April 15th.

Other Meds: metformin 500mg BID, Calcium 600mg QD, Vitamin D3 QD, Lisinopril 10mg QD, atorvastatin 40mg QD, glyburide 5mg BID,

Current Illness: none

ID: 1213122
Sex: M
Age: 72
State: MN

Vax Date: 02/12/2021
Onset Date: 02/17/2021
Rec V Date: 04/15/2021
Hospital: Y

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: Skin rash on top of feet lasting 5 days, Blood in stool starting starting 02/17/2021 after 2 dose continueing untill 04/15/2021 colonoscopy performed on 04/03/2021 mild inflammation was found in the distal rectum, in the proximal sigmoid colon and in the mid sigmoid colon secondary to proctosigmoid colitis treted with a course of 40mg prednisone starting 04/01/2021 decreasing by 10mg . bleeding increased on 04/12/2021 admitted to ER and hospitol until 04/14/2021. sigmoidoscopy performed on 04/13/2021 inflamation somewhat reduced.

Other Meds: Lisinapril 20mg, hydrochlorothiazide 25mg, atorvastatin 40mg

Current Illness: no

ID: 1213123
Sex: F
Age: 41
State: VA

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 04/15/2021
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: Pennicillen

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

Symptoms: vasovagal symptoms -- lightheaded, cold sweats, nausea, diarrhea, extremely low blood pressure and heart rate for ~30 minutes

Other Meds: Xyzal antihistamine and Nasacort corticosteroid the day prior (April 2, 2021)

Current Illness: None.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm