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: 1219886
Sex: M
Age: 35
State: TX

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

Lab Data:

Allergies: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: PATIENT RECEIVED FIRST COVID VACCINE AND WANTED TO GET HIS SECOND DOSE DURING VACCINE CLINIC OFFERED. PATIENT DID NOT HAVE HIS VACCINE CARD WITH HIM, BUT WAS CERTAIN HE HAD RECEIVED THE PFIZER VACCINE FOR THE FIRST DOSE. HE WAS GIVEN A DOSE OF THE PFIZER VACCINE TODAY AND WHEN WE GOT BACK TO THE CLINIC TO ENTER THE INFORMATION INTO THE EMR, IT WAS DISCOVERED THAT HE HAD THE MODERNA VACCINE FOR THE FIRST DOSE.

Other Meds: N/A

Current Illness: N/A

ID: 1219887
Sex: F
Age: 51
State: IN

Vax Date: 04/13/2021
Onset Date: 04/15/2021
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: No known allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: This patient is a 51-year-old female who states that she got her first dose of the Covid vaccine at 2:30 in the afternoon on Tuesday. Thursday morning at 1 AM she woke up with diffuse urticaria. She has been itching and has had no relief with Benadryl. She has no shortness of breath. She has no fever or cough. She believes her allergic reaction and urticaria is due to the vaccine and she has never had anything like this before.

Other Meds: Unknown

Current Illness: Unknown

ID: 1219888
Sex: F
Age: 52
State: CA

Vax Date: 03/02/2021
Onset Date: 03/04/2021
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: Penicillin and gluten

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

Symptoms: On the evening of 3/2/2021 I started having severe chills and I developed a fever, both symptoms lasted 24 hours. Then on 3/4/2021 around 2:00 pm I broke out into hives from the chest up. I took Benadryl a couple times that day and I was symptom free on 3/5/2021. After I recieved my second dose on 3/302021, I developed the same symptoms except the hives came on the same day and lasted two days.

Other Meds: Lexapro 20ml once a day

Current Illness:

ID: 1219889
Sex: F
Age: 44
State: WA

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

Lab Data:

Allergies: penicillin, amoxycillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Developed aching joints, fatigue and headache within 12 hours of injection. Conditions worsened. Fever off 100.6 within 24 hours. Fever disipated to 99.6 by 9 pm, severe headache persisted. Took Tylenol. Headache disipated by 1 AM. Developed pins and needles in arms, legs, chest, neck. Symptoms of pins and needles continues but comes and goes. This is day 4 after vaccination.

Other Meds: IUD, Levothyroxine (75 mcg daily)

Current Illness: none

ID: 1219890
Sex: M
Age: 34
State: CA

Vax Date: 04/11/2021
Onset Date: 04/12/2021
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: Ceclor

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

Symptoms: Diagnosed at ER with a transient ischemic attack. Right side went numb, struggled to speak and right side of face drooped

Other Meds: None

Current Illness: None

ID: 1219891
Sex: F
Age: 29
State: FL

Vax Date: 04/08/2021
Onset Date: 04/09/2021
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: Only seasonal pollen allergies.

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

Symptoms: I seem to have developed "COVID arm," where I have a rash around the injection site. It doesn't hurt but it is very warm to the touch and swollen. The rash is about the size as a baseball.

Other Meds: Escitalopram 20mg, Seed probiotic

Current Illness: No illnesses, but I was on my menstrual period.

ID: 1219893
Sex: M
Age: 56
State: WV

Vax Date: 04/12/2021
Onset Date: 04/12/2021
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: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: swollen, red, puffy, itching at injection site

Other Meds: aleve, sildenafil, amlodine, glimepiride

Current Illness: None

ID: 1219894
Sex: F
Age: 57
State: NY

Vax Date: 03/20/2021
Onset Date: 03/22/2021
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: Nuts, stone fruit, animals

Symptom List: Pharyngeal swelling

Symptoms: I had nausea, followed by vertigo, head aches, tinnitus. Still have mild headache and tinittus in Right ear.

Other Meds: None

Current Illness: none

ID: 1219895
Sex: F
Age: 60
State: IL

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

Lab Data:

Allergies: citalophram, cephalexin, bee stings

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt had the vaccine, went through observation period of 15 minutes and had been discharged. Left the building and was in car driving away when numbness began in her face. She describes feeling like she had been to the dentist and had a novacaine injection, her right ear felt as if it were plugged with cotton. Her left arm and tongue felt a little numb as well. Vital signs were BP 140/96, AP-96, Respirations 20 unlabored. Color pink. Alert and oriented x3. Signs and symptoms did not increase, but did persist and so local EMS notified. No medications given at this time. Care resumed by EMS/transported to hospital. Patient had no history of this type of reaction.

Other Meds: n/a

Current Illness: n/a

ID: 1219896
Sex: F
Age: 22
State: OH

Vax Date: 04/02/2021
Onset Date: 04/11/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I was achey/fatigued/chilled/feverish the day of, since I got it in the morning, and felt decent the next day. That following Sunday/Monday/Tuesday I had a moderate headache. 4/11 I had a severe headache and started feeling achey in my torso/mid region, especially when I breathed/coughed. 4/12 the headache was more moderate, but the aches were a lot worse, and I felt some mild dull pain in my lung area when I breathed. I woke up 4/13 with a very swollen and puffy face, and the aches are still here. I?m normally very active jogging and in the gym, and I haven?t felt anywhere close to normal - fatigue and aches go hand in hand. 4/14 I had a very swollen face, continued aches and abdominal pain. I went to urgent care 4/14. 4/15 face swelling went down a little, moderate headache, continued aches and abdominal pain. 4/16 (today) face swelling was down more, continued aches and abdominal pain. Fatigue every day and reduced activity levels and work.

Other Meds: tri-lo-marzia, spironolactone, regular calcium/vitamin

Current Illness: none

ID: 1219897
Sex: M
Age: 17
State: FL

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: nka

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

Symptoms: Injection was in left arm. A few hours later, left armpit/gland began hurting and was sore. Armpit felt swollen. Lasted 3 days. Ibuprofen given prn. Resolved.

Other Meds: Vitamin D3 PO qd, gummy multi-vitamin po qd, Adderall 10mg PO

Current Illness: none

ID: 1219899
Sex: F
Age: 56
State: SC

Vax Date: 04/08/2021
Onset Date: 04/09/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: cold tingling from shoulder to hand, to where it felt numb for approx. 24 hours, a 3"x2" raised rash near injection site, moderate itchiness and skin sensitivity for 3 days. Still have periodic tingling in my left arm or hand that comes and goes. After 14 hours after injection felt malaise about 24 hours. Otherwise I was fine.

Other Meds: Singulair, Zyrtec, Benedryl, Estradiol, vitamins - D3, Cholesteroff, Omega 3 Salmon Oil, ZMA, Skin, Hair & Nails

Current Illness: none

ID: 1219900
Sex: M
Age: 47
State: WI

Vax Date: 04/09/2021
Onset Date: 04/10/2021
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: Morphine

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

Symptoms: body aches, extreme fatigue, headaches and nausea

Other Meds: Amlodipine Lisinopril - HCTZ Omeprazole Rosuvastatin Cialis Ventlafaxine XR

Current Illness: Known known

ID: 1219901
Sex: F
Age: 20
State: VA

Vax Date: 04/10/2021
Onset Date: 04/11/2021
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: N/A

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

Symptoms: - Fatigue/Tiredness (Saturday Sunday and Monday) - Fever (Sunday) - Nausea (through sleeping into Sunday) - Headache (All day Sunday) - Extreme Muscle and Bone Pain (All day Sunday, very very mild Monday) - Injection site soreness

Other Meds: Adderall Lexapro Montelukast (for allergies)

Current Illness: Common Allergies but nothing else.

ID: 1219902
Sex: M
Age: 61
State: IA

Vax Date: 04/06/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: PCN, Lisinopril, Percocet

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

Symptoms: 8 days post 2nd covid vaccine (given on 4/6/21), patient awoke with stroke like symptoms. Evaluated in the ER and diagnosed with Bell's Palsy.

Other Meds:

Current Illness: none

ID: 1219903
Sex: M
Age: 16
State: PA

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

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

Symptoms: EMS providers approached by 17 y/o M pt complaining of rash local to injection site. Pt stated that he received the first dose of the Pfizer COVID vaccine at 17:21hrs today. Pt denied feeling any itching or pain at the site, and only noticed the rash upon visual inspection of the site. Pt denied chest pain, shortness of breath, nausea, womiting or diarrhea. Upon inspection, (R) upper arm found to have slight, non-raised rash, warm to the touch. Full assessment performed and vital signs obtained. GCS 15, P 76 regular, RR 18 non-labored, B/P 146/P, PERRL, SpO2 99% RA. No other associated symptoms found. Pt administered Diphenhydramine 25mg IM in RA. Pt monitored and denied any worsening of condition. (See Attached)

Other Meds: ZOLOFT SINCE TUESDAY

Current Illness: NONE

ID: 1219904
Sex: M
Age: 77
State: OR

Vax Date: 04/16/2021
Onset Date: 04/16/2021
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: Morphine, Flexeril

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

Symptoms: Patient complained of intense abdominal burning sensation across abdomen followed by intense flushing redness of face and lightheadedness. Symptoms resolved within 5 minutes, cool wash cloth to face. Patient on home oxygen canula. BP 142/84. HR 64 and regular. Resp 20-22. Patient observed for 45 minutes after vaccination without further complaints or symptoms

Other Meds: albuterol sulfate, amlodipine, gabapentin, ipratropium-albuterol(Combivent), Lopressor, Prilosec, Aldactone, Repimat

Current Illness: None

ID: 1219905
Sex: M
Age: 39
State: MA

Vax Date: 04/08/2021
Onset Date: 04/13/2021
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: erythromycin and penacillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt notes he had J&J covid vaccine on 4/8. He states that immediately, he had L arm pain and low grade temps for 2 days. He notes in the past few days he started having a rash around his ankles and left wrist area. He has also had some intermittent tingling in the first 3 fingers of his L hand. He states this is worse with use of his computer. No weakness. The rash on his legs are b/l. He hasn't had any allergen exposure that he knows of. He tried benadryl which did not cause any change. He notes that the triamcinolone that was prescribed seemed to wrosen the rash. He currently has no tingling in his arms.

Other Meds: n/a

Current Illness: n/a

ID: 1219906
Sex: F
Age: 60
State: FL

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Headache. Fatigue muscle pain and joint stiffness

Other Meds: None

Current Illness: None

ID: 1219907
Sex: F
Age: 73
State: TN

Vax Date: 04/14/2021
Onset Date: 04/14/2021
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: Macrodantin, Keflex, Avalox, Singulair, Plavix

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

Symptoms: Patient reports received vaccine 4/14/2021. During evening hours began having nausea that persisted all evening. During the night she was awakened. Upon getting up during the night, reports she "went down to the floor." She thinks she may have fainted but is unsure. Reports she was not injured but was unable to get up from the floor. Her husband called EMS who arrived at their home to assist patient from the floor. Reports no other symptoms other than feeling weak today.

Other Meds: Losartan, Hctz, Estradiol, Max Ox, Pulmicort, Vit D3,

Current Illness: none

ID: 1219908
Sex: F
Age: 46
State: LA

Vax Date: 04/14/2021
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: 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: fever, body aches, redness and swollen at the injection shot

Other Meds: Hydrochlorothiazide

Current Illness:

ID: 1219909
Sex: F
Age: 31
State:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: syncopy. Evaluated by EMS-Refusal to transport.

Other Meds:

Current Illness:

ID: 1219910
Sex: F
Age: 63
State: FL

Vax Date: 04/15/2021
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: LA

Lab Data:

Allergies: sulfa and bee stings

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

Symptoms: at 12:15 i woke up completely wet and with a temperature of 103.4 i am normally 96/97 i also had a pounding headache....and my legs kept feeling like they were buckling beneath me..... i couldn't walk. also i was having chills. pj's ,sweater,bathrobe and 4 blankets and i was still shaking and freezing. my fever is 100 now ...i still have the headache i feel very tired but so far my legs are not buckling anymore

Other Meds: immunotherapy for lung cancer

Current Illness: none

ID: 1219912
Sex: F
Age: 49
State: MD

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

Symptom List: Injection site pain, Pain

Symptoms: Severe headache several hours after injection. Took tylenol at 3am and it went away. Headache returned later in the day and for the next 14 days after the vaccination. Had to take motrin or tylenol every day.

Other Meds: linzess 290 mcg

Current Illness: none

ID: 1219913
Sex: F
Age: 39
State: AZ

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: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin, Amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Back pain, swelling near neck, pain on left side, random body aches

Other Meds: Turmeric, Daily Vitamin, Probiotic, Elderberry, Fish Oil, Apple Cider Vinegar Gummies

Current Illness: Poly cystic ovarian syndrome

ID: 1219914
Sex: F
Age: 37
State: IN

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient fainted after receiving the vaccine. She felt light headed immediately before fainting.

Other Meds:

Current Illness:

ID: 1219915
Sex: F
Age: 17
State:

Vax Date: 04/16/2021
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: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: syncopal. Evaluated by EMS-Refusal to transport.

Other Meds:

Current Illness:

ID: 1219917
Sex: F
Age: 56
State: NY

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

Lab Data:

Allergies: anaphylaxis to plasma, rash to penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 15 min after vaccine, pt began to have urticaria to left arm spreading to left trunk, nasal itching, felt dizzy. no angioedema or wheezing

Other Meds: COUMADIN, ALBUTEROL, SYMBICORT

Current Illness: none

ID: 1219919
Sex: F
Age: 29
State: MN

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: RA

Lab Data:

Allergies: None

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

Symptoms: Rash on neck, swollen lymph node near rash, sore throat

Other Meds: None

Current Illness: None

ID: 1219920
Sex: F
Age: 61
State: PA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
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: Mold & mildew, NKDA

Symptom List: Nausea

Symptoms: See attached Addendum for this pt.

Other Meds: Synthroid, Florocortizone

Current Illness: Unk

ID: 1219921
Sex: F
Age: 16
State: NY

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

Lab Data:

Allergies: NA

Symptom List: Injection site pain

Symptoms: No adverse effect, reporting patient was 16 at time of Moderna vaccine administration vaccine was give off-label

Other Meds: NA

Current Illness: NA

ID: 1219922
Sex: F
Age: 50
State: OH

Vax Date: 04/13/2021
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: LA

Lab Data:

Allergies: None

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

Symptoms: I had severe pain in my shoulder. Pain was not in the muscle of my arm but in my shoulder joint. I could not move my arm without pain throughout my shoulder up to my neck and down to fingers. I took Tylenol (3 tablets every 5-6 hours) to alleviate pain. Tylenol helped minimally. Severe pain that made it impossible to do daily activities lasted 24 hours. Pain was tolerable with continued Tylenol for another 24 hours. Pain still present today 4/16, but no Tylenol in 18 hours.

Other Meds: None

Current Illness: None

ID: 1219923
Sex: F
Age: 19
State: IN

Vax Date: 04/12/2021
Onset Date: 04/12/2021
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:

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

Symptoms: Patient received Moderna vaccine on Monday afternoon. That evening she started having body aches and a sore throat.

Other Meds:

Current Illness:

ID: 1219924
Sex: F
Age: 58
State: TX

Vax Date: 04/10/2021
Onset Date: 04/10/2021
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: Aspirin, Iodine, Dilaudid, Percocet, Darvocet, Alkaline Water

Symptom List: Tremor

Symptoms: Recurrent headaches since administration of the vaccine. Has been 6 days at the time of visit.

Other Meds: Atorvastatin, Doxycycline, Omeprazole, Metoprolol Succinate ER, Amlodipine, Fluorometholone eye drops

Current Illness: N/A

ID: 1219925
Sex: F
Age: 71
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
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: Erythema, Pruritus

Symptoms: 0815 144/73, 99% O2. RR 20, HR 65/min. Patient then started to experience mid sternal non radiating chest "tightness" 3/10. States she experienced the same sensation after first vaccine. Prior experience started after discharge and lasted 3-4 hours , evenChills: Status post emergency room evaluation for atypical chest pain after her second Covid vaccination. No further symptoms. Work-up unremarkable.

Other Meds:

Current Illness:

ID: 1219926
Sex: F
Age: 63
State: OR

Vax Date: 03/17/2021
Onset Date: 03/17/2021
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: Morphine, Bactrim, Amitriptyline

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

Symptoms: Patient advises that she has been experiencing lower back pain, leg painful and swelling on her right foot, a fogginess that "feels like I'm on a conveyor belt", depression, diarrhea and fatigue since receiving the vaccine. Patient also advises that she used to be able to walk her dogs 4 miles a day and now can barely walk them 20 min. Patient also states that the foot that is painful is also a blueish gray in color.

Other Meds: Lisinopril, HCTZ, Amlodipine

Current Illness:

ID: 1219927
Sex: F
Age: 26
State:

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

Lab Data:

Allergies:

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

Symptoms: Clamy, hyperventilation. Evaluated by EMS-Refusal to transport.

Other Meds:

Current Illness:

ID: 1219928
Sex: F
Age: 53
State: VT

Vax Date: 04/01/2021
Onset Date: 04/06/2021
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: fentanyl, Prevnar 13, lodine, Vioxx, Macrobid, nsaids, vioxin, asa, codeine, sulfur

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: bells palsy

Other Meds: baclofen, vitamin d3, tramadol, stool softener , Tylenol

Current Illness:

ID: 1219929
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

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

Symptoms: Headache, nausea, muscle and joint pain

Other Meds:

Current Illness:

ID: 1219930
Sex: F
Age: 67
State: CA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: Sulfa

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

Symptoms: Very sore arm for 7 days, small rash below injection site

Other Meds: Climara 0.1, Metronidazole 0.75% topical gel, Citalorpram 5 mg, Trazodone 25 mg

Current Illness: none

ID: 1219931
Sex: F
Age: 56
State: WI

Vax Date: 04/10/2021
Onset Date: 04/01/2021
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: aspirin morphine

Symptom List: Pain in extremity

Symptoms: April 10 and 11th had extreme headache and muscle soreness on ribcage/torso, that subsided . On April 12th and 13th had a rash on my torso, then that went away

Other Meds:

Current Illness: none

ID: 1219932
Sex: F
Age: 56
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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:

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

Symptoms: Patient experienced itchy throat and felt slightly wheezy. Patient assisted to ambulance for assessment with normal vitals. Patient felt better and did not need any further intervention.

Other Meds:

Current Illness:

ID: 1219933
Sex: U
Age:
State: KS

Vax Date: 03/16/2021
Onset Date:
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:

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

Symptoms: We did not discard the extra volume in the vial during our initial clinics. I came to realize this was not authorized under the EUA after the fact and ceased pooling doses after the first four clinics on 3/10, 3/11, 3/12 and 3/13/21. When we reported the extra doses, we were advised to cease pooling doses and report to VAERS, citing EUA guidelines. We noticed that some of the vials had enough residual volume to pull a full 6th dose and did so from 6 vials at our clinic 3/16/21. When we reported that information, we were then advised to cease pulling any residual volume from any vial, so we have not done so since.

Other Meds:

Current Illness:

ID: 1219934
Sex: M
Age: 41
State: MD

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin

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

Symptoms: Chills, Fever over 102, body aches and lethargic.

Other Meds: None

Current Illness: None

ID: 1219935
Sex: F
Age: 16
State:

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/16/2021
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:

Symptom List: Vomiting

Symptoms: No adverse event, patient was underage for vaccine administration recommendations.

Other Meds:

Current Illness:

ID: 1219936
Sex: F
Age: 21
State:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: dizzy. Evaluated by EMS-Cleared

Other Meds:

Current Illness:

ID: 1219937
Sex: F
Age: 61
State:

Vax Date: 04/16/2021
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:

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

Symptoms: Dizziness, Lightheadedness, Numbness, Sweating, hypotension, bradycardia Awake/alert/oriented observation, water, apple juice, recumbent transfer to ED

Other Meds:

Current Illness:

ID: 1219938
Sex: F
Age: 33
State: CA

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: medical tape

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Reported waves of dizziness after vaccine. GIven water, legs elevated, rested. BP 122-130/62-80

Other Meds: prenatal vitamin

Current Illness: none

ID: 1219939
Sex: F
Age: 65
State: GA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
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: hx of unknown, carries an epi-pen

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

Symptoms: Pt vaccinated at 11:30 am with COVID-19 Moderna, 1st dose. While waiting in her car at the observation station of the drive-thru site for 30 minutes due to hx of anaphylaxis to an unknown substance, pt began to feel like her nose and lips/mouth were itching at 11:54. Alert and talking, no distress noted. Pt given benadryl 25 mg tab at 11:56 am. Pt remained on site another 30 minutes. No worsening of symptoms and reported improvement. Pt was discharged to home via her own car with husband driving at 12:30 pm. Called the next day to check on pt. She took another benadryl that night. No further problems.

Other Meds: unknown

Current Illness: none

ID: 1219940
Sex: F
Age: 50
State: VA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: amoxicillin

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

Symptoms: Received first Pfizer vaccine 4/1/2021 about 0835am at Immun clinic. She was monitored 15 minutes and left; however she presented to ER about 0922 c/o feeling "weird" with nonspecific tingling all over body and a headache. She was taken to triage, and when in bathroom she became ataxic with sense of dizziness as if falling and being off balance and lightheaded. VSS, normal EKG (NSR). MD exam was normal with normal neuro and pt stated HA and dizziness better but still present. CT head w/o contrast normal w/o bleed, tumors, masses. Pt refused blood work. She was released at 1352 feeling better and no c/o dizziness, lightheadedness.

Other Meds: none

Current Illness: none reported

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm