VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1262646
Sex: M
Age: 38
State: CO

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: N/A

Allergies: Tylenol

Symptom List: Dysphagia, Epiglottitis

Symptoms: Second dose given 7 days after 1st dose. Offender has denied any complications.

Other Meds: None

Current Illness: None

ID: 1262647
Sex: F
Age: 53
State: IA

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: Cinnamon, intolerant of High Fructose Corn Syrup, Maxsult, Norco

Symptom List: Anxiety, Dyspnoea

Symptoms: Case reports almost exactly 24 hour post 2nd vaccine, watery diarrhea started, felt it smelled "medicinal". Is still having loose/soft stools. PCP told her she needed to call Public Health and make a report

Other Meds: Gabapentin, Percocet 5/325, meloxicam, baclofen, Vit D, collagen, super B, Probiotics,

Current Illness: Was on two different ATB in at the end of February for Sinus infection. The first ATB worked, but infection came back, was then put on Augmentin and 2 days later was in the ED with severe abdominal cramping.

ID: 1262648
Sex: F
Age: 43
State: NC

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/27/2021
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: Whey protein (dairy) - anaphylaxis/anaphylactic shock

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

Symptoms: Awakened during the night (approx 2:30 am) with extreme pain in ALL joints (ankles, knees, hips, shoulders and neck). 10 of 10 on pain scale. Lost consciousness several times due to amount of pain and was not able to get up until approx 6 am. Could not think straight due to pain and took approx 25mg of liquid Benadryl (out of habit due to food allergy) at that time. By 7 am, symptoms had reduced to dull muscle and joint aches and fatigue (3 of 10 on pain scale). Temperature read at 103.2F to 103.4F from 7am to 11pm that night. Was unable to take temperature during peak of symptoms. All symptoms resolved completely by 8am on 4/18/21. Did not seek medical treatment since symptoms responded to Benadryl. Please note, for comparison I would rate a broken bone as a 6 of 10 on the pain scale. This is now the worst pain I have ever experienced in my life.

Other Meds: Vitmain D 5000 UI

Current Illness: NONE

ID: 1262649
Sex: F
Age: 78
State: FL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: vomiting, diarrhea, n/v, metallic taste in mouth, syncope, weakness, anorexia, abdominal cramping Drinking warm ginger-ale, dried cheerios, sips of water with some relief. Recommended Mylanta to help soothe stomach. 4/23-symptoms lasted 1 week; feels improved. Still fatigues easily.

Other Meds: Synthroid

Current Illness:

ID: 1262650
Sex: F
Age: 64
State: AZ

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Tetnaus

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

Symptoms: Fever, chills, muscle twitching in left arm.

Other Meds: Tramedol, diclofenac, metformin, crestor

Current Illness: None

ID: 1262651
Sex: F
Age: 64
State: MI

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/27/2021
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: Patient had received Moderna at Pharmacy as first Covid vaccine. Patient self-scheduled to received second dose. Patient was inadvertently given Pfizer Covid vaccine as a second dose. No adverse events resulted.

Other Meds:

Current Illness:

ID: 1262652
Sex: M
Age: 78
State:

Vax Date: 02/25/2021
Onset Date: 03/11/2021
Rec V Date: 04/27/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was seen in the ED/hospitalized within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1262653
Sex: F
Age: 36
State: WI

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

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

Lab Data:

Allergies: wheat/gluten allergy, intolerant to corn/sugar/dairy

Symptom List: Pharyngeal swelling

Symptoms: I felt drunk, and then had severe pain. My skin hurt, hair hurt, muscles and entire body hurt. Freezing shivers. The severe pain lasted about 36 hours and I had about 2 weeks of fatigue that would come and go. I still have bouts of fatigue and shortness of breath now.

Other Meds: doxycycline, womens multi vitamin, probiotic, zyrtec (all daily)

Current Illness: none

ID: 1262654
Sex: M
Age: 20
State: TX

Vax Date: 04/04/2021
Onset Date: 04/04/2021
Rec V Date: 04/27/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Light headedness, Sweating

Other Meds:

Current Illness:

ID: 1262655
Sex: M
Age: 22
State: IN

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: In ED, blood pressure 134/78, temp 99.3 and HR 82 about 10 minutes after the event.

Allergies: No known allergies per patient.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient experienced seizure like activity 10 minutes after receiving the vaccine. Patient tensed up and became unresponsive. He was slightly shaking. This lasted for under a minute (RN estimated 20-30 seconds). Has had one seizure in the past as a child. Currently not taking any medications for this.

Other Meds: None known, verified not on any medications for seizures.

Current Illness:

ID: 1262656
Sex: F
Age: 59
State: NC

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

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

Lab Data: None

Allergies: PCN

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

Symptoms: Petechiae on leg. 4 small red dots, 7 days after vaccine.

Other Meds: Tamoxifen, fish oil, vitamin E, vitamin B, calcium, vitamin c, vitamin d, ginkgo biloba

Current Illness: None

ID: 1262657
Sex: F
Age: 68
State: FL

Vax Date: 01/28/2021
Onset Date: 02/05/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: 3/29/2021 endoscopy - Cause of recurring diarrhea is still undetermined

Allergies: iodine contrast

Symptom List: Rash, Urticaria

Symptoms: Intense and recurring diarrhea, abdominal cramps and bloating. Also persistent discomfort in left upper quadrant. Symptoms continuing for over 2 months.

Other Meds: synthroid omeprazole vit D Multi-vitamin

Current Illness: hypothyroid GERD lichen sclerosus

ID: 1262658
Sex: F
Age: 42
State: TX

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: Sedimentation rate westergren 67

Allergies: None

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

Symptoms: On 4/9, let eye turned red along with burning, itching, swelling, tearing in the eye. Swelling in the armpit. On 4/11, the pain in the eye became quite severe. Eye was also sensitive to light and touch. On 4/13, elevated ESR levels (67) were detected and Prednisone (60mg daily) s was prescribed. On 4/14, optometrist diagnosed iritis and prescribed Prednisone eye drops. On 4/19, further tests ruled out other possible causes for iritis and Prednisone was stopped.

Other Meds: Prednisone 20mg, prednisone acetate ophthalmic suspension 1%, ibuprofen 200mg, acetaminophen 500mg

Current Illness: Anemic

ID: 1262659
Sex: F
Age: 68
State: MD

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 04/27/2021
Hospital: Y

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: Contrast dye, Iodine, Latex, Penicillins, Except

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

Symptoms: Per patient she was feeling fine with her treatment (said dose was given) till she went home and felt so tired that she couldn't eat the next day (April 13, 2021). So her daughter called ambulance and sent her to the hospital. In the hospital, a lot of tests and procedures were done including cardiac cath. One of the patient's nephrologists stated that patient admitted with possible myocarditis after her second shot of Covid but no significant intervenable disease after the cardiac catherization and it's difficult to attribute it to the shot completely. Patient got discharged from the hospital on April 17, 2021.

Other Meds:

Current Illness:

ID: 1262660
Sex: M
Age: 16
State: IL

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/27/2021
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

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

Symptoms: Pt had a seizure roughly 5 min after receiving the vaccine

Other Meds: N/A

Current Illness: No known

ID: 1262661
Sex: F
Age: 17
State:

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
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: Hives/itchiness mon upper chest, R arm&leg , self resolved in 15 min

Other Meds:

Current Illness:

ID: 1262662
Sex: F
Age: 68
State: DC

Vax Date: 04/01/2021
Onset Date: 04/26/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: None so far. Will see ENT if this continues. I?ve never had a hearing problem or sound like this.

Allergies: No

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

Symptoms: Two weeks after 2nd dose, suddenly have ?shoosh? or ?thrum thrum? sound in right ear. In time with heartbeat. Not very loud but noticeable when quiet or trying to sleep. Hope it goes away!

Other Meds: Phenobarbital daily for epilepsy lifelong

Current Illness: Epilepsy Shingles (ended early March).

ID: 1262663
Sex: F
Age: 24
State: KS

Vax Date: 04/17/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: n/a

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: She explained a raised area (like a knot) on her arm at injection site occurred a couple days after vaccine. It went down after a few days and then reoccurred on day 9 and got bigger through day 10. She indicated it was about twice the size of the 1st time. Complained of tenderness, irritation, feeling nauseated and having headache. I called her on day 11 and she said she felt it was starting to subside and she felt a little better.

Other Meds: None

Current Illness: None

ID: 1262664
Sex: F
Age: 60
State: FL

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Talked to PCP the day before the 2nd dose, knows about headaches after first dose. Still encouraged her to take 2nd dose. Tried to but unable to get into contact (over the phone) with PCP.Per Poisons Specialist - if taking the migraine medication (Ubrelvy) does not help with the headache, you can take tylenol (according to package instructions) and see if your headache subsides. If it does not subside, please seek a health care provider to get help with your symptoms. In regards to your blood pressure (BP) medication (Metroprolol, Losartan, Lyrica) - you mentioned you took your blood pressure measurement before you took your medication. Please measure it again, if it is still high despite already taking your BP medications please speak to your cardiologist.

Other Meds: Metroprolol 50 mg in morning and 50 mg at night - Losartan 100 mg a day - Lyrcia 100 mg 3 times a day - Ubrelvy 50 mg when needed for migraines (taken yesterday and today)

Current Illness:

ID: 1262665
Sex: F
Age: 43
State: WI

Vax Date: 04/05/2021
Onset Date: 04/12/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: Wed 4/14/21 - Sought medical attention at ED. Was evaluated for blood clots, none found on this day. CT scan, ultrasound of both legs, blood tests. Returned home with directions to take Extra Strength Tylenol for headache.

Allergies: Levofloxacin (Levaquin)

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

Symptoms: Mon 4/12/21 - Headaches started and have continued daily. Tue 4/13/21 - Soreness in right calf muscle, continued for 4 days. Headache continued. Wed 4/14/21 - Sharp pain in pelvis (right and left side) same location I experienced pain the day of receiving vaccine. Occasionally felt this pain 2 or 3 times / day for 2 days. Sought medical attention at ED on the advice of our Nurse Call Center. Was evaluated for blood clots, none found on this day. CT scan, ultrasound of both legs, blood tests. Returned home with directions to take Extra Strength Tylenol for headache. Thu 4/15/21 - Shooting pain in random parts of my body, mostly legs and arms. Experienced throughout this day only. As of 4/27/21, 22 days after being vaccinated, I am still experiencing headaches. More noticeable when I am exerting myself - walking outside for 1-2 minutes triggers the headache. Headaches are usually located in the lower back of my head. Before being vaccinated, I would experience less than 1 headache per month, and they go away within the day.

Other Meds: Daily multivitamin

Current Illness: Between 7 hours and 14 hours after having vaccine on 4/5/21, I had severe chills, severe headache, internal sharp pain in my pelvis (right and left side).

ID: 1262666
Sex: F
Age: 19
State: MN

Vax Date: 04/17/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
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: EKG, Chest Film, Blood work.

Allergies: None

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

Symptoms: Costochondritis.

Other Meds: None

Current Illness: None

ID: 1262667
Sex: F
Age: 21
State: MT

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/27/2021
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: Patient received first dose of Moderna Vaccine on 3/8/2021 Lot 036A21A, second vaccine received on 4/5/2021 was Pfizer Dose. Patient reports no side effects, no issues with receiving two different vaccines. Patient was advised that she was fully vaccinated and no further immunizations were required.

Other Meds: None

Current Illness: None

ID: 1262668
Sex: M
Age: 40
State:

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/27/2021
Hospital: Y

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: Patient found unresponsive and transported to ED. Currently hospitalized and admitted with following issues: Present on Admission: ? Intraventricular hemorrhage (HCC) ? Bilateral thalamic hemorrhage ? Acute encephalopathy ? Abnormal eye movements ? Respiratory failure requiring intubation (HCC) ? Mucoid impaction of bronchi

Other Meds:

Current Illness: None known

ID: 1262669
Sex: F
Age: 31
State: MI

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: Chills, muscle aches (~6 hours)/fatigue, headache (~24 hours); Advil; symptoms resolved after 24 hours

Other Meds: N/A

Current Illness: None

ID: 1262670
Sex: F
Age: 74
State: MD

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: None drawn.

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Hep B shot, #2, was given 3 days after receiving Pfizer Covid-19 vaccine, #1. No notification from clinic of Hep B schedule. Hep B shot #3 was scheduled for 4/19/2021, 16 days after Pfizer Covid-19 vaccine #2. Hep B #3 shot was postponed at my request. By 3/19/2021, patient is seen by PCP for suspected vesicular rash. Received Valtrex for 10 days.

Other Meds: Regular and Levemir insulins; antihypertension meds; depression and chronic pain meds. Multivitamins.

Current Illness: ESRD requiring hemodialysis

ID: 1262671
Sex: F
Age: 29
State: MA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: VS MONITORING, LUNG SOUNDS

Allergies: MORPHINE (ANAPHYLAXIS)

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

Symptoms: HIVES ON CHEST, UPPER BACK, L ARM SELF-RESOLVED IN 15 MIN 2ND DOSE IN SERIES BAND-AID REMOVED FROM L ARM

Other Meds: NONE

Current Illness: NONE

ID: 1262672
Sex: F
Age: 31
State: MA

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/27/2021
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: none

Allergies: latex (no latex gloves used), shrimp, juniper

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: redness and hives on the face. No problems with breathing, lips, trouble swallowing. Redness to injection site.

Other Meds: escitalopram, Norethindrone Acet-Ethinyl Est 1-20 MG-MCG Tablet and Mirena IUD,

Current Illness: no

ID: 1262673
Sex: M
Age: 34
State: MD

Vax Date: 04/01/2021
Onset Date: 04/14/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Tnnitus

Other Meds: Np

Current Illness: No

ID: 1262674
Sex: F
Age: 58
State: IN

Vax Date: 03/23/2021
Onset Date: 04/02/2021
Rec V Date: 04/27/2021
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: Doctor's visit.

Allergies: Penicillin allergy

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

Symptoms: I developed shingles on my neck and upper back.

Other Meds: Plaquenil, Prednisone, Restasis, Metoprolol, lisinopril, furosemide, Diclofenac Sodium, Vitamin D, Folic acid

Current Illness: Systemic lupus, Sjogren's syndrome, Reynauds

ID: 1262675
Sex: F
Age: 21
State: MA

Vax Date: 12/22/2020
Onset Date: 04/19/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: Positive Covid Test 4/21/21

Allergies: allergic to doxycyline

Symptom List: Nausea

Symptoms: Mild cough, runny nose, loss of taste and smell, Headache, sore throat, nausea beginning on 4/20/21

Other Meds: none

Current Illness: none

ID: 1262676
Sex: F
Age: 29
State: NY

Vax Date: 04/12/2021
Onset Date: 04/18/2021
Rec V Date: 04/27/2021
Hospital: Y

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

Lab Data: Blood tests done. Allergy panel negative for allergic reaction. White blood cell and procalcitonin count high.

Allergies: None

Symptom List: Injection site pain

Symptoms: On 4/18 woke up with a rash on arms, legs, butt, and back. Went to Urgent care and was given a steroid and benadryll. That evening the rash intensified and went to the emergency room. Was admitted so they could monitor the rash. Was discharged on 4/20 with instruction to start a steroid pack and continue with benadryl cream, benadryl, claratin and pepcid. Rash is still continuning to appear as of 4/27/21. Very itchy and irritating. TRYING TO ENTER HOSPITALIZATION DATES IN PART 21 BUT IT WILL NOT ALLOW ME TO TYPE ANYTHING. , 2 DAYS STAY,

Other Meds: Lamictal, Junel

Current Illness: None

ID: 1262677
Sex: F
Age: 55
State: NY

Vax Date: 04/08/2021
Onset Date: 04/11/2021
Rec V Date: 04/27/2021
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: Sulfa - rash. Penicillins -unknown reaction

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

Symptoms: Patient had a fever of 101 status post vaccine with body aches, rash to the left chest, sinus congestion and post-nasal drip. Symptoms started about 3 days after vaccine administration. Patient is currently inpatient

Other Meds: Dexlansoprazole and spironolactone

Current Illness:

ID: 1262678
Sex: F
Age: 73
State: NY

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient got Moderna (Lot: 037A21B) for her first dose and came back in 4 weeks for dose 2. That day our vaccination clinic was doing both Moderna and Pfizer dose 2. I, the provider, was told by the front staff that the next cycle/room of patients were all Pfizer patients. The patient received a Pfizer dose (Lot: ER8735) with the rest of the room and the mistake was noticed after receiving her card to fill out. In the 30 minutes that the patient was there after the vaccine, she experienced no symptoms or side effects. Before patient left, she was told of all side effects and to seek out medical care if she were to experience any adverse side effects such as severe headaches, shortness of breath, chest pain, paralysis, or etc..

Other Meds:

Current Illness:

ID: 1262679
Sex: M
Age: 26
State:

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: near syncape, hx of near syncope w/ vax/shots

Other Meds:

Current Illness:

ID: 1262680
Sex: F
Age: 42
State: MN

Vax Date: 01/12/2021
Onset Date: 04/26/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: COVID-19/SARS COV2, NAAT Positive for COVID 4/26/21.

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient tested positive for COVID 4/26/21. Completed COVID vaccine series 1/12/21.

Other Meds:

Current Illness:

ID: 1262681
Sex: F
Age: 55
State: FL

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 04/27/2021
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: Fever, chills, nausea and vomiting this morning. Soreness of arm. Advised to please stay hydrated and drink fluids/Pedialyte to help with vomiting. Headache, fever, chills, malaise or "flu-like" symptoms are common side effects to the vaccine and should resolve in 2-4 days. Treatment of "flu-like" symptoms include common over-the-counter pain relievers/anti-fever medication such as ibuprofen, naproxen and acetaminophen (according to package instructions). See a healthcare provider if the "flu-like" symptoms last longer than 4 days.

Other Meds: None

Current Illness:

ID: 1262682
Sex: F
Age: 26
State: OH

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: peanuts, tree nuts, milk protein

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

Symptoms: Patient describes loss of consciousness and seizure like episode witnessed by her husband and lasting 10 minutes on the evening of the day she received the vaccine. EMS was called by husband, she declined transport to ER at that time and presented to a walk-in Express clinic 3 days later.

Other Meds: oral contraception

Current Illness: None

ID: 1262683
Sex: F
Age: 41
State: MN

Vax Date: 04/07/2021
Onset Date: 04/16/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On 08-APR-2021 (1 day after first vaccine): experienced headache/fatigue/difficult concentrating On 16-APR-2021 (9 days after first vaccine): experienced a sudden reaction at the injection site. The area became swollen, red, hot to the touch, itchy, and painful. The affected area was approximately 4 inches in diameter, surrounding the injection site. Medical attention was not sought. Discomfort was treated with icing of the area. The symptoms resolved at approximately 24 hours after onset.

Other Meds: Basic Care Fexofenadine Hydrochloride Tablets, 180 mg once daily (NDC 0113-7571-47) Nature's Bounty Vitamin D3 125 mcg (5000 IU) rapid release softgels once daily Rite Aid diphenhydramine HCl 25 mg once daily, at bedtime

Current Illness: N/A

ID: 1262684
Sex: F
Age: 42
State: FL

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data: none

Allergies: Gluten, Celexa (mouth locked closed for two weeks), adhesives, metals, shellfish

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

Symptoms: Site of injection began with soreness after one day. After two days, the site had about a 2 inch circular area of bright red around it, felt hot, was slightly swollen, was slightly itchy, and was painful to the touch. After three days, the red area got larger but not brighter, and was about 3 inches in diameter, the entire muscle in the arm is swollen and hot and was painful to the touch and it was more itchy. Today is day 5 and it it still the same, without itchiness so far. I would say when pressed on, the pain is painscale 5.

Other Meds: Pramipexole, Bupropion, Lyrica, CBD, Vitamin D, probiotics, Allegra, famotidine, sublingual immunotherapy for dust mites

Current Illness: nothing

ID: 1262685
Sex: M
Age: 31
State: CO

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/27/2021
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: N/A

Allergies: No known Allergies

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

Symptoms: Offender given 2nd shot 7 days after 1st dose. Offender denies adverse outcome.

Other Meds: None

Current Illness: None

ID: 1262686
Sex: F
Age: 58
State: MI

Vax Date: 03/01/2021
Onset Date: 04/18/2021
Rec V Date: 04/27/2021
Hospital: Y

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

Lab Data: Ct head with and without contrast. Kidney ultrasound, echocardiogram, stress test. Bloodwork

Allergies: Morphine , cipro

Symptom List: Pain in extremity

Symptoms: April 18 went to Er dizziness, fatigue, chest pain Released 4/21/2021, unstable blood pressure ( high blood pressure. Given atrovastatin high cholesterol, losartan 50 mg and metoprolol 25 mg

Other Meds: Multivitamin and vitamin D

Current Illness:

ID: 1262687
Sex: F
Age: 35
State: MT

Vax Date: 04/15/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data: Venous Ultrasound study

Allergies: nkda

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

Symptoms: Acute non occlusive thrombus of common femoral and iliac vein in left leg

Other Meds: fluoxetine

Current Illness: n/a

ID: 1262688
Sex: F
Age: 64
State: VA

Vax Date: 03/12/2021
Onset Date: 03/24/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: ibuprofen, lisinopril

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

Symptoms: Patient was driving on 3/24 when her vision became blurry in her left eye. She saw her eye doctor on 4/21 and was sent to a specialist. On 4/23 she was diagnosed with a blood clot in her left eye. She is to begin eye injections for treatment.

Other Meds: hydrochlorothiazide, valsartan, metformin, genuvia, simvastatin, venlafaxine, aleve, probiotic, anti-diarrheal, clear eyes moisture eye drops

Current Illness:

ID: 1262689
Sex: F
Age: 63
State: NC

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Fever (101 - 102.6 occurred 18 hrs after vaccination, lasting 2 days), headache (12 hours after vaccination, lasting 4 days), swollen gland in L arm (24 hours after vaccination, lasting 6 days), body aches, chills, exhaustion, and loss of appetite (12 hours after vacc, lasting 3 days)

Other Meds: Zyrtec, Pepcid AC, Lovastatin, Estradiol

Current Illness:

ID: 1262690
Sex: F
Age: 44
State: MA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Patient had a rash on left side neck, back, chest.

Other Meds:

Current Illness:

ID: 1262691
Sex: F
Age: 24
State: RI

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/27/2021
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: Eggs Dairy

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: EMS called to pt who just received first dose of Moderna. 24/F with a PMH of anxiety and migraines. Allergies to Eggs and dairy Pt started feeling dizzy and nauseous right after administration of vaccine which pt states is normal for her every time she's near medical personnel and when she gets shots. Pt was taken into hallway where vitals were taken. BP 102/71, HR 90, RR 16, SPO2 98% Vitals are within normal limits. Pt appears pale. She was given water and stated she was feeling better, skin color improved. Pt continued under observation for 30 minutes. Observer helped registrer pt and she was showed the exit when her observation time was up.

Other Meds: Epi-Pen

Current Illness:

ID: 1262692
Sex: F
Age: 28
State:

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/27/2021
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: 24 hours after receiving my 2nd Pfizer vaccine, I developed a rash on the back of my left arm. The rash has continued to worsen daily and is now over my entire body. Small bumps and hives flare-up, go away and then reappear in a different area of the body. They are itchy and sometimes burn. I was prescribed Zyrtec at an urgent care facility. I picked up some Calamine lotion and Benadryl cream. Nothing has stopped the outbreak.

Other Meds: None

Current Illness: None

ID: 1262693
Sex: F
Age: 52
State: MA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/27/2021
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: "MYCINS", DEPAKOTE, KEPPRA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: PT HAD SEIZURE LASTING <1MIN. SELF RESOLVED. PT BECAME AWAKE AND ALERT. PT REFUSED TX TO HOSPITAL AMA

Other Meds: GABAPENTIN, FLUOXETINE, WELLBUTRIN, TRAZEDONE, PANTOPRAZOLE

Current Illness: KNOWN SEIZURE DISORDER

ID: 1262694
Sex: M
Age: 39
State:

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: Needele and syringe detached while in guestes arm. estimated more than 50% of vax given

Other Meds:

Current Illness:

ID: 1262695
Sex: F
Age: 23
State: IN

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/27/2021
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: N/A

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

Symptoms: , fever, sweating, vomiting, headache

Other Meds: Abilify, lamictal, buspar, doxycycline, linzess

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am