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: 1222351
Sex: F
Age: 61
State: NJ

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Aggravated and extreme tinnitus

Other Meds:

Current Illness:

ID: 1222352
Sex: F
Age: 36
State: NV

Vax Date: 03/30/2021
Onset Date: 04/15/2021
Rec V Date: 04/17/2021
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: - Prednisone - Diflucan

Symptom List: Anxiety, Dyspnoea

Symptoms: On 4/15 I began experiencing sharp pains in my chest and left side. I had difficulty speaking. My entire left side including face, arm, leg, foot, were all numb and continue to have intermittent numbness. I went to the emergency room. CatScan with and without contrast are negative for stroke or heart attack. MRI of brain was normal. I have no past history of heart issues.

Other Meds: - Xyzal for allergies nightly - albuterol for asthma as needed

Current Illness:

ID: 1222353
Sex: M
Age: 23
State: NC

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: COVID-19 Pfizer BioNTech EUA Felt light headed, dizzy, parent helped him sit on ground, laid down, drank water BP 126/76 P 80

Other Meds:

Current Illness:

ID: 1222354
Sex: M
Age: 74
State: OR

Vax Date: 03/31/2021
Onset Date: 04/09/2021
Rec V Date: 04/17/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was admitted on April 16, 2021 with at least 1 week history of worsening of progressing severe shortness of breath associated with mild dry cough, no sputum production. The patient had the first dose of Moderna vaccine on March 31, 2021. He thinks, after he got the vaccine he initially developed some shortness of breath which went away, but then over the last week he developed above-mentioned symptoms. He denies fever, chills, diarrhea. He also his presents with generalized weakness and very poor appetite and poor oral intake. On admission he was found to be in severe hypoxemic respiratory failure with multiple infiltrates in both lungs on chest x-ray. He had elevated D-dimer on admission and CT angiography revealed acute right lower lobe pulmonary embolism. COVID-19 PCR also came back positive. Internal medicine service was consulted. The patient was placed on BiPAP, will start with remdesivir, dexamethasone, levofloxacin for possible superimposed pneumonia and therapeutic doses of Lovenox. Letter Doppler study revealed nonocclusive left popliteal vein DVT. Patient remains hospitalized for continued treatment due to COVID19 infection, right lower lobe PE, L popliteal DVT, severe hyperglycemia.

Other Meds: ASP EC 81mg daily, Albuterol/PROAIR HFA 90mcg/inhaler Q4H PRN, NOVOLOG 100unit/mL - 15unit PM, NOVOLOG 70-30 FLEXPEN 100unit/mL 50unit AM/PM, Metformin 500mg tab BID, Metoprolol 25mg tab BID, Crestor 20mg daily

Current Illness: None

ID: 1222355
Sex: F
Age: 64
State: PA

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/17/2021
Hospital: Y

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

Lab Data:

Allergies: FLAGYL RITALIN SULFA ANTIBIOTICS

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

Symptoms: The patient received vaccine at the pharmacy and stayed for an observational period of 15 minutes. The patient left the pharmacy seeming fine but then reported on 4/17 that she had fainted at her residence and she was taken in an ambulance to a hospital. Patient said that the hospital ruled out a blood clot.

Other Meds: CIMETIDINE DOXEPIN FUROSEMIDE HYDROXYCHLOROQUINE LEVOTHYROXINE OMEPRAZOLE ONDANSETRON TRAMADOL

Current Illness: UNKNOWN

ID: 1222356
Sex: F
Age: 38
State: MO

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/17/2021
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: Sulfa

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

Symptoms: Fever of 104 and elevated heart rate that wouldn?t drop below 100

Other Meds: No e

Current Illness: None

ID: 1222357
Sex: M
Age: 79
State: FL

Vax Date: 04/10/2021
Onset Date: 04/15/2021
Rec V Date: 04/17/2021
Hospital: Y

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

Lab Data:

Allergies: NA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 4 days after vaccination, beginning at 3AM on Wed 04-15-21, began uncontrolled and unending concurrent watery diarrhea and vomiting and abdominal pain, and sweating. Taken to hospital by ambulance and admitted for 2 days. I was Administered IV fluids, IV zofran, oral vancoymcin, etc. Upon discharge, I was directed to continue oral Zofran and Vancomycin for 9 more days during which I continued to experience watery diarrhea, nausea, and abdominal cramps.

Other Meds: 1) 20 mg Pantoprazole. 2) 25mcg Levothyroxin. 3) 60 mg Isosorbide Mononitrate. 4) 75 mg Plavix. 5) 10 mg Ramipril. 6. OTC probiotic 7) 50mg Hydralazine. 8) 100mg Metoprolol ER.. 9) over 50 male multivitamin. 10) 40 mg Atorvastatin. 11) P

Current Illness: none

ID: 1222358
Sex: M
Age: 23
State: NJ

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

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

Lab Data:

Allergies: no

Symptom List: Pharyngeal swelling

Symptoms: Received a mixed dose series. 1st dose was Pfizer Lot# EP6955 on March 17, 2021 at a different facility and missed appointment for 2nd dose. Then shows up for 2nd dose of Moderna Lot# 039B21A on April 16, 2021 at our facility, but never stated he had gotten a first dose elsewhere, as we were only giving 1st doses.

Other Meds: no

Current Illness: no

ID: 1222359
Sex: F
Age: 43
State: NM

Vax Date: 04/08/2021
Onset Date: 04/11/2021
Rec V Date: 04/17/2021
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 that I know of

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: My period is horrible I'm on day 6 with excessive bleeding hasn't stopped yet this vaccine is clearly affecting female hormones and needs to be addressed adequately

Other Meds: none

Current Illness: none

ID: 1222360
Sex: F
Age: 41
State: VA

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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: Penicillin, ceclor,latex and all adhesive tapes.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: When I woke up on 4/16/2021 my arm was in moderate pain till pressure of any kind was applied then it was severe. I didn't use my arm much and applied ice to the injection site. About 2 hours after waking up my left nostril began to severely run and had a tickling sensation. I began to sneeze profusely. Most times the lesser amount of sneezing was 6 times. Other times I would sneeze and not be able to take a breath before I would sneeze again.it was severe. I've never had that happen before. So I called Pharmacy and talked to healthcare professional. He advised me to take a 50mg of benadryl and 25mg every 6 hours till I went to bed. I also used my daily dose of Flonase. The symptoms eased just enough it was tolerable. That evening about 6:00 pm I began to run a low grade fever. I took advised to treat the fever. I felt like I was ill. I went to bed around 1:00 am 4/17/2021. When I woke up around 11:00am all symptoms was gone but the swelling and pain at the injection site

Other Meds: No

Current Illness: No

ID: 1222361
Sex: M
Age: 55
State: VA

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

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

Lab Data:

Allergies: None

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

Symptoms: Swelling of lymph nodes, right underarm

Other Meds: Diclofenac Sodium, Lialda, Delzicol, Sudafed, Vit B12, multi vit, biotin, viagra

Current Illness: None

ID: 1222362
Sex: F
Age: 29
State: NY

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/17/2021
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: 6 hours after J&J shot, began shivering uncontrollably and immediately went to bed. Was in bed with flu-like symptoms for 24 hours. Took Advil Day 2 and 3 after shot, had a mild headache. Took ibuprofen Day 4 to present, noticed a red, raised, somewhat itchy ?bubble? patch of skin on the side of my nose, which my mom said looks like Hives. I also have red patches of slightly itchy skin under my eyes. Took Benadryl but doesn?t seem to be helping

Other Meds: None

Current Illness: None

ID: 1222363
Sex: F
Age: 75
State: IL

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/17/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillins Sulfa abx

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

Symptoms: Patient received 2nd dose at unknown location on 4/15/2021. Patient presented to emergency room at the Hospital with stroke symptoms. Assessed by neurology and did not receive tPA, of note, also had elevated BG levels at presentation (496). Patient has history of confusion related to hyperglycemic episodes. MRI on day 2 of admission (4/17/21) reported punctate recent or sub-acute infarcts present. Initial symptoms of unilateral weakness is resolved on day 2.

Other Meds: Allopurinol (100 or 300 mg, pt unsure) daily aspirin 81 mg daily atorvastatin 20 mg daily Calcium carbonate 1250 mg daily denosumab 120/1.7 mL 60 mg injection escitalopram 20 mg daily fenofibrate 160 mg daily folic acid 1 mg daily hydrochl

Current Illness: n/a

ID: 1222364
Sex: F
Age: 57
State: PA

Vax Date: 03/20/2021
Onset Date: 03/27/2021
Rec V Date: 04/17/2021
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: Meloxicam, bee stings

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

Symptoms: Itchy, red, swollen, warm, size of an orange, took ibuprofen, lasted 4 days

Other Meds: Vitamins

Current Illness: none

ID: 1222365
Sex: F
Age: 27
State:

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies: No known allergies.

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

Symptoms: Patient reports feeling short of breath, nauseous, clammy, and chest tightness. This RN assisted patient to wheelchair and wheeled her to the private observation area. Assisted patient into recliner with feet elevated. Vital signs at 1410: BP 125/81, P92, RR 20, 98% RA. Patient reports a similar reaction to the second Gardisil vaccine approximately 10 years ago. Patient reports being 17 weeks pregnant, but the symptoms she is experiencing do not feel pregnancy related. Patient reports getting the ok from her OB to get the Covid vaccine. Patient also reports not eating or drinking anything in a while. Provided a Gatorade and granola bar. After about 20 minutes patient reports she is back to her baseline. Patient reports her husband will be picking her up.

Other Meds:

Current Illness:

Date Died: 04/07/2021

ID: 1222366
Sex: F
Age: 78
State: PR

Vax Date: 02/23/2021
Onset Date: 04/07/2021
Rec V Date: 04/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None reported

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

Symptoms: Died a natural death

Other Meds: Norvasc, Losartan, Gabapentin, Atorvastatin, Prednisone, Aspirin, Vitamin D

Current Illness: None reported

ID: 1222367
Sex: F
Age: 60
State: NY

Vax Date: 03/11/2021
Onset Date: 03/15/2021
Rec V Date: 04/17/2021
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: Nuts, Cranberries,Phenergan, Codeine, Dupixent

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

Symptoms: 4 days following the injection I had chest pain similar to the reaction after Dupixent injection.

Other Meds: VitD2, Amlodipine Besylate 10mg, Symbicort 160/4.5, Albuterol

Current Illness: Sinus infection

ID: 1222368
Sex: M
Age: 49
State: IN

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies: None that I know of

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Around 3PM on 4/16 I started to get sick to my stomach. Around 5PM I started to get light headed and then around 6:30 PM I started to get the chills really bad. I took Dual Action Advil with Acetaminophen, 500 mg & 250 mg respectively, at 7:00 PM. The chills went away around 9:30-10:00 PM. I woke up feeling ok but rested for the morning. At 12:30 PM I went and hooked up my camper and moved it to a different location and that is when the symptoms started again. Specifically being light headed, loss of all energy along with an upset stomach and slight headache.

Other Meds: Symbicort 160-4.5 MCG Inhaler HFA Aerosol Inhaler, Mometasone Fur 50mcg Spr, 17ct, Omeprazole 20 mg, Zinc, Vitamin D3, Vitamin C, multi-vitamin, and Vitamin B

Current Illness: none

ID: 1222369
Sex: F
Age: 38
State: PR

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

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Pineapple, grapefruit, lemon, pork, lobster, shrimp. Benadryl raises my blood pressure.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After getting vaccinated at 20 minutes I felt dizziness and tachycardia for about 1 minute. Do not notify the pharmacy because it relieves me in the minute. Then I left after 10 minutes I felt the same again for 2 minutes. I took my blood pressure but it was fine but my pulse was 95. I improved a little although the symptoms came and went. Already at 9 o'clock in the evening the dizziness and tachycardia disappeared. Today in the morning I felt a slight tachycardia but it went away when I took the 30mg cardizem.

Other Meds: Cardizem 30mg 2 times a day Sinvastatin 20mg once a day

Current Illness: Asthma

ID: 1222370
Sex: F
Age: 16
State: WA

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies:

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

Symptoms: pt was 16 years old at the time of vaccination. This is an off label use of Moderna

Other Meds:

Current Illness:

ID: 1222371
Sex: F
Age: 30
State: OH

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
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: Patient received her vaccine and waited with her mother for the 15 minutes. They were about to leave and the mother called me over. Patient was nauseous, had a headache, had blotchiness on her chest and stated she was having some heart palpitations. She denied the call to 911. With the blotchiness, 10 ml of liquid diphenhydramine was administered. Water was given but never used. I sat with her and asked for frequent updates. She denied the 911 call a few more times. At 4:32 pm she stated she wanted to leave so she could lay down in bed. Her mother escorted her out.

Other Meds:

Current Illness:

ID: 1222372
Sex: F
Age: 88
State: UT

Vax Date: 04/05/2021
Onset Date: 04/10/2021
Rec V Date: 04/17/2021
Hospital: Y

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

Lab Data:

Allergies: ACE inhibitors, metformin, levaquin

Symptom List: Unevaluable event

Symptoms: SMV thrombosis; CT scan of the head WO IV contrast shows no e/o CSVT

Other Meds: triamcinolone (KENALOG) 0.1 % cream Apply 1 application topically to affected area 2 times a day. For 2 weeks. Then off for 1 week, then repeat. ? dicyclomine (BENTYL) 20 mg tablet TAKE ONE TABLET BY MOUTH EVERY 6 HOURS FOR ABD SPASMS/C

Current Illness: Diabetes First dose Moderna given 3/9/2021 Lot #001B21A Second dose Moderna given 4/5/21 Lot #027B21A

ID: 1222373
Sex: F
Age: 60
State: TN

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/17/2021
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: penicillin, some antibiotics

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

Symptoms: itchy lips, then itchy scalp and feet. started 45min after shot. lips may have been swollen or may have seemed that way because of itchiness. I could not see them. lips issues ended within an hour from starting and the rest of itchiness ended after 2-3 hours. headache next day and lifting arm soreness next day.

Other Meds: none

Current Illness: none

ID: 1222374
Sex: F
Age: 38
State: MI

Vax Date: 03/10/2021
Onset Date: 04/03/2021
Rec V Date: 04/17/2021
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: PCN, Laytex

Symptom List: Injection site pain, Pain

Symptoms: 1st dose given 2/10/2021 with no event. 2nd dose Lot#002B21A- On April 3rd, both ears started ringing with a low buzz/humming sound. I had not been sick or had any allergies at the time. I have no history of auditory issues or have not had any circumstances that would trigger or make me predisposed to auditory problems. I took over the counter decongestants with no relief. On 4/7, I made a appointment with my PCP office. Upon exam, there was no infection and no blockages noted. I was prescribed a methylprednisolone staggering dose pack. The pack was completed as prescribed and there has been no decrease in the ringing.

Other Meds: Losartan Potassium 25mg q day, Guanfacine HCL ER 2mg q day, Metoprolol Tartrate 50mg BID, Adderall 20mg BID. All medications have been at some dosages with no issues for almost 4 years.

Current Illness: None

ID: 1222375
Sex: F
Age: 23
State: NC

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Johnson & Johnson Janssen COVID-19 EUA Community Vaccine Clinic c/o dizziness, became obtunded, eased to floor, progressed to sitting then to standing escorted to post-vax for further monitoring

Other Meds:

Current Illness:

ID: 1222376
Sex: F
Age: 59
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/17/2021
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: nka

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

Symptoms: Patient received dose 1 of the COVID Moderna vaccine (Lot 041B21A, exp 5/6/2021) at 1130 from vaccinator RN . At approximately 1120, 10min before vaccination, the patient requested her O2 be taken (95% on room air) as she had COPD and ran out of oxygen. Approximately 16min after vaccination, patient informed RN that she had felt lightheaded and similar to a hot flash but it had passed already before she told RN . RN informed PHN and EMT . At 1136, vital signs: pulse 102, O2 96% on room air, blood pressure 130/86, respirations 18. Patient reported feeling back to baseline with all symptoms resolved. PHN offered patient Benadryl but patient declined. Patient denied allergies. Medical condition includes COPD, hypothyroidism, hypertension, diabetes. Medications include blood pressure medications, 2 long-acting inhalers, albuterol rescue inhaler, metformin, and synthroid. At 1140, vital signs: O2 95%, pulse 90, blood pressure 128/84, respirations 18. Patient reported that she continued to feel well with no symptoms. PHN accompanied patient out. Patient left walking with steady gait at 1203.

Other Meds: blood pressure medications, 2 long-acting inhalers, albuterol rescue inhaler, metformin, and synthroid

Current Illness:

ID: 1222377
Sex: M
Age: 32
State: GA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt fainted. Staff alerted by customers that someone was laying in floor. We immediately ran out. Pt was laying face door on floor. Pt was tapped, and verbally asked if he could hear us. Initially there was no response. Checked for breathing, then begin checking for pulse, but he came to. He started speaking with us, saying he was feeling light headed, and got up to notify us, but then he couldn't remember the rest. Asked if he had a history of seizures or diabetes and he said no to either. At some point he went out again, briefly. Meanwhile, the tech called 911. He came to again, begin talking with us. At some point he requested water, which we got. After seeping, he wanted to sit up. We asked him to place his back against the wall, if he wanted to. He did so, and after a few seconds said he wanted to lay down again. EMS came. They asked if he wanted to go to the ER which he consented to. They rolled him out on a stretcher.

Other Meds: n/a

Current Illness: n/a

ID: 1222378
Sex: F
Age: 53
State: TN

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 21 hours after 2nd shot developed tenderness, swelling and pain left armpit area possible interpectional nodes. Also experiencing nausea.

Other Meds:

Current Illness: None

ID: 1222380
Sex: F
Age: 59
State: OK

Vax Date: 03/27/2021
Onset Date: 04/10/2021
Rec V Date: 04/17/2021
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 known

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

Symptoms: Two weeks after vaccine started with upset stomach, nausea, and diarrhea. Has continued daily to current date of 4-17-2021. Also, at times have headache and chills, but no fever. Self treatment with Pepto-Bismol, Mylanta, Tylenol and Aleve. Some relief from treatments, but diarrhea continues every morning. And stomach nausea & grumbling is almost constant.

Other Meds: Carisoprodol, Losartan-hydrochlorothiazide, Hydroxyzine,

Current Illness: none

ID: 1222381
Sex: F
Age: 48
State: HI

Vax Date: 03/28/2021
Onset Date: 04/05/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Nausea

Symptoms: Pt reported to PCP office on 04/15/21 with itchy and painful red lesions to L elbow, L hand, L neck, and face x1 week - 10 days. Onset around 04/05/21. She reported a sudden onset of sharp pain to face lesions the day before while at work. She has been using creams for that she had at home including Triamcinelone and Desonide cream to no relief. Pt reports some swelling to L elbow and blood when she scratched. PCP diagnosed her with Herpes Zoster and prescribed valACYclovir 1 GM Tab Take 1 Tab 3 times Daily for 7 days on 04/15/21.

Other Meds: Benzonatate 200mg Loratadine 10mg

Current Illness: None

ID: 1222382
Sex: M
Age: 73
State: NY

Vax Date: 02/15/2021
Onset Date: 02/19/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies: Mosquitoes bites

Symptom List: Injection site pain

Symptoms: Inflamed lymph nodes in stomach

Other Meds: Simvastatin Lisinopril

Current Illness: 2nd Remission from CLL

ID: 1222383
Sex: F
Age: 15
State: TX

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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 provided

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

Symptoms: No adverse events noted. Patient received dose but at the time was ineligible due to age of 15.

Other Meds: None provided

Current Illness: None

ID: 1222384
Sex: M
Age: 19
State: NY

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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: None

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

Symptoms: Headache, soreness, chills.

Other Meds: None

Current Illness: None

ID: 1222385
Sex: F
Age: 56
State: MA

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
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: Sudden full body red, prickly rash along with chills. lt lasted several hours. I took a Claritin that melts in your mouth. As of the time of this writing at 4:50pm, I have not symptoms.

Other Meds: None

Current Illness: None

ID: 1222386
Sex: F
Age: 27
State:

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
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: Swollen lymph nodes in armpits Fever 102F Body aches Chills symptoms started ~12 hours after vaccination 2nd dose

Other Meds: Zyrtec

Current Illness:

ID: 1222387
Sex: F
Age: 40
State: TX

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
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: Patient answered "no" to receiving any other COVID vaccine and denied verbally. When processing vaccine, there was a history of patient receiving Janssen vaccine on 4/12/21. Called patient to verify and patient never answered. Received a copy of the consent form she filled out on 4/12/21 and it is the same patient.

Other Meds:

Current Illness:

ID: 1222388
Sex: F
Age: 52
State: NC

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/17/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: left face, arm, leg numbness and tingling

Other Meds: amlodipine 5mg daily, aspirin 81mg daily, benazepril 40mg daily, dolutegravir 50mg daily, descovy 200-25 one tab daily, toprol 37.5mg daily, atorvastatin 40mg daily, albuterol inhaler prn, atrovent inhaler prn

Current Illness:

ID: 1222389
Sex: F
Age: 45
State: IN

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/17/2021
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: 15Apr 11:30pm: chills, fever 16Apr 8am: body aches, headache (chills continue) 16Apr 11:30am: arm tenderness, headache continues but other symptoms subside 16Apr 8pm: body aches, slight fever; headache subsides 17Apr: 7am other symptoms subside; noted a red, raised area at injection site. 2.5inches wide, 1.5 inches tall, irregular borders. Soreness under the armpit at the lymph node area, no noticeable swelling in that area.

Other Meds: Claritin 10mg, pantoprazole 40mg, metoprolol ER 50mg, diclofenac EC 50mg

Current Illness: None

Date Died:

ID: 1222390
Sex: M
Age: 72
State: WA

Vax Date: 03/20/2021
Onset Date: 04/01/2021
Rec V Date: 04/17/2021
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's wife presented for her 2nd dose of Moderna today. She reported to us that her husband died between his 1st dose of Moderna and now (date not reported). His death was NOT related to COVID.

Other Meds:

Current Illness:

ID: 1222391
Sex: M
Age: 42
State: IN

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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: None.

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

Symptoms: Fatigue, head and body aches

Other Meds: None.

Current Illness: None.

ID: 1222392
Sex: F
Age: 17
State: CO

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 04/17/2021
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: Pain in extremity

Symptoms: Vaccine injected into underage patient, 17 year old.

Other Meds: unknown

Current Illness: unknown

ID: 1222393
Sex: M
Age: 46
State: FL

Vax Date: 04/06/2021
Onset Date: 04/14/2021
Rec V Date: 04/17/2021
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: On 4/14/21 in afternoon I started to feel tingling in my feet and hands. The tingling in my feet progressed to intermittent burning and pain. Pain kept me awake Thursday and Friday nights. It appears to have started in just the tips of my toes and now I am having sensation up to my calves. I went to ER on Saturday morning where lumbar CT ruled out nerve impingement and lab tests for Lyme disease are still pending.

Other Meds: None

Current Illness: None

ID: 1222394
Sex: M
Age: 68
State: SC

Vax Date: 04/03/2021
Onset Date: 04/12/2021
Rec V Date: 04/17/2021
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: paxil, Ativan, remicaide, androgel, pamelor, nasonex (hives)

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

Symptoms: Bilateral pulmonary embolism, clot in leg, pneumonia developed after the vaccine. Patient was hospitalized for 3 nights.

Other Meds: Humira, Lyrica, Remeron, multivitamin, Zofran prn, mesalamine suppositories prn, probiotic, nexium, pristiq, krill oil

Current Illness: treated for folliculitis within a months

ID: 1222395
Sex: F
Age: 44
State: CA

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Hive type rash on my right inner thigh and measles/chicken pock rash on my stomach and back. I also have swollen and sore lymph nodes in my left armpit. I also experienced fever and chills.

Other Meds: Daily multivitamin; Zyrtec

Current Illness: None

ID: 1222396
Sex: M
Age: 46
State: FL

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/17/2021
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: experienced chills and fever from about 10:30am which took advil and after 4 hours tylenol and drank water and reseted.

Other Meds: albuterol, advair, singular, losartan, vitamin A,B,C,D, Zinc, flomax, escitalipram, flonase

Current Illness: none

ID: 1222397
Sex: M
Age: 79
State: CT

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 04/17/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PCP notes in progress notes upon the patient return on 1/12/2021 Hospital course CT head/CTA neck/CT perfusion studies concern for possible right ICA and MCA thrombus, transferred to neuro ICU. TPA ( s/p alteplase). CTA shows >90% R ICA stenosis. Vascular consulted. Started on AC (heparin, plavix and loaded with brillanta). Pt underwent R TCAR (Transcarotid Artery Revascularization) on 1/11. No post-op complication. pt stable/neurologically intact. Pt offers no acute concerns. pleasant, pain is controlled. No CP, sob, palpitation. neck incision CDI. HR and BP controlled. He is happy to back to the rehab. CEREBRAL INFARCTION DUE TO UNSPECIFIED OCCLUSION OR STENOSIS OF RIGHT CAROTID ARTERIES

Other Meds:

Current Illness: 1/7/ 2015 PERSONAL HISTORY OF TRAUMATIC BRAIN INJURY Converted from ICD-9-CM V15.52 PERSONAL HISTORY OF TRAUMATIC BRAIN INJURY

ID: 1222398
Sex: F
Age: 51
State: MD

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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: Stinging insect allergy

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

Symptoms: After an hour of injection felt a lump in my throat like I do with bee sting, whole body turned red and got nauseous

Other Meds: Lorathadine 10 mg allergy pill

Current Illness:

Date Died: 03/23/2021

ID: 1222399
Sex: M
Age: 75
State: PR

Vax Date: 03/03/2021
Onset Date: 03/20/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies: None reported

Symptom List: Injection site swelling, Limb discomfort

Symptoms: POC alleges that she observed that resident began to swell and retain fluids and the nurse noticed that he was not urinating, felt a lot of tiredness and had swollen legs. He was evaluated by the doctor and sent for several studies (EKG) and his heart was weakened. He was sent to do another study, because snoring was heard. He was transferred to the hospital to the ER, he had the fluid in his lungs. He is placed intensive and dies on 3/23/2021 from heart failure.

Other Meds: Levotiroxine, Celexa 20 mg, Setraline 25 mg, Aspirin 81 mg, Pracovix 75 mg, Digoxin 0.25 mg, Omeprazole, Vitamin D1,000, Vitamin B, Indur 30 mg, Lantus, Carvedilol

Current Illness: None reported

ID: 1222400
Sex: M
Age: 55
State: NC

Vax Date: 03/21/2021
Onset Date: 03/29/2021
Rec V Date: 04/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Previous mild tinnitus 2-3 worse (louder) since 2nd vaccine shot.

Other Meds:

Current Illness:

ID: 1222401
Sex: F
Age: 24
State: MD

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/17/2021
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: NA

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

Symptoms: The patient received the Pfizer vaccine, given by HCP. After the vaccine, the patient felt a little anxious with increased heart rate so she asked HCP for a bottle of water. HCP went to get the water and informed the pharmacist on duty. Both pharmacist and HCP came back to the patient. She got the bottle and was about to open the bottle, but closed her eyes and started shaking like having a seizure and passed out. She came back right after passing out but didn't know what happened. She then started shaking again for a few seconds but didn't pass out. Everything happened so quickly when she remained sitting on the chair. We called 911 and paramedics came. She mentioned that the seizure happened to her before, maybe once or twice a year. When paramedics came, they checked her blood pressure and it was ok. We asked her and she wanted to come to the hospital to check out to make sure that she is ok.

Other Meds: NA

Current Illness: NA

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm