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: 1218308
Sex: M
Age: 71
State: MN

Vax Date: 03/26/2021
Onset Date: 04/04/2021
Rec V Date: 04/16/2021
Hospital: Y

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: Presented to ED and patient hospitalized within 6 weeks of receiving COVID vaccine.

Other Meds:

Current Illness:

ID: 1218309
Sex: M
Age: 79
State: TX

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/16/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: weakness, near syncope , hypotension

Other Meds: Eliquis, Lyrica, aspirin, Lasix, labetalol

Current Illness:

ID: 1218310
Sex: M
Age: 30
State:

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
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: Fever and chills along with headache and fatigue

Other Meds:

Current Illness:

ID: 1218311
Sex: F
Age: 21
State:

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: reported light headedness when First responder arrived. stated she "always has this type of reaction" whenevery she gets an injection or has blood draw. Also reports a h/o anxiety over getting vaccine due to her mother being "anti-vaccine" TX - car heat immediately reclined mask removed for fresh air, emotional support. OJ & pretzels. Total observation time 30 mins.

Other Meds:

Current Illness:

ID: 1218312
Sex: F
Age: 64
State: NC

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Chill , fever aches,pain,headache,weak joint pain numbness in feet could hold my eyes open and stayed in bed 2 days couldn?t do anything except use bathroom taste off 3D day weak but up short periods diarrhea (hope tomorrow better)

Other Meds: Tylenol ginger ale

Current Illness:

ID: 1218313
Sex: F
Age: 63
State: AL

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/16/2021
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: No

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

Symptoms: 8 hours after shot severe headache that started in back of neck, freezing cold, shaking and shivering uncontrollably. Back ache. Shakes and shivers lasted 4 hours. Headache and back ache lasted 48 hours. Severe fatigue for first 24 hours, last 24 hours moderate fatigue. After 48 hours, I was back to 100% health. I took aspirin to begin with for the headache, then switched to ibuprofen when aspirin didn?t work for headache. Ibuprofen helped back ache immensely. Also, when pharmacist gave me the 2nd shot when I got home and changed clothes I realized I had bled a lot. Blood had oozed out from the bandage and down to my elbow. Arm sore for 2 days, and still swollen on 4th day a bit larger than golf ball size.

Other Meds: Acyclovir 400 mg/day, venlafaxine 75 mg/day, anastrozole 1 mg/day, hydrochlorothiazide 25 mg/day, omega-3 w/coQ10

Current Illness: No

ID: 1218314
Sex: M
Age: 20
State: GA

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

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

Lab Data:

Allergies: No allergies to medications/foood Environmental allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Received the Pfizer vaccine around 3:00 PM. After shot took Benadryl just incase I had a reaction (history of allergic/ anaphylactic reaction to bee stings). Felt fine the first 6 six hours; experienced some fatigue but nothing serious. Then after the six hour mark, I believe the Benadryl went away and I started to itch and grow a rash on my right side. I then looked in the mirror and my chest, stomach, back, and behind my ears were red and covered in hives. I went to the ER incase the reaction would turn anaphylactic and they said I was alright. They prescribed me Benadryl and prednisone to help with the reaction.

Other Meds: Claritin D 24 hour (once a day) Nasacort (1 pump each nostril once a day) multivitamins

Current Illness: N/A

ID: 1218315
Sex: F
Age: 58
State: MA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: Pharyngeal swelling

Symptoms: Pt became ill the day after receiving the shot. She had high fever 101-102 F with throbbing headache, chills, aches and violent vomiting. Of note, Pt was positive for Covid 19 and sick for about 13 days with high fever in April of 2020 (almost a year before the shot). Also, this was her second dose of the Covid 19 vaccine and she had the same reaction to the first shot.

Other Meds: Paxil, lisinopril

Current Illness:

ID: 1218316
Sex: F
Age: 36
State: CA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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, Amoxicillin, Eriythmicin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Tongue and lip numbness since Thursday morning at 1am I took a Claritin at that time and same Friday morning at 1am; however tongue itching and hives on tongue persist

Other Meds: Losartan 100 mg QVAR 80mcg Flonase Xarelto 20mg

Current Illness: Acute Pulmonary Embolism

ID: 1218317
Sex: F
Age: 61
State: SC

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/16/2021
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: When receiving chemotherapy in 2013, would have chest discomfort with adriamycin, bleomycin, DTIC, and vinblastine. Administration of diphenhydramine via IV prevention that reaction subsequently.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: About 9 hours after receiving 2nd dose of vaccine, patient awoke with quite significant itching (vaccine site as well head, neck, scalp, ears, trunk, arms, palms, and legs) , swelling around eyes (almost swollen shut), and tightness in chest. After 1st dose of vaccine, she had mild swelling around eyes and a little tightness in chest that she thought was related to pollen.

Other Meds: Levothyroxine, Zolpidem

Current Illness: Slight reaction to first Moderna COVID vaccine 3/10/201 - mild swelling of eyes and mild wheezing.

ID: 1218318
Sex: F
Age: 34
State: NC

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, medent, hormonal birth control

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

Symptoms: I have a history of heavy periods which resulted in the need for an ablation in October 2018. Since the ablation my periods have been much more manageable. I got my period 13 days after receiving the shot and it started out much heavier than normal, by the second day I was bleeding extremely heavily, soaking an overnight pad in less than 2 hours with bright red blood and passing clots the size of dimes and pennies. Day 3 has started out the same as day 2. Prior to my period starting my back hurt and I had much worse than normal abdominal cramps. Nothing in my life has changed besides the vaccine, I am certain there is a connection between the two. I am not sure how long this will last, I was instructed to go ahead an report the adverse event.

Other Meds: Ranitidine, zyrtec, sertraline, nabumetone, acetaminophen, vitex, l theanine, vitamin d, pepcid ac

Current Illness: None

ID: 1218319
Sex: F
Age: 18
State: NY

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/16/2021
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: peanut and tree but allergy

Symptom List: Rash, Urticaria

Symptoms: severe chills, shaking throughout the day. Severe right arm pain and lethargy ongoing at time of report.

Other Meds: none

Current Illness: none

ID: 1218320
Sex: M
Age: 33
State: LA

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 04/16/2021
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: Congestion in left ear. Noticeable decrease in hearing in left ear that has persisted until today 4/16/21.

Other Meds: APAP Cetirizine

Current Illness: none

ID: 1218321
Sex: F
Age: 56
State: WI

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 04/16/2021
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: peanuts and wasps

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

Symptoms: face was starting to itchy right after getting the vaccine, ear also started to itch. she also had hives the next day but went away after taking benadyl.

Other Meds: none

Current Illness: none

ID: 1218322
Sex: M
Age: 48
State: MS

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/16/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: I recently began monitoring my blood pressure at home with an Omron Platinum series monitor. On the morning of Wednesday, April 7, I received a reading of an irregular heartbeat. I also received a reading of an irregular heartbeat on the evening of April 7, the morning of April 8, the evening of April 8, and the evening of April 9. I reported this information to my doctor who suggested I wear a Holter monitor for 48 hours to see if I had any issues with my heart. The result of the Holter monitor showed that I am having PVCs less than 1% of the time. Since I got so many readings of irregular heartbeat in a short amount of time on my monitor, I thought the irregular heartbeats may be related to the vaccine which was administered the afternoon before I began getting the irregular heartbeat notifications.

Other Meds: None

Current Illness: None

ID: 1218323
Sex: F
Age: 35
State:

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 04/16/2021
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: Pt. given vaccine at 0800 and observed for 30 minutes. Pt. left without s/s of rxn. Pt. returned to vaccine clinic 0910 c/o of submandibular tightness, denied soa or difficulty breathing. Vitals reviewed and WNL. Pt. reports hx of anxiety and allergy to sulfa(n/v). Pt. kept in observation for 20 minutes after arrival with no change until the 20 minute mark when the pt. reported chest discomfort and tingling in L hand. Pt. transferred to ER. Patient given Duoneb and discharged from ER and instructed to follow up with primary care provider within 2 to 3 days.

Other Meds:

Current Illness:

ID: 1218324
Sex: F
Age: 58
State: CT

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/16/2021
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: Fever, Chills, Body Aches, Nausea, Bad Headache, Dizziness, Stomach Pains, Sore Arm for 2 days. I took Tylenol, rested, ate light & drank water.

Other Meds: Pantoprazole Sodium 40mg, Escitalopram Oxalate 2.5mg, Claritin 10mg

Current Illness: Tendinitis & Bursitis in my left shoulder

ID: 1218325
Sex: M
Age: 17
State: AZ

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: Chest discomfort, I think muscular and mild shortness of breath

Other Meds: none

Current Illness: none

ID: 1218326
Sex: F
Age: 30
State: MO

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/16/2021
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: After patient received this vaccine dose, it was discovered that the vial had been stored outside of the recommended temperature range calling into question its efficacy After conferring with immunization experts it was determined that this dose needs to be repeated. Patient was contacted by the person completing this form and made aware of this information. The patient is unsure if she plans to repeat the dose or not.

Other Meds:

Current Illness:

ID: 1218327
Sex: F
Age: 56
State: MI

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/16/2021
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: Cerebral venous sinus thrombosis with venous infarct. Was also found to have antithrombin III deficiency and elevated factor 8. She had uncontrolled HTN and DM at the time and untreated OSA.

Other Meds: Norvasc 10 mg QD, lipitor 20 mg qHS, farxiga 10 mg QD,glipizide 5 mg BID, Lantus 40 units daily, vit D 50000 IU once a month, Claritin 10 mg QD, Levothyroxine 112 mcg daily, Hyzaar 100/25 mg daily, Glucophage 1000 mg BID, Metoprolol XL 50 m

Current Illness: uncontrolled hypertension, uncontrolled DM, untreated OSA, hyphypothyroidism-stable, and asthma

ID: 1218328
Sex: F
Age: 71
State: WI

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/16/2021
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: 0

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

Symptoms: Headache, fever, chills, upset stomach

Other Meds: 0

Current Illness: 0

ID: 1218329
Sex: F
Age: 52
State: OR

Vax Date: 03/07/2021
Onset Date: 03/17/2021
Rec V Date: 04/16/2021
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: Unevaluable event

Symptoms: About 10 days after the vaccine, I started having shortness of breath, fatigue, night sweats and some chest pain. The chest pain is mostly a constant chest discomfort, along with brief sharp or burning pains in the center of my chest. The shortness of breath, night sweats and chest pain have not gotten any better and is still continuing on this day, 4/16. These are new symptoms for me and I felt absolutely fine before getting the vaccine.

Other Meds: Tegretol

Current Illness: None

ID: 1218330
Sex: F
Age: 28
State:

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: reported warm flush on administration of vaccine - then headache & dizziness after driving to 30 min. lot and called for help. Also reported anxiety / panic with long h/o panic attack - has a service dog who accompanies her. TX - reclined car seat. mask removal for air flow. water & apple juice. Symptom abated. Total observation time 40 mins. Drove off lot independently.

Other Meds:

Current Illness:

ID: 1218331
Sex: M
Age: 79
State: NJ

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 04/16/2021
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: Gabapentin , Penicillins, Procaine

Symptom List: Injection site pain, Pain

Symptoms: Shortness of breath, weeping edema , diminished lung sounds

Other Meds: Allopurinol 10 mg, Zyrtec 10 mg, Eliquis 5 mg ( BID), Ferrous sulfate 325 mg , Flonase spray, Lasix 80 mg, Singulair 10 mg, K-Dur 40 meq, Requip 2 mg, Revatio 20 mg ( TID), Flomax 0.4 mg , Trelegy Ellipta, Ventolin, Benadryl 25 mg, Gas-X 12

Current Illness: Conjunctivitis, Pruritus, Cellulitis

ID: 1218332
Sex: F
Age: 30
State: NY

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/16/2021
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: Injection site pain, Menorrhagia

Symptoms: Severe chills and shivering, extreme sensation of coldness, teeth chattering, intense migraine with nausea, high fever

Other Meds: None

Current Illness: None

ID: 1218333
Sex: F
Age: 51
State: ID

Vax Date: 04/07/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: Tree Nuts

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

Symptoms: A week after the injection, the injection site is hot, has a lump that is about 3?, has a large solid red rash, and is itchy and achy. Picture available if needed.

Other Meds: None

Current Illness: None

ID: 1218334
Sex: M
Age: 47
State: TX

Vax Date: 03/11/2021
Onset Date: 03/20/2021
Rec V Date: 04/16/2021
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: Longer-term headaches, tired feelings, abdominal cramping in the mornings, tiring pain in legs. Specially left leg feeling Sharp shooting pains.

Other Meds:

Current Illness:

ID: 1218335
Sex: F
Age: 50
State: MO

Vax Date: 04/01/2021
Onset Date: 04/09/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies: UNKNOWN

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Arm got really red rash about 4 inch by 3 inchs, 8 days after shot was given. Patient went to dr office and said due to shot. still red yesterday 04/15/21.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1218336
Sex: F
Age: 40
State: MN

Vax Date: 01/26/2021
Onset Date: 04/05/2021
Rec V Date: 04/16/2021
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: no

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

Symptoms: 1/5/2021 1st covid vaccine Pfizer EL0140 2p Left arm 1/26/2021 2nd covid vaccine Pfizer EJ1686 2p Left arm 3/25/2021 work place exposure 4/4/2021 ill 4/5/2021 Covid positive test with PCR

Other Meds: Depression, anxiety, ADD meds

Current Illness: no

ID: 1218337
Sex: M
Age: 30
State: MI

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/16/2021
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: Patient had other reduced mobility. Patient refused evaluation or care, Released against medical above.

Other Meds:

Current Illness:

ID: 1218338
Sex: M
Age: 17
State: MN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/16/2021
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: wrong age for this vaccine, stated was correct age for vaccine on his consent. Vaccinator did not catch the birth date was wrong for this vaccine to be given. No adverse affects from vaccine, was just give 9 months early.

Other Meds:

Current Illness:

ID: 1218339
Sex: M
Age: 20
State: WA

Vax Date: 04/08/2021
Onset Date: 04/16/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies: Benzonatate

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

Symptoms: Woke up with my left leg hurting.

Other Meds: Minoxidil

Current Illness:

ID: 1218340
Sex: F
Age: 50
State: GA

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 04/16/2021
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: Penicillin

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

Symptoms: Severe cough Lethargy Nasal congestion Chest congestion Digestive issues Gassy Headaches Achy neck Shaking Slight fever

Other Meds: Trazadone Topamax

Current Illness: None

ID: 1218341
Sex: M
Age: 39
State: GA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 04/16/2021
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: Tremor

Symptoms: fever, chills, muscle soreness, sinus congestion, nausea, headache, myalgia, injection site pain

Other Meds: Losartan

Current Illness: none

ID: 1218342
Sex: F
Age: 60
State: RI

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/16/2021
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: Yes, sulfa, codeine, percocet, eggs, flu vaccine

Symptom List: Erythema, Pruritus

Symptoms: She stated that after vaccination, she was feeling numbness in arms and tongue. No difficulty breathing, appeared well, in no acute distress. No throat swelling. Heart rate 70, SpO2 99%. She medicated herself with 25mg of Benedryl PO. Instructed to go to ER if difficulty breathing or throat swelling occurred. She was accompanied by support person to drive her home.

Other Meds: None

Current Illness: Stated had similar issue after 1st vaccination with Pfizer COVID-19

ID: 1218344
Sex: F
Age: 44
State: MD

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/16/2021
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: Vicodin, oysters

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

Symptoms: Redness , swelling, hardened skin at site of injection. One week later and it?s still swollen and hardened , but now it?s itching .

Other Meds: None

Current Illness: None

ID: 1218345
Sex: M
Age: 93
State: GA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: Tenderness at injection site. loss of energy in legs ,shaking chills Took an antihistamine pill

Other Meds: vitamin D

Current Illness: None

ID: 1218346
Sex: F
Age: 54
State: TX

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 04/16/2021
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, allergy to bees

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: tongue swelling, sob

Other Meds: metoprolol, atarax, lisinopril, rosuvastatin, clonidine, metformin

Current Illness:

ID: 1218347
Sex: F
Age: 28
State: FL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Client reported lightheadedness, dizziness, blurry vision and diaphoresis. Visibly pale. V/S checked by onsite EMS. BP 102/65, monitored for 10 minutes. BP reduced, 108/84. Monitored for 30 minutes. Reported, "I feel normal." Encouraged to follow up with emergency services and PCP as needed. Verbalized understanding.

Other Meds: Divalrex

Current Illness: none

ID: 1218348
Sex: F
Age: 56
State:

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
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: No

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

Symptoms: strong chills, headache and fever overnight. Headache, fever the following morning. No medication. symptoms subsided the following evening

Other Meds: No

Current Illness: No

ID: 1218349
Sex: F
Age: 51
State: WY

Vax Date: 04/08/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
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: Headaches for two days after shot. One week after shot, extreme tiredness, headaches, severe sore throat. Symptoms still persisting.

Other Meds: None

Current Illness: None

ID: 1218350
Sex: M
Age: 26
State: OK

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/16/2021
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: When putting patient information into the OSIIS system, pt record from OSIIS shows that he received the COVID 19 Vaccine Pfizer on 3/22/21, although on his consent paperwork he reports that he never received a COVID-19 Vaccine before and scheduled to have an initial Moderna COVID 19 vaccine through the AHC vaccine clinic. After discussing the situation with the patient, he states that he did in fact have a Pfizer vaccine on 3/22/21. He states that he that he did not report it on the forms because he decided to get the Moderna instead since he could get both doses on campus. Pt advised that he will not recieve another Moderna Vaccine as he has had a mixed dose series and advised to self monitor for any side effects and symptoms. VAERS report will be completed.

Other Meds: None

Current Illness: Contact Dermatitis 3/29/21- Resolved

ID: 1218351
Sex: F
Age: 64
State: TX

Vax Date: 03/11/2021
Onset Date: 04/02/2021
Rec V Date: 04/16/2021
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: Ibuprofen, NSAIDS

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

Symptoms: One side facial muscle weakness, drooling, unclear speech, eye lid drooping, diagnosed Bell's Palsy.

Other Meds: Metformin, pravastatin, Amlodipine

Current Illness: Diabetes, Hypertension, Hyperlipidemia

ID: 1218352
Sex: F
Age: 56
State: WI

Vax Date: 03/24/2021
Onset Date: 04/07/2021
Rec V Date: 04/16/2021
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: alfalfa, soybean oil, amphotericin B, cat hair extract, iodinated diagnostic agents.

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

Symptoms: Pt tested positive for COVID-19 as part of routine screening for a procedure at a local hospital on 4/7/2021. Pt began to have symptoms and was given monoclonal antibodies near where she lives on 4/12/2021. Symptoms grew worse overnight and she was admitted to her local hospital on 4/13/2021 with acute hypoxic respiratory failure and started on O2. O2 demands continued to increase during the day and she was transferred to our ICU. Currently on high flow nasal canula, but not intubated.

Other Meds: acyclovir, allopurinol, bupropion, chlorhexidine mouthwash, diphenhydramine, fexofenadine, levothyroxine, montelukast, nebivolol, omeprazole, simvastatin.

Current Illness:

ID: 1218353
Sex: F
Age: 70
State: NY

Vax Date: 03/17/2021
Onset Date: 03/29/2021
Rec V Date: 04/16/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: nka

Symptom List: Vomiting

Symptoms: On 3/31/2021 Patient developed blurred vision and excruciating headaches with extreme weakness. Pt went to an urgent care where they found bleeding in brain so they sent her via ambulance to ER at another hospital. She had MRI, CT and blood work. She was admitted into the ICU where she was treated for 3 days and then transferred to telemetry. Pt was discharged to FU w/ Neurologist and Ophthalmologist.

Other Meds: Tylenol

Current Illness: no

ID: 1218354
Sex: F
Age: 60
State: FL

Vax Date: 03/17/2021
Onset Date: 03/20/2021
Rec V Date: 04/16/2021
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 Levaquin Scopolamine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Lips swelled so badly, they cracked and scabbed and took about 2-1/2 weeks for the new skin to grow. Taste was affected for the same time period, everything tasted awful, if I could taste it at all. Inside of mouth felt "astringent" for several weeks, as if had been drinking cranberry juice.

Other Meds: Crestor

Current Illness:

ID: 1218355
Sex: F
Age: 40
State: GA

Vax Date: 03/28/2021
Onset Date: 04/16/2021
Rec V Date: 04/16/2021
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: Eggs, aluminum

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

Symptoms: I woke up with a swollen and itchy upper and lower lip. Also, the area under the tongue is swollen and sore. I have not used a different product or eaten any different foods. I am taken Benadryl and it seems to be helping.

Other Meds: Birth control

Current Illness: None

ID: 1218356
Sex: F
Age: 21
State: CA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever, chills, joints hurt, migraine. Everything lasted all night (5 hoursish). I woke around 6am with still a really bad migrane that didn't go away until around 3pm.

Other Meds: None

Current Illness: None

ID: 1218357
Sex: F
Age: 29
State: WI

Vax Date: 04/06/2021
Onset Date: 04/13/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, penicillin, sulfa/bactrim

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

Symptoms: One week after the vaccine on 4/13, all of a sudden the vaccination site became red and raised. It was hive-like and the area felt tender and hard. The next day it was no longer raised but a bullseye rash remained about 3 inches in diameter. It is now 4/16 and the rash is still faintly there but it is fading and not as tender.

Other Meds: Welbutrin, Suboxone

Current Illness: None

ID: 1218358
Sex: F
Age: 31
State: MN

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 04/16/2021
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: **16 Weeks pregnant,. Due date September 2021. 1st pregnancy. I got the vaccine about 5:40pm-6pm. I started feeling tired and had chills. The next morning I couldn't move my arm at all, it was sore soar and I had chills, multiple blankets on and still feeling the chills. I had a massive headaches, I had a little bit of cramping. I ended up going to the Urgent Care. They check the baby's heart beat and check for UTI. All test came back negative and found the baby heart beat. I went home and took a Tylenol. I went in to see my OB and had a check up and everything is ok. The chills lasted about 48 hours, my arm was sore for several days.

Other Meds: Prenatal

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm