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: 1214266
Sex: F
Age: 20
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Stomach bloated and felt like heartburn but in my stomach. I vomited, couldn?t walk for two days, and felt very fatigued. My stomach has been cramping nonstop and symptoms are still not gone over 5 days after receiving the vaccine. I?m worried about long term effects and how the second dose will react in my body. My symptoms were so severe I almost went to the ER but instead contacted my doctor who said they can?t do anything, and I need to ?ride it out?. I can?t eat anything without feeling extremely sick, and the nausea when it comes lasts up to 12 hours until my next meal.

Other Meds: No medications taken at the time of vaccination, but the day before I took my usual Zyrtec, D3, Magnesium, and Digestive enzymes

Current Illness: Endometriosis

ID: 1214267
Sex: M
Age: 37
State: VA

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

Lab Data:

Allergies: ASA, NSAIDS

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient came to shot ex clinic for 2nd dosing of COVID vaccine. Was screened and received 2nd dose of vaccine then proceeded to waiting area with his spouse for 15 min observation period. After aprox 7 min patient and spouse called over nurse as patient was experiencing one of his "normal-see medical explanation above of patient condition" non-epileptic seizures. Staff of nurse and 4 men performed immediate first aid measures lowering the patient to floor for safety, supporting airway and 911 was called as patient vital signs were elevated. EMS services arrived within 5 min from call and proceeded to care for patient. Patient was given po fluids and nasal versed with good rapid resolution of symptoms. Patient and spouse both declined transfer to local hospital emergency services.

Other Meds: Azelastine HCL nasal spray, Mirtazapine, Vit D, Escitalopram oxalate, Dicyclomine HCL, Simethicone

Current Illness: The patient is a 37yoM with an approximately year-long history of spells of dizziness, chest and abdominal pain, and palpitations, with additional spells of altered consciousness and rhythmic jerking behavior beginning in OCT2020. He has undergone an extensive and thorough evaluation by cardiology, neurology (including a neuroautonomic specialist), ENT, gastroenterology, sleep medicine, and psychology since the onset of his symptoms, including an inpatient admission for video EEG with several convulsive episodes captured without EEG evidence of epileptic activity. Assessments from other specialists have not yielded an explanatory diagnosis; assessments from neurology/autonomic specialist and psychology have yielded a diagnosis of conversion disorder with seizures or convulsions, for which he has been followed now since DEC2020 with recurrent convulsive episodes, most not followed by any period of reduced consciousness (I.e., ?post-ictal? like state), and are congruent with the convulsive episodes which occurred following vaccine administration today. The patient was observed on several occasions to have bouts of apparently reduced consciousness (but without any cardiopulmonary compromise), followed almost immediately by return to full consciousness including normal speech pattern and apparent short- and long-term recall.

ID: 1214268
Sex: F
Age: 42
State: VA

Vax Date: 04/13/2021
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:

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

Symptoms: Staring at 3:00 am 04/14/2021, I was woke up with extreme stomach cramping and diarrhea. This lasted until around 12:00 PM (noon). Body aches like the flu was until about 2:00 PM. Freezing but no fever, then sweating. Exhaustion and felt spacey. All symptoms lasted until around 2:00O PM on 04/14/2021. Arm soreness

Other Meds:

Current Illness:

ID: 1214269
Sex: M
Age: 54
State: GA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pt. was given Moderna for first vaccine. The vaccination card was written improperly and said Pfizer, when it should have said Moderna. When pt. came to the clinic for his 2nd vaccine and presented his vaccination card, we verified his card and gave him Pfizer for his second dose. Pt. has hearing disability and was not able to communicate and verify.

Other Meds:

Current Illness:

ID: 1214270
Sex: F
Age: 34
State: MO

Vax Date: 01/22/2021
Onset Date: 02/09/2021
Rec V Date: 04/15/2021
Hospital:

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

Lab Data:

Allergies: bees-hives. PCN-hives. sulfonamides-hives

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

Symptoms: bilateral swelling and pain in knees beginning Feb. heat, ice, elevation, rest did not improve. pain and swelling in second toe in left foot. PCP office visit x3, ortho office visit x2. rheumatologist office visit x1. diagnosed with spondylarthritis by rheumatologist.

Other Meds: topmax QD, flexeril PRN, gapabentin QD, protonix QD, Tylenol PRN

Current Illness: none

ID: 1214271
Sex: F
Age: 46
State: NC

Vax Date: 04/01/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
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: Fever, chills, diarrhea

Other Meds: Blood pressure meds Anti depressants Arthritis meds

Current Illness: High blood pressure Migraines Arthritis

ID: 1214272
Sex: M
Age: 60
State: MO

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

Lab Data:

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Queasy stomach, chills, fever, achy joints like lower back, & fingers.

Other Meds: Tylenol, Motrin.

Current Illness: None

ID: 1214273
Sex: M
Age: 37
State: WA

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No.

Symptom List: Pharyngeal swelling

Symptoms: Shortness of breath. Ongoing.

Other Meds: N/A

Current Illness: No.

ID: 1214274
Sex: M
Age: 67
State: AL

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: LA

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: At approximately 10 minutes after receiving vaccination, patient reported difficulty breathing and felt like his throat was closing up. He became visibly anxious and sat on the floor in a tripod position. Patient was immediately assessed by medical personnel. Pt remained Alert and oriented x 3, PERRL, mouth and throat assessed without evidence of tongue, throat, or uvula swelling, patient tolerating oral secretions well, lungs CTA, resp with ease; no increased work of breathing. BP 158/82, pulse 80, Resp 18, FSBS 204, SaO2 97% RA. Pt had spontaneous improvement after 5 minutes with complete resolution of symptoms. Pt declined to be transported by EMS for further evaluation at local emergency department. Pt left facility accompanied by wife in stable condition after additional 30 minute observation and complete resolution of symptoms.

Other Meds: Setraline 100 mg daily, Lisinopril 20 mg daily, Glyxambi 10/5 mg daily, Allegra 180 mg daily, protonix 40 mg daily, brilinta 60 mg bid, carvedilol 3.125 bid, gabapentin 60 mg tid, tamsulosin 0.4 mg daily, lipitor 80 mg daily, ASA 81 mg dai

Current Illness: none

ID: 1214275
Sex: F
Age: 62
State: MN

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

Lab Data:

Allergies: Anesthesia S/i-40 (Propofol) [Propofol] Tetanus Vaccines And Toxoid

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dizziness, numbness and nausea. 12 lead ECG, 18g IV, Blood Glucose, Vitals stable, 4mg of Zofran, transported to Hospital

Other Meds: Albuterol ASA Atorvastatin bethmethasone valerate Cholecalciferol Vit D3 Cimetidine Citalopram famotidine levothyroxine lisinopril Mometsone Multi-Vit Omeprazole

Current Illness:

ID: 1214276
Sex: F
Age: 53
State: MD

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: SYR
Vax Site: LA

Lab Data:

Allergies: Allergies to certain foods. Patient was asked to stay 30 minutes for observation prior to vaccination.

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

Symptoms: About 10 minutes after vaccination patient reported feeling hot and itchiness on right side of face. Also had hive on right jaw line. No shortness of breath. Patient was evaluated by EMS who advised IM benadryl which patient refused. relative brought patient oral benadryl. The itchiness and hot flash resolved after 10-15 minutes.

Other Meds: Amlodipine Losartan Vitamin D

Current Illness:

Date Died: 02/26/2021

ID: 1214277
Sex: F
Age: 102
State: MD

Vax Date: 02/10/2021
Onset Date: 02/10/2021
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: Sulfa, Antibiotics, Bactrim, Actonel

Symptom List: Rash, Urticaria

Symptoms: After resident received vaccine there continued to be a decline in her overall health. Resident died on 2/26/21 at the age 102. The County Health Department requested that her information be forwarded to VAERS. There is no evidence that resident had a adverse reaction to the vaccination.

Other Meds: Antacid, Cephalexin, Daily Vitamin, Levothyroxine, Magnesium-OX, Metoprolol, Omeprazole, Vitamin D, Acetaminophen, Bisacodyl, Docustate Sodium, Haloperidol, Loratadine, Morphine, Ondansetron, Pepto Bismol, Balmex, Polyeth Glycol Powder

Current Illness: Resident had a steady decline over several months. She was under comfort care and it was the resident and families request to not be transferred to hospital and not to perform any medicals tests for diagnosis and treatment.

ID: 1214278
Sex: M
Age: 35
State: IL

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

Lab Data:

Allergies: None

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

Symptoms: Constipation. Normally I am very regular -- bowel movement at approximately the same time everyday. After receiving this vaccine on Monday, I have not had a bowel movement and it is already Thursday (3 days since vaccine).

Other Meds: Vitamin D supplements

Current Illness: None

ID: 1214279
Sex: F
Age: 60
State: AR

Vax Date: 03/01/2021
Onset Date: 04/15/2021
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: Patient's daughter called on her behalf to translate from Spanish. She reported that her mother was having "flu-like" symptoms approximately 3 weeks after receiving the J&J vaccine. She also mentioned that she was having a headache in the back of her head and neck which are known to be possible indication of a cerebral venous sinus thrombosis which has been rarely associated with the J&J vaccine. I advised the daughter to take the mother to the emergency department for further evaluation and she agreed that she would take her right away.

Other Meds:

Current Illness:

ID: 1214280
Sex: F
Age: 47
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

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

Symptoms: Pt developed a rash on forehead after 15min getting a covid vaccine. Rash - 10cmx4cmx0cm redness on forehead.

Other Meds: n/a

Current Illness: n/a

ID: 1214281
Sex: M
Age: 19
State: MO

Vax Date: 04/09/2021
Onset Date: 04/11/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Muscular twitches all over the body. They will happen every so often and could be anywhere. One focus site is the right leg above the knee. At times it will all of the sudden feel very hot and there will be many muscle twitches in the area. It is not pink or swollen, and does not feel hot to the touch. Also receiving the feeling of pins and needles in different places like the right leg, the shoulders and the neck.

Other Meds: Took Tylenol for the sore shot arm after vaccination but otherwise no other medicines

Current Illness: None

ID: 1214282
Sex: F
Age: 29
State:

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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:

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

Symptoms: abdominal pain Calculus of bile duct without cholangitis or cholecystitis without obstruction

Other Meds:

Current Illness:

ID: 1214283
Sex: F
Age: 61
State: KY

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient called 4/15/2021, states had first dose 3/17/2021 and approximately 1 hour after injection developed chest pain, had extreme sweating, became short of breath and experienced nausea. States went to bed and continued with these symptoms for 36 hours. Took nitroglycerin to relieve chest pain. Saw heart doctor today who told her to call us to report adverse reaction and advised to not take second dose.

Other Meds:

Current Illness:

ID: 1214284
Sex: F
Age: 66
State: WI

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Immediately bled from injection site, face got hot, flushed, and a little puffy, heart started racing, BP was taken by EMS 152/80 which is high for her. Patient was not taken to hospital, nor was any treatment given. Symptoms lasted about 30 minutes.

Other Meds:

Current Illness:

ID: 1214285
Sex: F
Age: 48
State: FL

Vax Date: 04/02/2021
Onset Date: 04/08/2021
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:

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

Symptoms: Severe headache especially on top of head with heat radiating from top of head. Pain also in forehead and occasionally in back or on sides of head. Temporary relief achieved from tylenol and advil. Relief also from myofascial release massage on top of head.

Other Meds:

Current Illness: Hashimotos hypothyroidism

ID: 1214286
Sex: F
Age: 46
State: OH

Vax Date: 04/07/2021
Onset Date: 04/07/2021
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:

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

Symptoms: rightleg, rt side on tongue was numb, slight headache, funny tasete in mouth, arm soreness

Other Meds: multi vit, pro biotic, digestive enzyme, calcium, iron

Current Illness:

ID: 1214287
Sex: F
Age: 71
State: NC

Vax Date: 02/11/2021
Onset Date: 02/28/2021
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: sulfa, cipro, codeine, erythromycin, Keflex, lactose intolerance, cephalexin, adhesive tape

Symptom List: Unevaluable event

Symptoms: pt says she had pain in the left side of her jaw under her ear. she went to her PCP on 3/3/21. She was told she had in fluid in both ears. she was given some medicine but the pain never went away. she went to a friends house and a doctor there told her she had Bells Palsy and told to go back and see her PCP. She went back to her PCP on 3/6 and she was diagnosed w/ Bells Palsy. She was prescribed Valtrex and prednisone. After completing her meds she had a another severe episode on 3/17/21. Her face was messed up more and to wear she cant close her left eye. She went back to PCP and was prescribed more Valtrex and prednisone and scheduled her to see a Neurologist. She went to a Neurology Center. They did blood work and ordered an MRI. She was prescribed her more Valtrex and more prednisone for 21 days. She went back to see neuro doctor after completing this medicine and then prescribed her 120 mg of prednisone and to taper down dose each day. She has trouble eating and drinking because of her mouth drooping and damaging the nerve in her face.

Other Meds: levothyroxine, Xarelto, atorvastatin, gabapentin, fish oil, B3, multivitamin, antihistamine,

Current Illness:

ID: 1214288
Sex: F
Age: 49
State:

Vax Date: 04/12/2021
Onset Date: 04/12/2021
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: bactrim, cipro

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

Symptoms: Patient reports tingling and paresthesias and slight pain throughout her left arm , hand, and left side of her face beginning immediately after receiving the vaccine. She has no change in motor ability or vision. This sensation continued Day 1, lessened on Day 2, and worsened on Day 3. She sought ED attention on Day 4 due to concerns for a stroke.

Other Meds: losartan, atorvastatin, aspirin, cyclobenzaprine, HCTZ

Current Illness:

ID: 1214289
Sex: F
Age: 74
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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin Seasonal Allergies

Symptom List: Injection site pain, Pain

Symptoms: reports symptoms of Other: shortness of breath. Writer has observed that patient had no difficulty breathing, no adventitious sounds were coming from patient, no wheezing, patient was not winded. Treatment/intervention vital signs at 1408: BP:139/87, SpO2: 98% as high as 100%, Pulse:84. Ice pack and water was given to patient, writer directed patient to sit up straight, and gave her permission to pull down her mask. Patient insisted to writer and other staff, multiple times, that she was comfortable to leave and that she did not need to stay to be observed any longer. Writer educated patient that she is to come to the emergency department if symptoms or reaction worsened.

Other Meds:

Current Illness:

ID: 1214290
Sex: F
Age: 60
State: CO

Vax Date: 04/10/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reported a "prickly rash" on their back, around side, and underarm 2 days after receiving vaccine. Patient reports is was itchy, she took Benadryl. Patient reports is has since improved.

Other Meds:

Current Illness:

ID: 1214291
Sex: M
Age: 32
State: CO

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: penicillin (hives)

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

Symptoms: Fainted a few mins after receiving the dose. Was sitting for his 30mins post vaccination due to allergy history and fell to the floor. Cut his upper lip during the fall. Will go to PCP to determine if he will need stitches for the lip. Woke within 15 seconds of fall, sweaty forehead and palms. Reported no similar incidents in the past after receiving a vaccine.

Other Meds:

Current Illness:

ID: 1214292
Sex: F
Age: 27
State: MN

Vax Date: 03/17/2021
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: LA

Lab Data:

Allergies: amoxicillin sensitive to Dairy

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Had the chills and fever at apox. midnight. It carried on until 8am 4-15-21.

Other Meds: Multi- vitamin, Nexplanon implant

Current Illness: no

ID: 1214293
Sex: M
Age: 70
State: FL

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: He says that he is about 80% better still exhibiting pain in the eyes, H/A, and fatigue. But on the night that he recieved the vaccine, he felt like he had Covid again with chills, fever, and could barely stand. The ambulance was called and they gave him antibiotics and fluids. He has an appt with his doctor Thurs 4/15, I told him that we will follow up on Friday 4/16 to see how his appt went and to check on him. Ambulance called and rushed to the hospital

Other Meds:

Current Illness:

ID: 1214294
Sex: F
Age: 22
State: NJ

Vax Date: 01/14/2021
Onset Date: 03/01/2021
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: runny nose/nasal congestion 2/28/2021

Other Meds: Vyvanse 20 mg Lexapro 15 mg Mirena IUD

Current Illness:

ID: 1214295
Sex: F
Age: 64
State: IL

Vax Date: 03/15/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Latex

Symptom List: Nausea

Symptoms: blood clot in arm

Other Meds: Xanax, Amlodipine, Vit B-12, Duloxetine, Gabapentin, Glimepiride, Hydrocodone, Metoprolol, Metoclopramide, Magnesium Oxide, Omeprazole

Current Illness: None

ID: 1214296
Sex: M
Age: 69
State: NM

Vax Date: 03/31/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Blistering Rash left arm , Back , Left side chest

Other Meds: Tamsulosin .4 mg, Ezetimibe 10mg

Current Illness: none

ID: 1214297
Sex: F
Age: 61
State: MO

Vax Date: 03/26/2021
Onset Date: 04/14/2021
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: LA

Lab Data:

Allergies: iodine (contrast agents), penicillin

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

Symptoms: patient was diagnosed with bilateral pulmonary emboli within 3 weeks of vaccine administration, developed dry cough within 1 week of vaccine that progressed to worsening shortness of breath.

Other Meds: fexofenadine, omeprazole, Breztri

Current Illness: no acute illnesses

ID: 1214298
Sex: F
Age: 29
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NO KNOWN ALLERGIES

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

Symptoms: Patient received vaccine in left deltoid at 1000. Around 1015 patient notified pharmacist that she was having a hard time swallowing and felt slightly light headed. Pharmacist provided a chair to help elevate the patient's legs and provided patient with water. After 2 minutes pharmacist double check with patient and patient said she didn't feel worse but still felt like she was having a hard time swallowing, but did not complain of any shortness of breath. The pharmacist then called the medical team and after further assessment, the medical team transferred the patient to the Emergency Room for further review. Patient was treated in the ER for anaphylactic reaction and discharged.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1214299
Sex: F
Age: 41
State: CA

Vax Date: 03/23/2021
Onset Date: 03/24/2021
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: Sometimes I get hives with Ibuprofen.

Symptom List: Tremor

Symptoms: Body pain, joint pain throughout the whole body, pain in the legs.

Other Meds: Not taking anything

Current Illness: None

ID: 1214300
Sex: F
Age: 25
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: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies.

Symptom List: Erythema, Pruritus

Symptoms: Patient complained of "I cannot breathe." She could not speak and she was pointing to her throat.

Other Meds: Unknown.

Current Illness: None at time of vaccination. Medical history for the prior month is unknown.

ID: 1214301
Sex: M
Age: 59
State: NH

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/15/2021
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: Amoxicillin

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

Symptoms: Abdominal pain, low fever, headache, muscle and joint soreness, fatigue/ weakness, nausea, diarrhea, congestion.

Other Meds:

Current Illness:

ID: 1214302
Sex: F
Age: 28
State: OR

Vax Date: 04/07/2021
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: LA

Lab Data:

Allergies: None

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

Symptoms: Lump on left collarbone about size of a cashew. feels like a bruise. I can move it around my collarbone with my hand. Suspect it's the side effect of the swollen lymph nodes.

Other Meds: Valycyclovir, Birth Control

Current Illness: None

ID: 1214303
Sex: F
Age: 28
State: PA

Vax Date: 04/05/2021
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: Allergies to penicillin, amoxicillin, sulfa derivatives. All cause a reaction 2-3 days later of body hives.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 04/13/2021 the patient's arm became swollen, red, and hot to the touch. She developed a UTI (confirmed through an at home UTI test) and has been treating at home for the past two days. On the night of 04/13/2021 the patient started having diarrhea that continued until 3:30pm 04/14/2021 after taking Imodium and Pepto Bismol. No fever. The patient did not seek medical help because she did not believe her symptoms were that severe at the time.

Other Meds: None

Current Illness: None

ID: 1214304
Sex: F
Age: 58
State:

Vax Date: 03/11/2021
Onset Date: 04/05/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: K92.2 - Gastrointestinal hemorrhage, unspecified gastrointestinal hemorrhage type R06.02 - Shortness of breath N18.6 - End stage renal disease E87.5 - Hyperkalemia D50.0 - Blood loss anemia J81.1 - Pulmonary edema I21.4 - NSTEMI (non-ST elevated myocardial infarction)

Other Meds:

Current Illness:

ID: 1214305
Sex: M
Age: 60
State: SD

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: fluoroquinolones

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

Symptoms: Five minutes after second dose of moderna, patient complaints of scratchy throat and numbness to the left side of his tongue. Benadryl 50 mg given IM and monitored additional 30 minutes and patient called X 2 in the next two hours with resolution of symptoms. Follow up with PCP, UC or ER if any worsening of symptoms. CNP

Other Meds: Patient complaints of scratchy throat and numbness to left side of his tongue. Benadryl 50 mg IM given. HEENT with in normal limits and VSS. Patient symptoms resolved after waiting additional 30 more minutes. CNP

Current Illness: no

ID: 1214306
Sex: F
Age: 29
State: WA

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: None

Symptom List: Pain in extremity

Symptoms: It started slowly with feeling extra tired and light arm soreness. Then rapidly became extreme shivering, a fever, headache and full body muscle aches. In the early morning I also got stomachache cramps and felt hungry, but food didn?t help. It actually made me feel nauseous. By 6am the next day I had a serious migraine too - sensitivity to light. My eyes hurt. It actually was so bad I caved and took 2 liquid Advil?s to help with the pain. From there I slowly got better over the day but still had the above mentioned symptoms, just less intense. Around 8pm the fever came back and I called it a night. Next morning I felt better, but still tired. Still had a headache but not a migraine. And occasional stomach aches. It?s now 2 days later and the head aches, arm soreness and occasional stomach aches have not gone away.

Other Meds: None

Current Illness: None

ID: 1214307
Sex: F
Age: 54
State: OH

Vax Date: 03/18/2021
Onset Date: 03/25/2021
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:

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

Symptoms: At second dose appointment, patient reported "Covid-Arm" (redness, itching, nodule spanning whole upper arm) starting approximately 8 days following first COVID vaccine. Symptoms have since resolved.

Other Meds:

Current Illness:

ID: 1214308
Sex: F
Age: 36
State: OR

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

Lab Data:

Allergies:

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

Symptoms: Patient noted beginning to feel a headache, dizziness, itchiness and scratchiness of throat and mild throat tightness at 9:27A. Vital signs were done and a brief history was taken. Patient reported history of tension headaches, and hay fever. Patient reported that she has had mild allergic reactions to soy, bananas, and cantaloupe. Patient reported that she take Claritin, Flonase, and anti-histamine eye drops every morning for allergy management. Patient denies history of diabetes, any cardiac related issues, and any other chronic conditions. Vital signs taken at the 9:31A, 9:46A, and 10:00A. At around 10:05A, Patient was taken to a private room to provide education for epi-pen use. ER precaution reviewed with patient and patient agreed with the plan of care. Patient verbalized understanding to seek care and medical attention should breathing become more difficult, the headache get worse, and if other symptoms worsened. Patient left the clinic to go to the pharmacy at 10:15A. Patient will pick up Epi-pen and then head home.

Other Meds:

Current Illness:

ID: 1214309
Sex: M
Age: 41
State: TX

Vax Date: 04/07/2021
Onset Date: 04/14/2021
Rec V Date: 04/15/2021
Hospital: Y

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

Symptoms: Patient developed Chest pain at 0700. Came on suddenly. Pressure, squeezing and tightness that radiated up to his shoulder.

Other Meds: na

Current Illness: na

ID: 1214310
Sex: F
Age: 41
State: CT

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: Gluten

Symptom List: Vomiting

Symptoms: Immediate numbness at vaccine site, followed by numbness of L side of face, diaphoresis, lightheaded, she immediately went to ER. Symptoms have persisted , now day 5 after vaccination,with L facial numbness, circumoral in Trigeminal nerve sensory nerve distribution V 2-V3, also numbness of tip of L tongue and upper L palate. She reports associated numbness of both hands and toes. Also feeling fatigue and lightheaded

Other Meds: albuterol ( Proventil HFA, prn ;alclometasone 0.05% cream BID;Beclomethason ( Qvar RediHaler ) 89 2 puffs daily;certizine 10mg daily;olopatadine (Patanol) 1% ophthalmic 1 drop both eyes BID;pantoprazole 40mg daily, Nuvaring 24vaginal ring e

Current Illness: Celiac disease

ID: 1214311
Sex: M
Age: 43
State: NJ

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin Clyndamycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Arm pain, fever, chills, nausea, headache, body aches. Lasted about 12 hours, except for arm pain which continues.

Other Meds:

Current Illness:

ID: 1214312
Sex: F
Age: 48
State: FL

Vax Date: 04/02/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Large hive/welt on arm below injection site. No treatment yet. Just presented this morning upon waking up.

Other Meds:

Current Illness: Hashimotos Hypothyroidism

ID: 1214313
Sex: F
Age: 36
State: VA

Vax Date: 03/17/2021
Onset Date: 03/24/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Symptoms of a really bag cold, sneezing, sore throat, coughing

Other Meds: Birth control

Current Illness: N/A

ID: 1214314
Sex: F
Age: 38
State: NJ

Vax Date: 03/15/2021
Onset Date: 03/16/2021
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: No allergies

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

Symptoms: My symptoms started the next day after my second dose of phizer, my lymph nodes were swollen in my arm and my neck and chest...this subsided but my arm and wrist ached for weeks...it seemed to get better and now 4 weeks out, my left arm is sore again, some burning in my shoulder and bicep muscle again

Other Meds: I take Lexapro-10mg in the morning

Current Illness:

ID: 1214315
Sex: M
Age: 43
State: MO

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

Lab Data:

Allergies: No

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

Symptoms: Dizziness, Lightheaded, Diaphoretic

Other Meds: Synthroid

Current Illness: Hypothyroidism

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm