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: 1220706
Sex: F
Age: 18
State: CA

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: no known allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient came to clinic with mother to get COVID 10 Vaccine. Patient received vaccine at 1515 and stated she felt nervous and asked for water and she vomited right after and was trembling. NP was notified. Patient was then escorted by nursing to another room to have her lay down. Patient was assisted to bed and VS were take BP LA Laying 122/89 HR 132 Oxygen Saturation 99% RA appeared pale. Patient awake and answering questions. BP at 1530 105/79 HR 101 Pulse Oxygenation 100% RA. VS at 1542 102/74 LA Laying HR 95 Pulse Oxygenation 99%. NP cleared patient to leave at 1545 stable vital signs patient stated she felt better no pallor noted no difficulty walking left with mother.

Other Meds: none

Current Illness: none per Pt

ID: 1220707
Sex: M
Age: 29
State: TX

Vax Date: 04/08/2021
Onset Date: 04/11/2021
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: Codeine

Symptom List: Anxiety, Dyspnoea

Symptoms: 4/11/21 - 0400 - awoke with nausea/diarrhea; 0900 - vomiting/diarrhea; 1300: rash/hives started at neck and spread to all areas; 1530: went to ED - treated via IV with zofran, benadryl, pepcid and prednisone. Discharged 1900 - symptom-free with orders to continue meds prn 4/12/21 - 0400 - awoke with diarrhea, swelling to lips, rash/hives. 0800 - fever noted at 103.3. 0830 - Went to ED. Treated via IV with decradon and benadryl. 0130 - Discharged with symptoms and orders to continue zofran, prednisone, benadryl, pepcid PRN. 1420 - Went to clinic physician. Recd orders for continue all prev prescribed meds plus claritin, PRN. 4/13/21 - symptom-free

Other Meds: None

Current Illness: None

ID: 1220708
Sex: M
Age: 37
State: NY

Vax Date: 04/12/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None that I am aware of

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

Symptoms: Severe and Debilitating Abdominal Pain. Extreme sweating and Hot and Cold Temperature. Currently still feeling exhausted and slight body cramps

Other Meds: Wellbutrin, Effexor

Current Illness: None. Perfectly Healthy

ID: 1220709
Sex: F
Age: 53
State: MN

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

Lab Data:

Allergies: Ibuprofen, aspirin and amoxicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Swelling of left ear for first 6 days, then swelling worked way down into neck, causing swollen lymph nodes and body aches and headaches. Also suffer from RA and it seemed to have caused a painful flare up or swollen and stiffness in shoulders.

Other Meds: Hydroxycloriquine for RA Zyrtec Antihistamine

Current Illness:

ID: 1220710
Sex: M
Age: 16
State: IL

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: unknown

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

Symptoms: Patient felt dizzy, hot and light headed immediately following vaccination. He lied on the floor for about 5 minutes and had some water. He sat up since he was feeling better. He then became nauseated and lied back down. After another 5 minutes he was feeling better. He slowly went from lying to standing to walking. He sat outside for another 5 minutes and felt back to normal.

Other Meds: unknown

Current Illness: unknown

ID: 1220711
Sex: M
Age: 25
State: NY

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

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

Symptoms: Vomiting for 2 days, first day around 10 times, second day 4-5 times. Muscle weakness overall body 5 days, lower back muscle pain, ongoing. Nausea (bloating, gas, etc.) ongoing. Headache ongoing.

Other Meds:

Current Illness:

ID: 1220712
Sex: F
Age: 27
State: CA

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

Lab Data:

Allergies: Nka

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever of 101, severe body aches. At 330 am post injection, incredibly stiff neck/spine. Could not turn head. Went to er, evaluated ROM of neck, gave IV fluids and torodol, kept under observation for 1.5hrs. discharged bc ROM and pain improved. At home took 1000mg Tylenol every six hours for 12hrs following. Feverish at 1700 16Apr.

Other Meds: Zoloft

Current Illness: None

ID: 1220713
Sex: F
Age: 52
State: NY

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

Lab Data:

Allergies: Penicillin, biaxin, zithromax

Symptom List: Pharyngeal swelling

Symptoms: Throat itchy, chest and back itchy, ears itchy, post nasal drip and cough. Three days later, upper body including arms very itchy, throat itchy, post nasal drip and cough.

Other Meds: Meloxicam, Lisinopril, Allegra, Citalopram, Culturelle

Current Illness: none

ID: 1220714
Sex: F
Age: 59
State: NC

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Symptoms within a few minutes of vaccine administration: body aches and headaches (although these two specifically are not uncommon for pt), jaw pain, left arm shaking until bedtime that night, twitching (also not uncommon for pt per seizure disorder). Symptoms resolved by next morning at 7am, but within 2 hours, symptoms returned, including swollen face that is painful to the touch, intense fatigue, burning/throbbing/tingling sensation in arms and legs, worsening of arthritic pain, jaw pain, chills/hot flash-like episodes, decreased appetite, stinging sensation in the eye, home measurement had pulse ox 98% and HR at 93 bpm (pt endorsed). Note that pt was COVID positive on Dec 1st, 2020

Other Meds: lorazepam 0.5mg TID, quetiapine 25mg QD, oxcarbazepine 300mg BID, albuterol, hydroxychloroquine 300mg QD, gabapentin 400mg QID

Current Illness: seizure disorder

ID: 1220715
Sex: M
Age: 32
State: WA

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

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient came in excited to get his first moderna covid vaccine. Got his dose at around 1230pm and was instructed to sit down for 15 minute post -vaccine to make sure he felt ok before leaving. About 10-15 minutes later, he came up to the cashiers and his face was pressed against the plyglass and started to go down. (RPH) and (tech) ran out to catch him from falling to the ground. We pulled a chair up to where he was so he could sit down. He reported to be warm, weak, and dizzy. He remained seated but was alert. He has no allergies, no medical conditions, no prior reactions to vaccinations. He last ate at 8:30am. He said he felt warm, but I took his temp again and it was 96.7 degrees. We gave him some water and he remained seated. After several minutes, he was able to get up and was fine with moving his chair away from the front registers and towards the side wall (within sight of pharmacy). Kept checking on him and he was getting better and better. He did call his friend to pick him up instead of driving home himself.

Other Meds: none

Current Illness: none

ID: 1220716
Sex: F
Age: 33
State:

Vax Date: 04/14/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Developed severe neck pain and cannot move her neck; went to chiropractor today who did adjust lumbar and thoracic spine did not adjust her neck. Taken Aleve a couple times on 4/15/21 with no relief; also drinking electrolytes.

Other Meds:

Current Illness:

ID: 1220717
Sex: M
Age: 36
State: IL

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: Patient fainted post vaccination sitting in chair, fell on floor, scraped facial area, brief LOC, EMS placed on stretcher, recovered and released.

Other Meds: None known

Current Illness: None Known

ID: 1220718
Sex: F
Age: 47
State: WA

Vax Date: 02/06/2021
Onset Date: 02/06/2021
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: First moderna vaccine 01.07.2021 uneventful. Second vaccine 02.06.2021. Experienced full compliment second vaccine symptoms of chills, shakes, aching, arthralgia, etc. lasting acutely approx. 4 days followed by 2 days less intense sx. Since this time have had persistent joint arthralgia that was not present before vaccine. Additionally pre-existing paresthesia's at right mastectomy and lymphectomy sites have become much more pronounced and painful. This increased nerve pain is not subsiding with time. Have received body work, taken OTCs and discussed w/ my providers. May resume gabapentin if arthralgia and paresthesia sx do not subside

Other Meds:

Current Illness:

ID: 1220719
Sex: F
Age: 58
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Shortness of breath and dizziness, BP 157/76, HR 73, RR17. 59 y.o F with history of insulin required DM, HTN, high cholesterol on Metoprolol, statin, ASA, insulin, and claritin. Had dizziness 15 minutes after Pfizer dose #2, later developed chest tightness and SOB. Didn't take insulin today. SOB releived in 15 minutes, chest pain and dizziness improved. Left in stable condition and advised to go to ER if symptoms continue

Other Meds:

Current Illness:

ID: 1220720
Sex: M
Age: 54
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:

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

Symptoms: Patient accompanied relative in clinic for their COVID19 vaccine. There was a leftover dose in clinic and the patient was asked if he would like a COVID19 vaccine. The patient was advised at this time the vaccine being given was Pfizer. Patient stated his second dose was scheduled for 04/20/21; however, would like to receive now as possible. Advised patient he must be a minimum of 21 days from the first dose; patient verbalized he was at least 21 days from first dose. Patient was provided second dose Pfizer vaccine and again advised that this was the vaccine he was receiving. After the patient waited the required 15 minutes in the lobby, he realized he had received the Moderna vaccine first dose.

Other Meds:

Current Illness:

ID: 1220721
Sex: F
Age: 42
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient called hospital call center at 2pm with c/o heaviness, which pt describes as on and off dizziness and sensation in left leg since 10am when pt woke up. pt received pfizer vaccine yesterday (4/14/21) at Stadium. Reported to MD during telephone visit that she has HA and mild nonspecific decrease sensation in LLE but no other symptoms concerning for TIA/CVA or DVT. Pt advised to use Tylenol 500mg q6-8hours and adequeate hydrations. If symptoms worsens, patient has ED precautions.

Other Meds:

Current Illness:

ID: 1220722
Sex: F
Age: 48
State: CA

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: aspirin ciprofloxin

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

Symptoms: vaccine was administer at 9:07 am patient started complaining at 9:09 am numbness on the lips , tongue , it was having difficulty of swallowing . nausea . vitals were check every 5 min . patient started emesis . per Dr order i administer epi -pen at 9:13 am 911 was call .

Other Meds: n/a

Current Illness: no

Date Died: 04/16/2021

ID: 1220723
Sex: M
Age: 36
State: AL

Vax Date: 04/06/2021
Onset Date: 04/14/2021
Rec V Date: 04/16/2021
Hospital: Y

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

Lab Data:

Allergies: bactrim, clindamycin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 36 year old male with hx of hypertension , asthma, schizophrenia . he recieved Janssen vaccine on 4/6/2021. he started to fell unwell on 4/14 and on 4/15 he was found by his father unresponsive then sent to the hospital. Pt was diagnosed with massive pulmonary embolism, severe shock, acute renal failure ,Diabetic ketoacidosis , hyperglycemic hyperosmolar nonketotic coma, acute respiratory failure, patient expried from massive pulmonary embolism within 48 hours after admission.

Other Meds: amlodipine aspirin, albuterol inhaler, HCTZ

Current Illness: hypertension, schizophrenia, asthma, morbid obesity, diabetes

ID: 1220724
Sex: F
Age: 16
State: CA

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Dizziness and elevated heart rate of 133 resting for 48 hours.

Other Meds: Flovent, albuterol, vitamin d

Current Illness: Hashimotos disease and asthma

ID: 1220725
Sex: M
Age: 50
State:

Vax Date: 03/17/2021
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: None

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

Symptoms: DVT of right leg post vaccine

Other Meds: Lisinopril, amlodipine and efudex

Current Illness: COVID positive two weeks post vaccine

ID: 1220726
Sex: M
Age: 16
State: MI

Vax Date: 04/10/2021
Onset Date: 04/12/2021
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: Severe arm tremor from elbow down to hand; significant nerve pain and muscle weakness. This tremor was severe Monday, Tuesday. Still experiencing muscle weakness and nerve pain 6 days post shot only in right arm that vaccine was injected into.

Other Meds:

Current Illness:

ID: 1220727
Sex: F
Age: 73
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
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: Patient had a short term chest pain, she said she was fine after the 2nd half day

Other Meds:

Current Illness:

ID: 1220728
Sex: F
Age: 28
State: ID

Vax Date: 04/12/2021
Onset Date: 04/12/2021
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: None

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

Symptoms: Chills, headache, fever of 103, muscle aches

Other Meds: None

Current Illness: None

ID: 1220729
Sex: F
Age: 75
State: OH

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Allergic reaction to pneumonia vaccine 5-6 years ago Continuous arm swelling/hardness Neomycin allergy

Symptom List: Injection site pain, Pain

Symptoms: Did not sleep well, woke with arm pain at 6am. Pt was fatigued and developed a worsening H/A as day progressed. Felt she had a mild fever with nausea. Did not feel hungry and avoided eating. Progressed throughout day, took acetaminophen 500mg and rested around 5:30pm. Ate a banana with medication, took a nap and reported feeling better.

Other Meds: Pt on calcium + vit D and vit b12 sublingual

Current Illness: None

ID: 1220730
Sex: M
Age: 35
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: About ten minutes after vaccine he became diaphoretic, dizzy, had a numb face and blurred vision. His legs were lifted, ice applied to neck. He was at that time taken to treatment and report handed off.

Other Meds: aspirin

Current Illness:

ID: 1220731
Sex: F
Age: 36
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient has been experiencing a headache since her vaccine. She states the headache comes and goes and is not severe. However, since it has been 8 days, I advised her to contact her doctor to followup.

Other Meds:

Current Illness:

ID: 1220732
Sex: F
Age: 46
State: CA

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: EstrogensHeadache RamelteonSwelling Seroquel [Quetiapine]Seizure Corticosteroids (Glucocorticoids)Altered mental status or confusion ErythromycinNausea And Vomiting Dairy Aid [Lactase]Abdominal Pain GlutenAbdominal Pain Flagyl [Metronidazole Hcl]Rash Sulfa (Sulfonamide Antibiotics)Rash

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient stated that immediately/within 5 minutes of the vaccine being given, it became difficult to swallow. Patient stated she could walk/was not dizzy or nauseous, no trouble breathing, but would like to go to a private room for observation and wanted to walk there herself. Once inside private room, vitals taken. HR 62, O2Sat 99%, BP 155/100. Patient speaking without difficulty. Patient stated she was having difficulty breathing and her brow began to perspire. ED offered. Patient accepted. ED nurse came to take her to the ED.

Other Meds: albuterol (PROVENTIL HFA, VENTOLIN HFA) 90 mcg/actuation inhaler Inhale 2 puffs into the lungs every 4 (four) hours. ascorbic acid, vitamin C, (VITAMIN C) 1000 MG tablet Take 1,000 mg by mouth daily. cholecalciferol (VITAMIN D3) 5,000 unit

Current Illness: Unknown

ID: 1220733
Sex: M
Age: 74
State: MS

Vax Date: 04/09/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient presented to the clinic today reporting onset of pain to posterior left knee with swelling to left lower leg and ankle on 4/14/21. Patient sent to local hospital for venous ultrasound of left leg which showed thrombus to left distal superficial femoral vein, popliteal vein, and peroneal vein. Patient was then sent over the emergency department where he was evaluated and started on Eliquis.

Other Meds: Unknown

Current Illness: none

ID: 1220734
Sex: F
Age: 23
State:

Vax Date: 04/14/2021
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: Shellfish, gluten, red dye #40

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

Symptoms: I?m on birth control pill and have been for years. After my second dose, within a few days I was experiencing spotting and stomach cramps. I?m in the middle of my pill pack and have never had issues with spotting/irregular periods while on the pill

Other Meds: Cyclafem, gabapentin

Current Illness:

ID: 1220735
Sex: M
Age: 17
State: CA

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: PCN

Symptom List: Nausea

Symptoms: On 4/16/2021 at 2:17 PM, 17-Year-old white male received his first dose of Pfizer vaccine lot #ER8729 0.3 ml to his right deltoid. At 2:28 pm while patient in the observation area, patient noted pale in color, he was complaining of dizziness, blurred vision. Patient taken to designated area while provided complete privacy. Vital signs as followed: BP 90/60, respiration 16, pulse 54, o2 sat 97% on room air, patient lowered to the floor with his feet elevated . 2: 33 pm Patient voiced that his feeling better. Patient skin color improved 100/80, respiration 18, o2 sat 98% on room air. Patient endorsed allergy to penicillin which he describes reaction as hives, also as per patient and his mother who currently in vaccine clinic, patient had similar above reaction to flu vaccine a year ago. Patient denies any known past medical history nor currently on medication. 2:38pm Sitting vital sign : BP 110/70, pulse 76, o2 sat 97%, resp 18, Patient denies any further symptoms. 2:43 Pm Standing BP 120/80, pulse 65, o2 sat 97%, resp 18. Patient remained stable, able to ambulate steady gait. No complain voice Patient released thirty minutes post observation accompanied by his mother in stable condition. Writer recommended to patient if symptoms reoccur to sick immediate medical help. Patient and family verbalized understanding.

Other Meds: None

Current Illness: None

ID: 1220736
Sex: M
Age: 38
State: NJ

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

Lab Data:

Allergies: Citrus

Symptom List: Injection site pain

Symptoms: Redness, swelling, soreness

Other Meds: Levimer, Novolog

Current Illness:

ID: 1220738
Sex: F
Age: 62
State: CO

Vax Date: 04/09/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: latex penicillin nuts berries shellfish

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

Symptoms: Severe headache and tinnitus, very cold/couldn't get warm, nausea/diarrhea, felt as though I could not move, extremely swollen and sore armpit glands on same side as injection

Other Meds: valacyclovir, bebadryl

Current Illness: none

ID: 1220739
Sex: F
Age: 25
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Swelling of throat, given water, MD assessed. BP 118/74, HR 93, RR16. Patient stable and released from vaccination site, advised to follow up with PCP No N/A Resolved

Other Meds:

Current Illness:

ID: 1220740
Sex: F
Age: 56
State: FL

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

Lab Data:

Allergies: codeine

Symptom List: Tremor

Symptoms: Patient received the vaccine on 4/13/2021 and woke up the morning of 4/14/2021 with her face and eye swollen. She contacted to her Doctor and was instructed to take Benadryl.

Other Meds:

Current Illness: cancer

ID: 1220741
Sex: F
Age: 41
State: VT

Vax Date: 04/10/2021
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: Benadryl Penicillin

Symptom List: Erythema, Pruritus

Symptoms: significant swelling of left axillae lymph nodes neck stiffness/tendereness brain fog metalic taste

Other Meds: Armour Thyroid

Current Illness: none

ID: 1220742
Sex: F
Age: 41
State: VA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
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: Epinephrine - mild allergy

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

Symptoms: Lyph node swollen and tender at 8 days post injection. Shoulder, area of injection, visibly swollen, tight and very warm to the touch.

Other Meds: Levothyroxin, iron, sronyx

Current Illness:

ID: 1220743
Sex: M
Age: 73
State: MO

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

Lab Data:

Allergies: None reported

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

Symptoms: noticeable, persistent dull ache about 1-2 inches distal of the injection site. Pain is still present and worsens slightly when moving arm in certain motions (mostly raised above shoulder level)

Other Meds: Eliquis 5mg BID; CoQ-10 200mg AM; Atorvastatin 40mg daily; Cartia XT 180mg daily; Carb/Levo 25-100mg QID; Omeprazole 20mg daily; Metformin ER 500mg 2 tabs (1000mg) qam; Vitamin C 500mg BID; Zince 30mg daily; Calcium citrate w/D3 630mg/13mc

Current Illness: None reported

ID: 1220744
Sex: M
Age: 32
State: CA

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Uncontrollable shaking for roughly 1-hour and 20-minutes. Convulsive as though extreme hypothermic, patient could not control it. Shaking was so severe that my wife woke up in bed (heavy sleeping) and was so concerned that she was going to call 911, instead she called ER first and they said they couldn't provide any advice. I said I felt cold, even though I had a fever that was extremely high (no thermometer to measure) my wife then put the 30lb weighted blanket on me and after about 15-minutes the shaking started to decrease before finally subsiding completely. I then had a drink of water at room temperature which lowered my internal core body temperature and slight shaking started again until I warmed back up and stopped. Our house was 73 degrees F which normally I would sleep in my underwear, instead I was fully dressed, under all our blankets plus the 30lb weighted blanket and I still felt cold. That night I had sweated more than ever, my pillow was literally a swamp and stayed damp until the next night although pillow cases were removed. Half of the king size bed was soaking wet and yet I still felt cold. I sweated through the sheets again for 2 more nights before my body finally started regulating its temperature again and have since been okay. Felt very lethargic for 5-days.

Other Meds: Magnesium, Vitamin D, Omega 3 & 6

Current Illness: None

ID: 1220745
Sex: F
Age: 57
State: IL

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: SYR
Vax Site: LA

Lab Data:

Allergies: latex, peanuts and shellfish

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

Symptoms: Pt received Moderna dose 1 at approx 1715. While at the observation room, pt reported feeling tightness at the back of her throat. Pt taken to the triage area for closer monitoring, placed on a pulse ox sats 99-100%. Vital Signs 1739- 174/92 HR 107 O299% 1743-151/89 HR 100 O2100% 1748 149/81 HR92 O2 100% Discussed options for Benadryl po or IM or Pt prescription of EPI-PEN. After reporting that the tightness was subsiding slowly, pt opted to take oral Benadryl 50 mg that was administered at 1750. Pt stated ok to return to obs room to be monitored for a bit longer.

Other Meds: Epi-Pen

Current Illness:

ID: 1220746
Sex: F
Age: 54
State: CA

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

Lab Data:

Allergies:

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

Symptoms: The pharmacy contacted the patient to follow up and educate regarding current pause of Janssen vaccination. In doing so, the patient notified the pharmacist that she has been experiencing more migraines and right leg muscle spasms. She contacted her PCP and is completing a workup. Patient stated that her initial tests have come back negative.

Other Meds:

Current Illness:

ID: 1220747
Sex: F
Age: 54
State: CA

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: LA

Lab Data:

Allergies: Kiwi fruit

Symptom List: Pain in extremity

Symptoms: - Tinnitus since the injection - vertigo starting 03/29/21 with 6-7 incidences so far. Three episodes were severe enough to impact ability to work or function for several hours. Others were more mild and could be managed with anti-nausea meds. - I did seek treatment for the most severe episode from my physician

Other Meds: None

Current Illness: Mild sore throat

ID: 1220748
Sex: F
Age: 65
State: MN

Vax Date: 03/17/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: sulfa, some antibiotics, chocolate

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

Symptoms: Questionable spot in left breast.

Other Meds: medications for high blood pressure, a variety of dietary supplements B,D,E, Fish Oil etc

Current Illness: none

ID: 1220749
Sex: F
Age: 43
State: WA

Vax Date: 04/07/2021
Onset Date: 04/15/2021
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: None

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

Symptoms: Patient developed L sided weakness and numbness on 4/15/21, and was found to have a transient ischemic attack.

Other Meds: None

Current Illness: None

ID: 1220750
Sex: F
Age: 46
State:

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

Lab Data:

Allergies: No

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

Symptoms: I want to report that after 12 hours from the second dose I woke up felling terrible and I started to shake for almost 2 hours. after I felt dizzy and almost trow up, I stopped to shake and I had headache, nausea, pain in my body and 101.7 temperature. I couldn't sleep, eat only a little and really really bad for 24 hours. I took Tylenol 1000 every 8 hours. The second night I could sleep and today I am feeling almost normal. I know that my symptoms are kind of normal but the shaking part I don't know why, anyway I only want to report. I didn't need to contact my doctor and I am okay now. Thank you!

Other Meds: Lithium 450 mg - 1 tablet a day Estroven- 1 tablet a day Melatonin- 10 mg - 1 cap a day Levothyroxine 50 mcg - 1 tablet a day Quetiapine - 25 mg- 1/2 tablet a day Megared 500 mg - 1 soft gel a day Gummies -probiotic and calcium

Current Illness: No

ID: 1220751
Sex: F
Age: 74
State: FL

Vax Date: 03/31/2021
Onset Date: 04/11/2021
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: SULFONAMIDE DERIVATIVES

Symptom List: Vomiting

Symptoms: Patient's friend stated patient had gone to the emergency room and found to have a brain bleed. She stated the Doctor told her to report to vaccination site.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1220752
Sex: F
Age: 33
State: WA

Vax Date: 03/09/2021
Onset Date: 04/05/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Intrauterine fetal demise at 16 weeks by dates, measuring 15 weeks by crown rump length

Other Meds: Prenatal vitamins, hydrocortisone suppositories

Current Illness: nausea and vomiting of pregnancy, 1st trimester vaginal bleeding received Rhogam

ID: 1220753
Sex: F
Age: 37
State:

Vax Date: 04/09/2021
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: Penicillin

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

Symptoms: I had a lot of pain where the vaccine was given initially, but thought it was not a big deal. It seemed to go away after a few days, but today (a week after vaccination) for some reason, it's back, and I noticed the spot around where I was vaccinated has grown to the size of a golf ball.

Other Meds:

Current Illness: I had vertigo two weeks prior, but other than that, I can't think of anything.

ID: 1220754
Sex: M
Age: 36
State: CA

Vax Date: 04/01/2021
Onset Date: 04/16/2021
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: Patient reported nausea 15 mins after vaccination and then experienced emesis x3 times. Patient stayed in clinic for 1 hour; reported headache and fatigue before leaving for home. RN and Paramedic discussed with patient ED precautions; to stay properly hydrated and to rest; patient reported understanding.

Other Meds: n/a

Current Illness: n/a

ID: 1220755
Sex: F
Age: 32
State: MI

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: RA

Lab Data:

Allergies: hydrocodone-acetaminophen - anaphylaxis, hives dye- contrast - nausea & vomiting Estrogens - headache

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

Symptoms: Pt felt dizzy, had mild difficulty breathing, and felt mildly confused for a few hours following getting her first Pfizer COVID19 vaccine on 4/13/21. Symptoms started within two hours. Pt is pregnant, as well. Pt scheduled for c-section on 6/18/2021 (reported EDC 6/23/21) G2P1. Message sent to PCP for clearance on reported s/s

Other Meds: adderall XR 25 mg antivert 25 mg zoftran 4 mg protonix 20 mg prenatal _DHA 28 mg iron

Current Illness:

ID: 1220756
Sex: M
Age: 37
State: CA

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: RA

Lab Data:

Allergies:

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

Symptoms: While RN BSN CCM was conducting educational facts about the covid 19 vaccination. Observed patients body went stiff and fell backwards in sitting position in his chair and started to exhibit seizure like symptoms in his chair for approximately 8-10 seconds. RRT called immediately and arrived 1 minuted after. Pt had beads of sweat dripping off forehead. Temp obtain 86.6. Sp02 95% Attempted to obtain BP vitals but machine did not complete cycle before pt blacked out again. ED transferred at 1055.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm