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: 1220606
Sex: M
Age: 24
State: CO

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: Cephalaxin, pineapple

Symptom List: Dysphagia, Epiglottitis

Symptoms: Adverse events: 2:05 p.m. Erythema, flushing, tightness in throat and chest, flushing Treatment: 2:10 p.m. EpiPen administered and call to emergency line

Other Meds: As of 2/18/21 when medication was last checked in chart. Mritazapine, estradiol, altuterol, melatonin, spironolactone

Current Illness: unknown

ID: 1220607
Sex: F
Age: 17
State: CO

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient received 2nd dose of Moderna series today 4/16/21. This was an "off Label" use as the patient is 17. CDC recommends if under age patient receives 1st dose Moderna it is appropriate to finish the series.

Other Meds:

Current Illness:

ID: 1220608
Sex: F
Age: 83
State: NJ

Vax Date: 04/08/2021
Onset Date: 04/10/2021
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: Latex, Sulfa,adhesive tape, neoprene

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

Symptoms: Red spots varying in size on left and right side of face, and left and right arm. Similar in color. Legs swollen and red from the knees down,

Other Meds: Amantadine 100mg 2x, bisacodyl 10mg 1x, calcitonin 1 spray 1x day, ferrous sulfate 325 mg 1x, FLUoxetine 20mg 1x, furosemide 20mg 1x, hydrocortisone (perianal), methylphenidate 5mg 1.5pills 2x, mirtazapine 30mg 1x, pantoprazole 40mg 1x, se

Current Illness: Stroke on 02/26/2021.

ID: 1220609
Sex: F
Age: 33
State: CA

Vax Date: 03/31/2021
Onset Date: 04/07/2021
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: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Wednesday, a week later - I noticed soreness at injection site and it was sensitive to the touch. Next day I started having redness and it was still sore to touch. The next day, it was 2 inches by 1 inches around injection site and still sore to touch but it was getting better a little (the soreness). Every day the soreness lessened. By the 5th day, everything was fine. Televisit - called the appt line - The patched me through to a doctor and the doctor told me about recent research - and called it a delayed local reaction. She told me I could apply ice - I did try but it didn't seem to help. I didn't need to feel the need to take Tylenol. Pregnancy history - my third pregnancy - 1st was miscarriage; 2nd was chemical pregnancy; this is the first viable pregnancy; Estimated date of delivery - July 30, 2021.

Other Meds: Synthroid; Singulair; Prenatal Vitamines

Current Illness: allergy congestion

ID: 1220610
Sex: F
Age: 64
State: CA

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:
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: feeling of closing of the throat. Pt came in for covid vaccine. Answered no to screening questions. Was given Janssen single dose. Pt asked MA, what an allergic reaction looks like. I stepped in and told pt. hives, swelling/ closing of the throat, and feeling like you can't breathe. Pt stated @ 1535 that she felt her throat was closing up a little and that breathing was getting difficult. Pt was speaking in clear full sentences w/o difficulty. I told her to take deep breathes and drink water. I assessed her, she was warm and dry and no apparent swelling of the throat, no itchiness or dryness of the throat. MA brought in BP machine, vital signs were stable. O2 was at 95%. Pt has asthma. I wanted to seek a second opinion on pts well-being, MA went to seek provider that had seen pt prior to vaccination. As MA went to get nurse, I continued to talk to pt about her status. I asked if the feeling was getting better or worse and pt said it was staying the same. Pt was not in distress and speaking in clear full sentences. I told her if her status worsens I have an epi pen to help her breathe better. MA came back 5 minutes later w/o provider and pt stated her throat closing as she had her hands on her throat and was worried. MA did not realize the urgency of the situation and went back to get the nurse. During this time I asked pt if the feeling was getting worse and pt said yes. I told her I have the epi pen and thats when pt requested I administer it to her. I administered the epi pen at 1554. One minute later Nurse comes in to assess pt. Pt is calm and speaking in clear full sentences. MA takes vital signs and BP is elevated and O2 is at 99%. I inform the nurse that I administered epi and she advised to keep pt for observation, she left to see another pt. Pt was calm and speaking in clear full sentences A&O X4 and stated that the feeling was better. At 1610 Pt stated that her throat was feeling the same closing feeling as before the epi pen. I messaged my nurse supervisor, at 1612 about pt and she proceeded to bring Dr. for assessment. Dr. assessed pt and told me to call 911. Pt was not in distress and speaking in clear full sentences. Fire dept. came and took over the situation approximately 8 minutes later. Pt requested to be taken to Hospital.

Other Meds: unknown

Current Illness:

ID: 1220611
Sex: F
Age: 31
State: TX

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

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

Symptoms: Pt reports immediately after receiving her second dose, she felt the injection go straight to her heart. Approximately 15 min after the injection she complained of chest pain, as if being ?punched in the heart?. The pain was rated as an 8 on scale of 0-10. The pain never subsided during clinic visit prior to emergent transport to EC.

Other Meds: NOne

Current Illness: None

ID: 1220612
Sex: F
Age: 40
State: FL

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: Seasonal allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 1:33 pm Patient complained of increasing dizziness and blurred vision. Immediate evaluation by onsite EMS and NP. 1:35 vs 148/96; p. 67. R 12. O2 Sate 97% on RA 1:45 vs 148/98; p.69; R 12. Offered water and cereal bar to eat. 1:46 - stated she was no longer dizzy and was discharged home. Felt that all symptoms had resolved

Other Meds: Pheriamine 375 mg qd

Current Illness: Patient admitted to drinking alcoholic beverages to excess the evening before. Got vaccinated today while recovering from that event.

ID: 1220613
Sex: M
Age: 25
State: MA

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:

Symptom List: Pharyngeal swelling

Symptoms: describes feeling anxious

Other Meds:

Current Illness:

ID: 1220614
Sex: F
Age: 59
State: FL

Vax Date: 04/03/2021
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: LA

Lab Data:

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: extreme headache that lasted 2 days ,mild headache for an additional 5 days

Other Meds: plaquenil Humira

Current Illness:

ID: 1220615
Sex: M
Age: 31
State: VA

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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Onset chills and fever starting 9hrs post injection, 103F+ fever even after taking Tylenol 500mg every 4hr. Fever, chills, lethargy continuing to present (25hrs post injection)

Other Meds: None

Current Illness: None

ID: 1220616
Sex: F
Age: 44
State: NJ

Vax Date: 01/20/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Betadine

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

Symptoms: I received my second dose of the moderna vaccine on 1/20/21. I tested positive for covid on 4/14. I have mild symptoms. My youngest daughter also tested positive for covidZ.

Other Meds: anoro, birth control, vitamin d, vitamin c, vitamin b12, Zyrtec

Current Illness: None

ID: 1220617
Sex: F
Age: 44
State: WI

Vax Date: 04/08/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Several cold sores. Bottom lip blistered almost completely across, swollen and painful. Top lip has small tiny, painless blisters.

Other Meds: None

Current Illness: None

ID: 1220618
Sex: M
Age: 47
State:

Vax Date: 04/14/2020
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient experienced dizziness, BP 126/86, HR 69, RR16, 15 mins later BP 131/81, HR73, RR16. Patient stable and released from vaccination site.

Other Meds:

Current Illness:

ID: 1220619
Sex: F
Age: 67
State: AZ

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Weakness, bodyaches, vomiting, diarrhea

Other Meds:

Current Illness:

ID: 1220620
Sex: M
Age: 17
State: OH

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: Penicillin

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

Symptoms: 2 minutes after receiving Covid vaccine- patient felt numbness in his left hand. About 1 min later he felt numbness in his right hand. About another minute later- his vision started to darken and he felt like he would faint (he was sitting down during this entire experience) and his face started to tingle. His vision went completely black but he did not lose consciousness. His eyes were very blood shot during this and he was very pale. He recovered from all symptoms after about 10 minutes. He felt very thirsty after this and throat felt dry.

Other Meds: none

Current Illness: none

ID: 1220621
Sex: M
Age: 38
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: IM
Vax Site: LA

Lab Data:

Allergies: Benadryl

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

Symptoms: Patient received vaccine about 5 minutes later he was pale, cold to touch, slouching and sweating. reported not feeling well. reported not being able to hear anything being said to him. Pressure was normal but he responsive but was almost to the point of passing out was sweating profusely. After laying on ground for a few minutes he was responding better said he has poor response to needles . He has passed out previously with needle stick. Emergency services was called patient was evaluated and released in good condition.

Other Meds: n/a

Current Illness: n/a

ID: 1220622
Sex: F
Age: 55
State: OH

Vax Date: 03/18/2021
Onset Date: 03/25/2021
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: Bactrum Vancomycin Amoxicillin

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

Symptoms: 3inch by 3inch rash abd burning on upper arm where injection was

Other Meds: None

Current Illness: None

ID: 1220623
Sex: F
Age: 19
State: WI

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Patient reported adverse reaction to Bactrim

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient claims she felt dizzy after vaccination and lost consciousness near checkout lane approximately 10 minutes after vaccination. She was assisted by asset protection staff and pharmacy staff. She left the store under her own power. She reported that she has had headaches and dizziness after the vaccination and was seen at an urgent care that did not provider her with a diagnosis, but felt her symptoms may have been caused by a concussion. She was advised by clinical team to contact her primary care doctor to follow-up, especially with recent reports of thrombosis linked with the J&J vaccine.

Other Meds: Unknown

Current Illness: Unknown

ID: 1220624
Sex: F
Age: 48
State: IN

Vax Date: 04/14/2021
Onset Date: 04/15/2021
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: Kiwi, cantaloupe, apples, pears

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I started out with a sore neck about 12 hours after the injection. As the day went on, fatigue, severe joint pain, general achiness set in. As the day went on I experience brain fog, chills and occasional dizziness. 24 hours after the injections I experience severe chills and night sweats. 36 hours after the injection, most of the pain subsided, but slight fatigue and brain fog remained. I took Tylenol the help with symptoms of pain soon after they began.

Other Meds: Zoloft, Zyrtec, Vit D

Current Illness: none

ID: 1220625
Sex: F
Age: 66
State: IL

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: Penicillin Sulfa drugs Most detergents, cleaners, wool

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

Symptoms: Sore upper arm, tired

Other Meds: Pravastatin Synthroid Vitamin D Vitamin C Vitamin B-6

Current Illness: None

ID: 1220626
Sex: F
Age: 62
State: OH

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/16/2021
Hospital: Y

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: Extreme dizziness and vomiting occurred 4/10/21. Diplopia and numbness began on 4/11/21 and continued. MRI and CT scans confirmed that the patient experienced a transient ischemic attack (TIA) and Veretebral artery dissection (HCC) between 4/10 and 4/11.

Other Meds:

Current Illness:

ID: 1220627
Sex: F
Age: 61
State: FL

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: none

Symptom List: Unevaluable event

Symptoms: Chills and low grade fever everday since I got vaccine. Temp running 99.3-100

Other Meds: metformin, pravastatin, Farxiga

Current Illness: none

ID: 1220628
Sex: F
Age: 64
State: CA

Vax Date: 03/30/2021
Onset Date: 03/30/2021
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: compazine erthromycin

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

Symptoms: 3/30/2021: lost consciousness for hours at a time for 36 hours extreme pain in lower back and side 4/10/2021 extreme pain in lower back, down left leg, shin, top of left foot. Could not stand or walk or lift anything without enormous difficulty. Restricted movement. Pain in all joints throughout body. Ongoing.

Other Meds: serevent flovent albuterol co-enzyme Q10

Current Illness:

ID: 1220629
Sex: F
Age: 28
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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish, compizine, ambian

Symptom List: Injection site pain, Pain

Symptoms: Severe bloody rash on my face and left arm left side of face paralyzed

Other Meds: Methotrexate, lyrica, 80 mg prednisone

Current Illness:

ID: 1220630
Sex: F
Age: 68
State: OR

Vax Date: 04/03/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Sulpha

Symptom List: Injection site pain, Menorrhagia

Symptoms: Day 2: chills, very achy, fatigued Day 14: solid, dark purple/red discoloration across tops of both feet up to ankle, same as after shot #1 on Day 4. Not a raised area, just under surface of skin.

Other Meds: Lisinopril-HCTZ 20-25 mg Amlodipine 2.5 mg Vitamin C 500 mg Biotin 1000 mcg Calcium/Vitamin D 500 mg

Current Illness: None

ID: 1220631
Sex: M
Age: 72
State: AZ

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

Lab Data:

Allergies: None

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

Symptoms: Body ache, headache, exhaustion.

Other Meds:

Current Illness: None

ID: 1220632
Sex: M
Age: 60
State: LA

Vax Date: 04/07/2021
Onset Date: 04/09/2021
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: no known allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: pain and swelling in right arm with severe swelling and severe pain in right hand and wrist. pain and swelling appears to affect joints as lower back and fingers on left hand has become swollen and painful several days after injection

Other Meds: furosemide, buprenorphine, potassium, plavix, toprol xl, asa

Current Illness: none

ID: 1220633
Sex: F
Age: 34
State: MA

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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: describes feeling anxious

Other Meds:

Current Illness:

ID: 1220634
Sex: F
Age: 35
State: CO

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

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

Symptoms: 2am the night of the vaccine I got a fever, chills, aches and lost my appetite. These mostly resolved Sunday then came back Wednesday and are still around on the following Friday, one week later.

Other Meds: Synthroid Birth control

Current Illness: None

ID: 1220635
Sex: F
Age: 49
State: AZ

Vax Date: 04/02/2021
Onset Date: 04/02/2021
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: keflex, gluten

Symptom List: Nausea

Symptoms: Face swelling, tongue swelling evening after vaccine. 2 days after vaccine until now, I have had an increase in fatigue that I normally have due to long covid (original infection 8/13/2020).

Other Meds: aleve, omega-3, turmeric, mulit-vitamin, vitamin d, coq10, flonase

Current Illness: long covid

ID: 1220636
Sex: F
Age: 60
State: PA

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient reported nausea/ fever. She was treated in the emergency room. She also reports having a headache 1 week after administration.

Other Meds:

Current Illness:

ID: 1220637
Sex: F
Age: 0
State: NV

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: Yes to morphine. Patient also stated that she "has similar reactions to a lot of shots"

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

Symptoms: Within 10 minutes of receiving dose patient felt like her throat was starting to swell. Taken to hospital Emergency room at 09:59 where she received Prednisone 60mg . She watched and then discharged 10:30 with no symptoms.

Other Meds: Asmanex INH, Lorazepam, EpiPen, Low-Ogestrel, ProAir HRA INH, amlodipine, atorvastatain, enalapril, levocetirizine, Levothyroxine, montelukast

Current Illness: None

ID: 1220638
Sex: M
Age: 60
State: AL

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

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: 60-year-old male with essentially no past medical history who developed acute left-sided weakness and aphasia. EMS was immediately called and he was taken to healthcare facility. He underwent an immediate work-up with an NIH of 12 with left hemiparesis. CT scan of the head did not show any evidence of acute bleed CTA was consistent with a right M1 occlusion. Patient was given TNKase at 0 755 and taken immediately for thrombectomy. Therapies successful. Patient has not had Covid during this pandemic but did receive the first dose of the pfizer immunization yesterday in his left arm.

Other Meds:

Current Illness:

ID: 1220639
Sex: F
Age: 16
State: SC

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

Lab Data:

Allergies: NONE

Symptom List: Tremor

Symptoms: After the vaccination the patient was sitting in the chair outside of the immunization room, and started to feel faint. The patient had cold and clammy skin, and she appeared to be very weak. The patient was comforted while she remained seated, and she never lost consciousness. The patient was given water and the emergency services were called. After a couple of minutes the patient vomited, and she started to feel better. The patient indicated the she has a fear of needles, and that she was holding her breath while she was being vaccinated. The were no signs of allergic reaction. The emergency services checked the patient's vitals, but the patient refused to be transported to the hospital.

Other Meds: NONE

Current Illness: NONE

ID: 1220640
Sex: M
Age: 50
State: OH

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: NO

Symptom List: Erythema, Pruritus

Symptoms: Patient came in for first Covid shot. After the vaccination, he was instructed to stay for 15 minutes in the "post vaccination" area. He went and sat there and I walked back into the pharmacy to finish the paperwork. I then was alerted by a customer that the patient fell off the chair and hit his head. I ran over to him and by then, he was back in his chair and just realized that he had passed out. While I was with him and talking with him, we paged out for code white. I had instructed one of my techs to call 911 as he was pale and palms were sweaty. I had him walk over to the IMZ area and had him lay on some towels and had his feet propped up on a chair. He was given water and I kept talking with him until EMS arrived. They checked his vitals and were asking standard questions and after about 15-20 mins, he was feeling better and didn't want to go to ER. By then, his coloring was much better and he stated he was feeling a lot better. I asked him if he had a headache and he says that he didn't have a headache and was more embarrassed than anything. He thanked me for my professionalism and care and assured me that he felt back to normal. I called him 2 hours later and he was doing well.

Other Meds: NO

Current Illness: NO

ID: 1220641
Sex: M
Age: 52
State: CO

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

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

Symptoms: Per pt report: Pt started having body aches within a couple hours of vaccine, developed severe 9/10 pain over the next several days. L shoulder pain radiating to ribs and neck w/ muscle spasms, causing HA, R hip and sacral pain, flank pain radiating down R leg. Pt reports that vision in L eye is blurry, R eye vision intact, numbness to L arm and hand, able to move. Pt reports 1in x 0.5 in blood clot when blowing nose Thursday morning, small clot subsequently about 1/2 the size, smaller clots later.

Other Meds:

Current Illness:

ID: 1220642
Sex: F
Age: 55
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: Sulfa drugs

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

Symptoms: Numbness in the right corner of lips and mouth

Other Meds: gabapentin Wellbutrin

Current Illness:

ID: 1220643
Sex: F
Age: 39
State: TX

Vax Date: 03/15/2021
Onset Date: 04/12/2021
Rec V Date: 04/16/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: possible adverse events

Other Meds: Levothyroxine, Lisinopril, Prozac, Tegretol

Current Illness: Hypothyroidism, HTN, Depression, anxiety

ID: 1220644
Sex: F
Age: 22
State: WA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received first COVID Pfizer vaccine on 3/12/2021. About 7 hours post vaccination, she developed a full body rash and facial swelling. No airway involvement. Rash started to improve in about 4 hours, at which time she went to the ER for evaluation and received benadryl. Her temp in the ED was 99.1, BP 145/98, HR 137. No other medication interventions (fluids, meds, etc) given. She reports arm soreness and itching for about 48 hours, but no other symptoms.

Other Meds:

Current Illness:

ID: 1220645
Sex: F
Age: 64
State: WI

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

Lab Data:

Allergies: allergic to ginger, seasoning

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

Symptoms: muscle pain, headache,chills, sleepy,not hungry, very thirsty,

Other Meds: hydrocodone acemetaphine 5-325, Vitamin D3 5000 ICU,B-12 5000mcg, Biotin 5000,Calcium 1200mg,, 1 a day multiple vitamin

Current Illness: none

ID: 1220646
Sex: F
Age: 17
State: NJ

Vax Date: 03/03/2021
Onset Date: 03/03/2021
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: The child received the first dose of Moderna vaccine at 17 years of age by providing a false date of birth. Then the child went for a second dose to a different facility, without notifying them of the first dose of Moderna. At this second facility, the child received Pfizer, Lot # ER8735 as the second dose. As such, this VAERS report is being competed due to an error type of Mixed Series.

Other Meds: none

Current Illness: none

ID: 1220647
Sex: M
Age: 17
State: PA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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: Patient received Moderna covid vaccine which is not yet approved for patients under 18. Pharmacist did not realize only the Pfizer vaccine is approved for under 18 at this time. Confusion arose from state's phased rollout of vaccine populations, where now all patients 16+ are able to be vaccinated but the limitations on which vaccine were not made abundantly clear. No adverse events/effects reported. Patient is in good health with no issues.

Other Meds: None

Current Illness: None

ID: 1220648
Sex: F
Age: 65
State: TX

Vax Date: 03/22/2021
Onset Date: 03/29/2021
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: Bactrim, Keflex

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

Symptoms: It has been a month since my first injection and I still feel pain at the injection site...especially when the arm is in use.

Other Meds: Tylenol

Current Illness:

ID: 1220649
Sex: M
Age: 63
State: NC

Vax Date: 03/26/2021
Onset Date: 04/06/2021
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: none

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

Symptoms: dizziness and loss of coordination in left leg; diagnosed TIA at hospital per symptoms; MRI and echocardiogram were normal

Other Meds: Crestor, 81 mg aspirin, vitamin D

Current Illness: none

ID: 1220650
Sex: F
Age: 35
State: IN

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

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: Fever, chills, fatigue, body aches, headache, nausea the entire next day

Other Meds: Claritin, Larissa, omeprazole, zoloft

Current Illness: None

ID: 1220651
Sex: F
Age: 60
State: OR

Vax Date: 04/01/2021
Onset Date: 04/08/2021
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: iodine, spring pollen

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: One week after Moderna vaccine she developed bilat lower extremity cramping. After three days it resolved except for the top of left foot still aches. Denies trauma or arthritis.

Other Meds: Allegra, OTC allergy eye drops, Vit B12, Vit E, Vit D

Current Illness: spring pollen allergies

ID: 1220652
Sex: F
Age: 34
State: NJ

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Blood clots (i started heavy menstrual cramps a day after the shot and I saw exceeding amount of blood clots which has never happened this excessively before) Fever, chills, headchae, nausea (all very severe level)

Other Meds: None

Current Illness: None

ID: 1220653
Sex: F
Age: 41
State: CA

Vax Date: 01/10/2021
Onset Date: 02/10/2021
Rec V Date: 04/16/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: developed thyroiditis went to ER following with endocronologist. thinks might be related to vaccine. updating previous report per request

Other Meds: N/A

Current Illness: NONE

ID: 1220654
Sex: M
Age: 51
State: NM

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: RA

Lab Data:

Allergies: none

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

Symptoms: Pt had severe nausea and vomiting 15 min after inj. noted to be SOB after emesis - VS stable, kept 10 min extra - no further emesis, VS stable. let go home

Other Meds: none

Current Illness: none

ID: 1220655
Sex: M
Age: 31
State:

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

Lab Data:

Allergies:

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

Symptoms: Pt fell forward on the table and was assisted to the ground; BP 135-137/92-94; HR 88-106; RR 18, SpO2 99%

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm