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: 1229072
Sex: F
Age: 42
State: NC

Vax Date: 03/22/2021
Onset Date: 03/23/2021
Rec V Date: 04/19/2021
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: none known

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received second dose 4/21/21 however, she wanted us to note that she developed a localized rash after her first dose (at injection site). Rash eventually resolved on its own without medical intervention

Other Meds: unknown

Current Illness: unknown

ID: 1229073
Sex: F
Age: 62
State: CA

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Febrile : 101 degrees. chills. headache. severe body aches.

Other Meds: amlodipine lisinopril hydrochlorathiazide atenolol bupropion lamotrigine

Current Illness: none

ID: 1229074
Sex: F
Age: 62
State: CA

Vax Date: 04/09/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
Hospital: Y

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: NKDA

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

Symptoms: Cardiac arrest

Other Meds: , Gabapentin 300 mg po tid, levothyroxine 50 mcg, 1 tablet po qd, ropinirole 1 mg po tid, Oxycodone 30 mg tablet po q 8 hours, clonazepam 2 mg po bid prn, linzess 145 mcg po qd, meloxicam 7.5 mg one tablet po qd, quetiapine fumarate 2 table

Current Illness: Fibromyalgia, hypothyroidism,

ID: 1229075
Sex: F
Age: 31
State: AZ

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Levaquin, vancomycin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Rash developed on back of hands and forearms approximately 4 hours after injection. Rash was red, with raised bumps, and itchy. Treated with 25mg IV Benadryl.

Other Meds: Stelara, propranolol, pantoprazole, Provigil, clonazepam, Femcon FE, melatonin, phenergan, maxalt

Current Illness: None

ID: 1229076
Sex: M
Age: 20
State: GA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt reported dizziness and shakiness after IM injection. Diaphoretic with (+) LOC, no head injury. Pt was found responsive laying down on floor, BLEs assisted onto chair. VS laying down 134/80, HR 90, sats 97% on RA. Water and snacks given, cold compress applied to forehead. Pt was then assisted to seated position on floor, VS sitting as follows: BP 138/66, HR 97, sats 98% on RA. Pt recovered within 15 mins, ambulated out of clinic in NAD and was escorted by staff to car, was driven home by friend.

Other Meds:

Current Illness:

ID: 1229077
Sex: F
Age: 70
State: OH

Vax Date: 02/16/2021
Onset Date: 02/16/2021
Rec V Date: 04/19/2021
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: Morphine and all related products; birth control; estradiol

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

Symptoms: Minutes after receiving vaccine I felt a tingling in my head, got a mild headache, brain fog. The tingling continued down into my body. Shoulders, chest, abdomen at which time I was slightly nauseas, and then slowly on to my knees when I became weak. The effects went on for several hours. These episodes went on for approx. 7 weeks. Not daily. In fact I didn't have another episode for several weeks. But at one time I had 11 days in a row. They lasted up to 4 hours. And several times I felt as though I would collapse when the effects reached my knees. But on the last week of the episodes, I could tell they were getting milder.

Other Meds: prevastatin 40; probiotic; allergy pills

Current Illness: none

Date Died: 04/15/2021

ID: 1229079
Sex: F
Age: 78
State:

Vax Date: 02/27/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Death

Other Meds:

Current Illness:

ID: 1229080
Sex: F
Age: 41
State: CO

Vax Date: 03/08/2021
Onset Date: 03/19/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Patient is a 41 yo woman with no PMH who presented to an outside urgent care with left flank pain found to have a wedgelike defect in the posterior left lower renal pole suggestive of a renal infarct. She underwent CTA which did not show any embolism, thrombus, dissection. The radiologist did note mild beading of the bilateral renal arteries, however the radiologist at Valley View reviewed the images as well and was not as convinced. Left renal infarct: Given suggestion of mild feeding of the bilateral renal arteries, patient underwent CTA of the chest, head and neck which did not show any other signs of fibromuscular dysplasia. Echocardiogram did not have any thrombus or decrease in function. Patient did not have any arrhythmias on telemetry. Blood cultures were ordered and pending on discharge, but patient did not have any of endocarditis A hypercoagulable work-up including factor V Leiden, protein C, protein S, Antithrombin, lupus anticoagulant, beta-2 microglobulin, anticardiolipin antibodies were all sent and are pending at the time of discharge Discussed the case with hematology at hospital: Most experts treat with 3 months of anticoagulation other evidence is not entirely clear and aspirin 81 mg may be a reasonable choice. In light of the patient's lack of insurance, decision was made to treat with 1 month of apixaban followed by 81 mg of aspirin daily indefinitely Discharged with a short course of oxycodone 5 mg #15

Other Meds: Vitamin B-12 500 mcg tablet ibuprofen 200 mg capsule take 3 capsule by oral route every 8 hours as needed cyclobenzaprine 5 mg tablet take 1 tablet by oral route every day at bedtime Calcium 500 + D 500 mg (1,250 mg)-200 unit tablet

Current Illness: Ovarian Cyst

ID: 1229081
Sex: F
Age: 49
State: AZ

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Patient denied Hx of allergies to medication and food. No prior immunization reactions noted.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient returned to observation area two hours post injection complaining of LA pain. Medic on site observed some swelling to the LA and proceeded to provide an ice pack. After further assesment patient did not appear in any distress and was instructed to stay in observation for an additional 30 min. At approximately 1300 the patient began scratching the vaccinated arm and mumbling in a language we could not understand. Immediately the interpreter was called and we prepared for an adverse reaction. Two of our LPNs began taking vitals, One RN began assessing the site where we noted possible infiltration to the subcutaneous tissues. We then moved the patient to a private room. RN chart note: "Patient crying sitting in chair, complains of L arm pain. Left arm swollen, softball size, hard to touch, patient sensation remains intact, left radial pulse +2 and present, patient can wiggle all fingers on command. Patient initially denied Benadryl, however after educated with safety and calling 911, patient denied ambulance, and agreed to IV placement. 20 g IV placed in Right AC, 50 mg IV push Benadryl once for swelling and itching of arm spreading in size, 500mL LR bag hung, Patient A0x4 on room air answering questions appropriately. Patient denied ambulance service at this time. Patient states headache is stronger and chest pain decreased." Patient then fell asleep and approximately at 1400 awoke with red eyes, continued headache that had gotten worse. BP retaken and was 162/102. At this point we decided we would need EMS to respond. With the language barrier and poor past medical history, we did not find it appropriate to continue treating the patient on site. She was still A&Ox4, denied restricted airways or significant chest pain. Our medical director was alerted of the event and instructed us to call EMS despite patient refusal. EMS arrived by 1430 and assessed patient, she finally agreed to transport.

Other Meds:

Current Illness: Patient denied recent illness and prior SARS-CoV-19 illness.

ID: 1229082
Sex: F
Age: 59
State: MO

Vax Date: 04/07/2021
Onset Date: 04/10/2021
Rec V Date: 04/19/2021
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: Chloroquine Antbiotics

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Flu like symptoms with fever of 101? for over a week. Now continue to have joint pain and EXTREME Hot Flashes that feel like I am in menopause again!

Other Meds: Stopped for vaccine do to recommendations

Current Illness: Sinus Infection

ID: 1229083
Sex: F
Age: 60
State: KS

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: PCN Levaquin Tetracycline Biaxin

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

Symptoms: SVT requiring an ER visit Diltiazem IV Increase in metoprolol Clinic and cardiologist follow up

Other Meds: Gabapentin Levothyroxine Metoprolol Atorvastatin Bupropion SR Clopidogrel ASA escitalopram Albuterol

Current Illness: none

ID: 1229084
Sex: F
Age: 41
State: IN

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Extreme exhaustion to the point I had to be helped inside my home by my family as well as neck and back pain. My neck and back are still not great today but much better than they were. I am wondering if the nurse hit a nerve maybe?

Other Meds:

Current Illness:

ID: 1229085
Sex: U
Age: 16
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received the Moderna vaccine prior to approval from the FDA of 18 year old requirement.

Other Meds:

Current Illness:

ID: 1229086
Sex: M
Age: 28
State: UT

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: codeine

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

Symptoms: Patient reported dry throat, then was observed for an additional 10 minutes. Patient had normal vitals when monitored.

Other Meds:

Current Illness:

ID: 1229087
Sex: F
Age: 65
State: CA

Vax Date: 03/28/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: My left arm pit started hurting to the touch and when lifting and moving arm. My arm pit is swollen and when pushing/feeling it when inspecting, it was very painful. I felt little tiny nodules. I sometimes take ibuprofen. The pain is still ongoing.

Other Meds: Estrodiol, Levo-thyroxin, Lisinipril, Atorvastatin

Current Illness:

ID: 1229088
Sex: M
Age: 51
State: MI

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 04/19/2021
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 was administered a Pfizer Covid-19 vaccine that was exposed to a temperature excursion. (Vaccine was between 8-14.5 degrees C for 7hrs and 48 minutes). Pfizer was contacted and advised the clinic to consider the dose as invalid and to revaccinate. Patient was revaccinated 03/19/21 and has since received dose 2 on 04/09/21

Other Meds:

Current Illness:

ID: 1229089
Sex: F
Age: 89
State: GA

Vax Date: 02/22/2021
Onset Date: 02/26/2021
Rec V Date: 04/19/2021
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: NKA

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

Symptoms: Patient states that after she received her vaccine she was moving the hose to the pool and twisted. She is unsure if her right shoulder is sore from the vaccine or moving the pool hose. She states that it became sore after 4-5 days and moving the hose. She called her provider and pharmacy and they instructed her to notify and use a warm compress on her arm and take advil.

Other Meds: hydrocodone 3x daily, 5/325mg zanax 0.5mg, 4 times per day lisinopril dose ? lipitor dose? baby aspirin daily

Current Illness: injured vertabra, lumbar region

ID: 1229091
Sex: F
Age: 78
State: WI

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient reports receiving 2nd dose of Moderna vaccine on 4/16/21. In the morning on 4/17/21 patient noticed a fist sized red area on her right arm beneath where she received the injection. Patient reports taking a shower and noticing that the area was larger later in the day. Client denies any pain, warmth, swelling, itching, discharge, or fever. Client denies any shortness of breath or difficulty breathing. Client advised to monitor the area and follow up with her provider if she develops any signs of infection, the area is getting larger, or it does not seem to be improving.

Other Meds: Patient reports taking Synthroid and BP medications.

Current Illness: unknown

Date Died: 04/14/2021

ID: 1229092
Sex: F
Age: 62
State: MN

Vax Date: 03/11/2021
Onset Date: 04/14/2021
Rec V Date: 04/19/2021
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: PATIENT GOT FIRST MODERNA DOSE 03/11/2021 AND SECOND DOSE 04/08/2021 AND PASSED AWAY ON 04/14/2021

Other Meds: METOPROLOL, DIGOXIN, SPIRIVA, OMEPRAZOLE, ALBUTEROL

Current Illness:

ID: 1229093
Sex: M
Age: 30
State: WI

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: On april 5th i had my first dose. From 1-2 days i had few symptoms like headach, tireness & injection site pain. Since it's been 2 weeks i still have few symptoms like mild headach, tiredness(full body pains), but those are not often (is there anything i need to worried)

Other Meds: No

Current Illness: After vaccination, i do have some mild headach and body pains (even it happens now)

ID: 1229094
Sex: F
Age: 57
State: OH

Vax Date: 04/02/2021
Onset Date: 04/12/2021
Rec V Date: 04/19/2021
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: voltaren

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

Symptoms: sore arm 3 days, couldnt lift arm

Other Meds: ibprofen 800, tramadol 50

Current Illness:

ID: 1229095
Sex: F
Age: 76
State: TX

Vax Date: 02/27/2021
Onset Date: 03/05/2021
Rec V Date: 04/19/2021
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: Sulfer drugs, leviquin, contrast dye, diamox, dilaudid, metronidazole, shell fish

Symptom List: Unevaluable event

Symptoms: Blood Clot in Lung, diagnosed March 27, 2021

Other Meds: Allopurinol, 300 mg Cefuroxime Axeti, 500 mg Citalopram HBR, 20 mg Digoxin, 125 mG Ditlazem 24 H, 120 Eliquis, 5 mg Fluocinolone Glipzide 5 mg Heartburn relief 20mg Iron, 65 mg Leovthyroxine, 25 mcg Lidocaine 5% patch magic mouth wash, 10 m

Current Illness: Allergies

ID: 1229096
Sex: F
Age: 35
State: CA

Vax Date: 04/08/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: Swollen lymph nodes (neck), sore throat - more sore externally than internally, redness and swelling at injection site, mild vertigo. All presented 8 days post injection, lasted 4 days

Other Meds: Flaxseed oil, women's multivitamin

Current Illness: none

ID: 1229097
Sex: F
Age: 55
State: NY

Vax Date: 04/18/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
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: penicillin, erythromycin, sulfa drugs, betadine iodine skin disinfectant, Griseofulvin, Diclofenac

Symptom List: Injection site pain, Pain

Symptoms: At time of injection, a significant portion of the vaccine spurted out of my skin and ran down my arm, the following morning there was a large lump under the injection site that was soft, movable and painful, also there was a slight rash around the injection site, after some squeezing and itching, the lump became hard and painful, the rash covered more area of the arm and the pain spread under the arm to the lymph nodes.

Other Meds: levothyroxine, multivitamin, probiotic

Current Illness:

ID: 1229098
Sex: F
Age: 53
State: IA

Vax Date: 04/14/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Latex adhesive

Symptom List: Injection site pain, Menorrhagia

Symptoms: Red bump at injection site, very warm to the touch and very itchy

Other Meds: Zoloft, Metformin, Allopurinol, Atorvistatin

Current Illness: none

ID: 1229099
Sex: M
Age: 27
State: GA

Vax Date: 03/13/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: On day 3 following, 2nd dose of Pfizer vaccine, he had right sided calf pain. Initially thought to be recurence of strain injury, although no history of trauma or obvious trigger. Pain conitnued to worsen and had different characteristics than original strain symptoms. Continued to worsen to point wher eunable to weight bear and swollen, hot and red. Saw orthopedist who refered to vascular surgeon, and on day 13 was officially diagnosed with large DVT extending form tibeal & peroneal, popliteal up to the femoral veins. Has no known clotting defects. Currently under evaluation with hematologist who recommended anticoagulants for remainder of his life.

Other Meds: none

Current Illness: calf strain

ID: 1229100
Sex: F
Age: 53
State: KY

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/19/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Extreme fatigue. Inflamed muscle, nerve pain, from fingers to shoulder blade, including pain in neck, right side of chest and breast, right armpit, arm, hand, finger, shoulder and shoulder blade, tingling in right fingers, fingers and hand extremely cold, sometimes burning sensation up and down arm, right arm range of motion is not high, grip is very weak, arm is very weak. Treatment: taking Ibuprofen.

Other Meds: Modafinil, Vitamin D3 tablets, Iron tablets, Vitamin C tablets, Hair, Skin and Nails capsules.

Current Illness: None.

ID: 1229101
Sex: M
Age: 16
State: PR

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
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: first a luttle fever, then rash in the body on Saturday with itch. On Sunday, the rash was there but mild Ob Monday, around 12:00 start to itch again and the rash was medium. Need to provide a Benadryl to calm the itch.

Other Meds: nond

Current Illness: none

ID: 1229102
Sex: F
Age: 52
State: MA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/19/2021
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: NKA

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

Symptoms: Pt first called on 4/13 to report throat and tongue tightness 3 hrs post first Pfizer vaccine. She tried Allegra with no response. She then called today to report symptoms that are continuing that she related to the first Pfizer vaccine. She started to experience lip swelling and tinglings as of 4/16. Her PCP instructed her to take Benadryl, and she has had good relief with that. Her throat and tongue tightness have improved since 4/13.

Other Meds: Macrobid PRN

Current Illness: hypothyroidism hypercholesterolemia

ID: 1229103
Sex: M
Age: 69
State: CA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea

Symptoms: I became and felt very medicated with glassy eyes. That lasted for four days. During that time, I experienced slight chill for about 30 mins/one day, and headaches off an on for about three days. I also felt somewhat tired - as if I never slept. That lasted about three days off and on albeit I went about my normal activities. For the headaches, I just took aspirin. The rest I let go it's course. I began to feel my real self about the fifth day, and then everything was fine.

Other Meds: Benazepril, Pravastatin, Albuterol, Wixela, Zolpidem, aspirin

Current Illness:

ID: 1229104
Sex: F
Age: 45
State: WI

Vax Date: 03/12/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient has been diagnosed covid positive after completing moderna series

Other Meds:

Current Illness:

ID: 1229105
Sex: M
Age: 42
State: CA

Vax Date: 03/22/2021
Onset Date: 03/29/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Shrimp

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

Symptoms: I developed Shingles approximately 1 week after vaccine was administered. My PCP placed me on 7-day antiviral course. Still having itching and discomfort even after rashes cleared up.

Other Meds: Advil

Current Illness: None

ID: 1229106
Sex: F
Age: 58
State: AZ

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient received 1st dose of Moderna COVID vaccine on 03/23/2021. When she woke up the next morning her lymph nodes were swollen and within 3 days she was in the Emergency Room . They did a CT with contrast from the neck up and sent her home with antibiotics. Her lymph nodes and tongue were still swollen so she went back to the ER where they did a CT with contrast from the neck down. Based on their findings they sent her via ambulance to the hospital in where she was admitted for 6 days and received IV antibiotics. She was released on 4/11/2021 and sent home with Augmentin and a Medrol Dosepak. Patient reported this adverse reaction to the pharmacy on the morning of 4/19/2021.

Other Meds:

Current Illness:

ID: 1229107
Sex: M
Age: 16
State: CA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/19/2021
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: Patient received the Moderna vaccine prior to approval from the FDA of 18 year old requirement.

Other Meds:

Current Illness:

ID: 1229108
Sex: M
Age: 84
State: TX

Vax Date: 03/11/2021
Onset Date: 04/01/2021
Rec V Date: 04/19/2021
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: Erythema, Pruritus

Symptoms: Itchy rash on torso, legs & arms.

Other Meds: Levothyroxine, Gabapentin, Doxepin

Current Illness: None

ID: 1229109
Sex: F
Age: 72
State: MI

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
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: PCN, Sukfa drugs

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

Symptoms: tightness to throat releaved by epi

Other Meds: ASA 81 mg Fosamax, Zoloft, senokot vit D

Current Illness: none

ID: 1229110
Sex: F
Age: 48
State: AZ

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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: Ceclor Bananas Melon

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

Symptoms: Shot received at approx. 10:45 am on 4/17/2021. Started feeling very tired in afternoon, by 6pm on same date, completely exhausted, achy and headache, sore arm, started having chills on and off 4/18/20 - woke up at approx. 4am crying in excruciating pain. I literally hurt from my hair to my toe nails and everything in between. More than regular muscle aches, could barely function. At some point during the day, I developed a fever. Several times checked thru the day, maintained around 100. Complete exhaustion 4/19/20 - woke up approx. 6am. The excruciating pain had moved to extremely sore muscle, still exhausted, no longer have fever. Notice swollen lymph nodes on left side. I have a welt about the size of a baseball located next to my armpit towards my left breast. VERY swollen and painful. Injection site is still sore and very hot. Fatigue is still keeping me from working. I had to call out sick to work today.

Other Meds: Vyvanse Lo Ogesterol Singular Spironolactone Metformin ER Zyrtec Vitamin D Omega 3 Probiotic Multi vitamin B12

Current Illness: None

ID: 1229111
Sex: F
Age: 59
State: OH

Vax Date: 03/19/2021
Onset Date: 04/02/2021
Rec V Date: 04/19/2021
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: PENICILLIN SULFA ANITBIOTICS PROCHLORPERAZINE MALEATE

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT STATES THAT 2-3 WEEKS POST RECEIPT OF VACCINATION SHE BEGAN HAVING SEVERE NECH PAIN ON THE RIGHT SIDE (SAME SIDE OF BODY AS VACCINATION), BRAIN FOG, AND AN UNUSUAL TASTE IN MOUTH. SHE IS STILL EXPERIENCING THESE SYMPTOMS. SHE ALSO DEVELOPED DIFFICULTY BREATHING AND HAS BEEN PRESCRIBED SPIRIVIA RESPIMAT. (SHE WAS EVALUATED BY HER PHYSICIAN FOR THIS) SHE HAD SEVERE ANXIETY REQUIRING EMT EVALUATION ON APRIL 15, 2021.

Other Meds: LISINOPRIL-HCTZ 10-12.5MG HYDROCODONE/IBUPROFEN 7.5/200MG

Current Illness:

ID: 1229112
Sex: F
Age: 59
State: NY

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 04/19/2021
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: None

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

Symptoms: Fever, Nausea, Chills, diarrhea, fatigue On March 11, I noticed a rash on my stomach. It looked like welts. It wasn't itchy and I didn't feel anything.

Other Meds: None

Current Illness: None

ID: 1229113
Sex: F
Age: 26
State: CA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: PATIENT WAS ADMINISTERED THEIR SECOND DOSE OF MODERNA COVID-19 VACCINE 22 DAYS AFTER RECEIVING THEIR FIRST DOSE INSTEAD OF THE MINIMUM 24 DAYS REQUIRED. THE DOSE WAS FLAGGED AS INVALID IN THE PATIENT'S IMMUNIZATION RECORD. THERE ARE NO KNOWN ADVERSE EVENTS ASSOCIATED WITH THIS PATIENT AT THIS TIME. THE PATIENT INDICATED ON AGENCY FORM PREVACCINATION CHECKLIST FOR COVID-19 VACCINES QUESTION 2 THAT SHE HAD NOT PREVIOUSLY RECEIVED ANY DOSE OF COVID-19 VACCINE. If a dose is inadvertently administered before the 4-day grace period, it does not need to be repeated. This means that when reviewing records, a second dose of Moderna COVID-19 Vaccine administered 23 or less days after the first dose does not need to be repeated. This is considered a vaccine administration error. Determine how the error occurred and implement strategies to prevent it from happening again. Additionally, you are required to report COVID-19 vaccine administration errors to the Vaccine Adverse Event Reporting System

Other Meds:

Current Illness:

ID: 1229114
Sex: F
Age: 22
State: CA

Vax Date: 03/24/2021
Onset Date: 04/09/2021
Rec V Date: 04/19/2021
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: Pain in extremity

Symptoms: This is my first pregnancy and I got pregnant on January 20th of 2021 and I miscarried on April 9th 2021 after my first dose of the Covid vaccine

Other Meds:

Current Illness:

ID: 1229115
Sex: F
Age: 48
State: CA

Vax Date: 04/09/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
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: I have a 5X8cm rash on top of my injection site. Just an oval patch of red & itchy skin.

Other Meds: none

Current Illness: none

ID: 1229116
Sex: F
Age: 45
State: KY

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/19/2021
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: Cefdenir

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

Symptoms: Swollen vein on top of hand like a blown vein.

Other Meds: Estradiol Bispurione

Current Illness: None

ID: 1229117
Sex: F
Age: 64
State: FL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/19/2021
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: Codeine.

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

Symptoms: She got the vaccine and 10 hours later started getting body aches like an intense workout. Then 13 hours later for about an hour her whole body shook/trembling and could not stop (not chills). She had a mild temp of 99, she was very thirsty so she drank water. Then she became sick to her stomach, and she drank more water and ate crackers but that did not help. She threw up 3 times and had to stay in bed all that day. The next morning she felt better, was not great, but was able to go to the grocery store. Then on 4/12/21, she woke up hoarse like with laryngitis. Then on 4/13/21 she still had the laryngitis. Then on 4/15/21 she was a new person, could breath better, she felt good, nothing ached it was just amazing and she continues to be able to breath which she has not been able to in 15 years ago. Once a year they normally have to go in and stretch something, and felt that it was coming on after the 1st vaccine.

Other Meds: One a day vitamin, Pantoprazole, fish oil, Asmanex, Fluticazone, Rosuvastatin.

Current Illness: None.

ID: 1229118
Sex: F
Age: 30
State: IN

Vax Date: 04/13/2021
Onset Date: 04/15/2021
Rec V Date: 04/19/2021
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: Morphine Gluten free

Symptom List: Vomiting

Symptoms: I was diagnosed with shingles on 3-18-21. I started having a rash on 3-15-21. I have been prescribed medication that I just started. I am breastfeeding and my son developed a rash on 3-15-21. The rash spread from his stomach to his entire body. The rash turned bright red and bumps were visible on his entire body. The redness decreased starting on 3-17-21. He was seen by a doctor on 3-19-21 and told it is a viral rash likely from the vaccine but nothing can be done.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1229119
Sex: F
Age: 23
State: MI

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/19/2021
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: mold, dogs, weeds, gluten

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Appx 2-3 mins following vaccine administration pt had generalized Tonic-clonic seizure with apnea. Seizure lasted appx 30-45 seconds. Pt gently laid on floor by mother and clinic staff. Pt with very brief post-ictal period. Pt evaluated by EMS and pt's mother requested discharge home and follow with neurologist. Pt with history of epilepsy,no rescue medication, last seizure appx 2 years PTA.

Other Meds: Vimpat

Current Illness: N/A

ID: 1229120
Sex: F
Age: 29
State: OH

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/19/2021
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: NA

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

Symptoms: Skin sensitivity, high fever for 12+ hours, chills, collapsing, headache, body aches

Other Meds: Generic Prenatal and 6000 iui Vitamin D daily

Current Illness: NA

ID: 1229121
Sex: F
Age: 51
State: AZ

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/19/2021
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: Sulfa, Penicillin, Egg and yeast food sensitivity.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Left arm at injection site is red and swollen and very sore. Had fever of 102.5 all day yesterday (16 hours), couldn't break it with advil, but was able to reduce it to 100.2 for about 2 hours, before climbing right back up. Very fatigued, slept all day. Today, slight fever of 99.5 and still fatigued but feeling much better than yesterday.

Other Meds: multi vitamin, vit e, vit D

Current Illness: none

ID: 1229122
Sex: F
Age: 59
State: IL

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 04/19/2021
Hospital:

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

Lab Data:

Allergies: Codeine & pears

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

Symptoms: Blood clots-1. 4/14/21 @ 1:35 pm on right side of mouth where the tooth was pulled. Tooth on the right was pulled on 4/9/21 @ 10:00 am. This is the side the abscess was on & 10 day amoxicillin was prescribed. 2. 4/17/21 @ 12:31 am woke up blood on pillow went to bathroom rinsed mouth out blood cloth came out just like the same as 4/14/21. Prior to vaccine no problems.

Other Meds: Tylenol & allergy medication

Current Illness: Abscessed that happened on March 23rd with 10 day supply of amoxicillin & allergies. 2nd blood clot occurred on 4/17/21 @ 12:30 am.

ID: 1229123
Sex: F
Age: 57
State: MD

Vax Date: 03/07/2021
Onset Date: 03/08/2021
Rec V Date: 04/19/2021
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: None

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

Symptoms: Muscle, tendon, joint aches, back ache; usually when I use my Valtrex, my symptoms go away within two days. I have had the symptoms for almost 2 weeks.

Other Meds: Valtrax, turmeric, Zoloft, blood thinner for hair loss, viviscal, progesterone

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm