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: 1229228
Sex: M
Age: 68
State: FL

Vax Date: 04/03/2021
Onset Date: 04/04/2021
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: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: After receiving the vaccine I returned to work and then went home, ate dinner, showered and bed. The following morning (Easter Sunday) I woke up at approximately 07:00 AM and when I got out of bed my legs (bi-laterally knee pain) were so weak that I almost fell down, I had to hold on to various furniture and walls to get to the bathroom. This weakness and joint pain has been constant and continuous and is still ongoing as of this writing. On 4/8/2021 I called my private physician, and explained what was happening and he prescribed me METHYLPREDNISOLONE 4 MG DOSEPK (medrol). I took the medication as prescribed and had no relief. On 4/14/2021 I went to ER and had X-rays taken of both knees and was sent home with a suggestion to follow-up with my private physician (on vacation until 4/26/2021) whom I have a telemedicine call scheduled with for that same day 4/26/2021. I have scheduled an appointment with an Orthopedic Specialist now on 4/20/2021 @ 3:20 PM for an evaluation.

Other Meds: Famotidine 40 mg. D3, B12, Zinc, Glucosimine Chondrontin, Testosterone

Current Illness: NONE

ID: 1229229
Sex: M
Age: 64
State: GA

Vax Date: 03/15/2021
Onset Date: 04/09/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: Morphine, Poison Ivy

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient awoke 04/09/2021 with visual disturbance and limited field of vision. Went to eye center and was evaluated. MD at eye center sent him to ER and told patient that it appeared he was having a stroke. Admitted to medical center 04/09/2021. Patient reports he was diagnosed with a stroke affecting the occipital region that affects his vision. Patient was discharged from the hospital 04/11/2021.

Other Meds: Eliquis, Sotalol, Vit B 12, Catalyst 7, Microactive Coq10, Xen

Current Illness: None

ID: 1229230
Sex: M
Age: 65
State: FL

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 04/19/2021
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: no

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

Symptoms: Chronic cough and congestion.

Other Meds: Zyrtec-d, aleve

Current Illness: none

ID: 1229231
Sex: F
Age: 35
State: CO

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vertigo, Dizziness, Mild stomach pain- lasted 24 hours

Other Meds: No

Current Illness: No

ID: 1229232
Sex: F
Age: 56
State: IL

Vax Date: 03/27/2021
Onset Date: 03/27/2021
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: None

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

Symptoms: 7.5 hours after receiving the Covid19 Vaccine, my nasal passages started burning. After about 30 min of my nasal passages burning (they continued to burn), I had a sudden onset of severe pain across my face in my sinus's. My upper teeth were also in pain. I could not drink anything hot or cold because it would cause a sharp shooting pain through my sinus's and would take several mins to subside. The pain continued the next day, so I went to immediate care but they refused to give me an antibiotic. They gave me a Covid test which was negative. 4 days after the extreme pain in my sinus's and teeth, I still had severe pain on the left side of my face, ear and teeth. I called my primary care physician and she prescribed a 10 day Augmentin antibiotic. Finally my pain subsided 7 days after my vaccine (3 days after the start of antibiotics). 2 days after I finished the antibiotics, I had a sudden onset of severe pain in my hips and lower back, the pain persisted for a week. I went for acupuncture treatment and this eased my pain. I just had my 2nd dose of the Covid19 vaccine and did not have any side effects.

Other Meds: Vitamin D and Iron

Current Illness: None

ID: 1229233
Sex: F
Age: 53
State: TX

Vax Date: 04/17/2021
Onset Date: 04/17/2021
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: NONE

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

Symptoms: About 8 minute after injection patient begin to get dizzy and become unresponsive for about 2 minute, her blood pressure was taken and was 80/90 EMS arrived about 417pm by then she was sitting up and responding to command

Other Meds: NONE

Current Illness: NONE

ID: 1229234
Sex: F
Age: 57
State: ID

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

Lab Data:

Allergies: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Ran a fever for 48 hours; several times over 105. Extreme joint and bone ache in forearms and shins to the point where it was too painful to move. most side effects ended 72 hours after injection but I am still experiencing a random and lower pain level in my forearms and dizzy spells.

Other Meds: OTC flonase and zrytec

Current Illness: none

ID: 1229235
Sex: F
Age: 60
State: CT

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient had syncopal episode falling from seated position in chair 10 minutes after vaccination. Pt had low BP and was transported to the hospital

Other Meds:

Current Illness:

ID: 1229236
Sex: M
Age: 67
State: PA

Vax Date: 04/09/2021
Onset Date: 04/18/2021
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: no known allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Per history, patient experienced a ground-level fall early 4/16, and was noted to have weakness on his left side. Patient was brought to the ER 4/18 with concern for CVA, found to have acute pulmonary embolism.

Other Meds: aspirin 81mg daily, atorvastatin 10mg daily, diclofenac 50mg bid prn, duloxetine 20mg daily, gabapentin 300mg bid

Current Illness: no known

ID: 1229237
Sex: M
Age: 71
State: TN

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: Cefaclor - severe swelling/hives

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 71-year-old male with lengthy past medical history presenting to the emergency department with fever (100.1) and chills on 4/8/21. Patient developed fever and chills after receiving the 2nd dose of his Moderna COVID vaccine on 4/7/21. He denies any cough nausea vomiting diarrhea chest pain shortness of breath or other symptoms. He triaged in the ER. His labs were within normal limits and his chest x-ray was negative for any acute infection. His troponin in the lab is slightly above the reference range however he has had elevated troponins in the past. He was given ASA and Morphine in the ER. He was discharged from the ER, but was so weak he was unable to ambulate to his car, so he was admitted for overnight stay/observation. In the hospital, he was continues on his home meds, and was discharged home on 4/8/21.

Other Meds: Apixaban 5 mg po BID, Entresto 24/26 mg PO BID, Magnesium Oxide, Loratidine, Spironolactone, Torsemide, Aspirin, Insulin Aspart, Sertraline, Metformin, Donepezil, Oxycodone/Apap, Insulin Degludec, Dulaglutide, Fesoterodine, Cholecalciferol

Current Illness:

ID: 1229238
Sex: F
Age: 17
State: NY

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

Lab Data:

Allergies: none reported

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

Symptoms: I gave the patient the immunization. She seemed fine after getting the shot. I asked her to go outside the immunization room and wait 15 minutes for observation. Immediately upon leaving the room, she felt dizzy and made it to the chair to sit down, when she said she briefly blacked out. By that time, her father arrived, and gave her some orange juice to drink. She said she was starting to feel better, but that her stomach felt queasy. After15 minutes, the patient was feeling better and walked out with her father with no other reports of problems.

Other Meds: unknown

Current Illness: none reported

ID: 1229239
Sex: M
Age: 43
State:

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

Symptom List: Rash, Urticaria

Symptoms: vasovagal reaction with dyspnea

Other Meds: amlodipine, Entyvio infusion

Current Illness:

ID: 1229240
Sex: M
Age: 21
State:

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:
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: Syncope

Other Meds:

Current Illness:

ID: 1229241
Sex: F
Age: 69
State:

Vax Date: 03/18/2021
Onset Date: 03/25/2021
Rec V Date: 04/19/2021
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:

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

Symptoms: Patient hospitalized within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1229242
Sex: F
Age: 40
State: IL

Vax Date: 03/31/2021
Onset Date: 03/31/2021
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: None

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

Symptoms: Approximately 12 hours after vaccination, I experienced chills, fever, sever muscle aches and joint pain, eventually sweating. Symptoms subsided 24 hours after vaccination, and had completely subsided by 48 hours after vaccination.

Other Meds: St. John?s Wort 300mg daily

Current Illness: None

ID: 1229243
Sex: F
Age: 34
State: FL

Vax Date: 04/15/2021
Onset Date: 04/17/2021
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: Feeling lightheaded and dizzy for 3 days already

Other Meds:

Current Illness:

ID: 1229244
Sex: M
Age: 52
State: MA

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

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

Lab Data:

Allergies: No known allergies

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

Symptoms: 4 episodes of nausea/vomiting/diarrhea, then found by spouse with altered mental status and nonresponsive/snoring. Taken to Emergency department for stroke evaluation. Ruled out for stroke, intubated for airway protection and cerebral edema with meningeal enhancement observed on CTA. Admitted to ICU.

Other Meds: Amlodipine 5 mg PO daily; Baclofen 10 mg PO BID x 28 days; Fluoxetine 40 mg PO daily; gabapentin 300 mg PO TID; Lisinopril 40 mg PO daily; simvastatin 40 mg PO daily; tramadol 100 mg PO TID PRN x 28 days Ashwagandha (adaptogenic supplement)

Current Illness: chronic back pain

ID: 1229245
Sex: F
Age: 39
State: VA

Vax Date: 04/07/2021
Onset Date: 04/16/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient had Pfizer COVID vaccine # 2 on 7 April, 2021. Starting on 16 April - she developed a rash to each upper arm. Rash was red, very itchy, and painful. Worst symptoms were on 17 April. Cortisone -10 cream did not make an improvement. Exam with macular rash to each upper arm with mild warmth, redness. and tenderness (that is not cellulitis.) Rash is consistent with "Covid Arms" delayed vaccine response. Patient seen in Dr's office (my clinic) on 19 April.2021. I prescribed atarax and triamcinolone cream for symptom relief.

Other Meds: none

Current Illness: none

ID: 1229246
Sex: M
Age: 48
State: CA

Vax Date: 04/18/2021
Onset Date: 04/18/2021
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: Mustard (causes digestive challenges)

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pain at injection sight (upper arm) has spread from up and down the left side of my body. My left hand is cramping, and gripping anything is painful. My left shoulder and neck are cramping (up to my ear) and raising my arm is painful. Even my left knee is bothering me. The amount of discomfort is surprising. I had none of these symptoms prior to the injection.

Other Meds: None

Current Illness: None

ID: 1229247
Sex: F
Age: 32
State: MA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: Unknown

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

Symptoms: Patient has history of period v tach. 9:26 Vtach. 0xygen 99%, heart skipping, bp 140/90 (normal range (110/70) Some dizziness 9:35 BP 140/86 9:46 BP 130/96 P-100 with bcc skipped beat 9:55 Patient feels okay and dizziness has resolved. Cleared by Dr. Feels well enough to go home. Husband is paramedic so he will take her to the station for a cardio strip and she will go to ER if she feels unwell.

Other Meds: Unknown

Current Illness: None

ID: 1229248
Sex: M
Age: 68
State: MN

Vax Date: 03/04/2021
Onset Date: 04/02/2021
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: Ibuprofen, shellfish

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

Symptoms: DVT leg leg: leg pain started around 3/24, then he developed swelling on 4/2 and a DVT was diagnosed on 4/3. He had been on Xarelto 10 mg daily for history of recurrent DVT (had never had one while on anticoagulation) at the time this was diagnosed.

Other Meds: rosuvastatin, rivaroxaban 10 mg daily, probiotic, prostate health supplement, magnesium supplement

Current Illness: Mild asthma flare

ID: 1229249
Sex: M
Age: 47
State: IL

Vax Date: 03/02/2021
Onset Date: 03/03/2021
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: none

Symptom List: Unevaluable event

Symptoms: Initially after second vaccination had fever, chills and fatigue....sweating and waking up in cold sweats(03/03/21-03/04/2021), a week later noticed muscle twitches in body hands neck and arms, it has continued. mid march woke up in cold sweat, no fever April 16 woke up in cold sweat...no fever muscle twitches continue

Other Meds: Alprazolam as needed

Current Illness: none

ID: 1229250
Sex: M
Age: 75
State: PA

Vax Date: 02/05/2021
Onset Date: 02/18/2021
Rec V Date: 04/19/2021
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: HPI: Chief Complaint: L sided weakness HPI: 75M with HTN, mild cognitive impairment who presented with L sided weakness and neglect. I spoke with wife who stated she was with the patient today, he worked outside shoveling and snow blowing with the winter storm. She saw him minutes before 4pm (she estimated 3:58p) and he was his normal self, then she walked to another room, called out to him, he didn't respond, so she ran back to where he was and saw him slumped over and weak on the L, she immediately called 911. She has record on her phone of calling a family member (daughter?) about this at 4:01, right after she had called 911, so LKN consider just before 4pm. Patient states he takes only medications for hypertension at home. Denies being on any blood thinners and no record of blood thinners in his chart. Denies recent surgeries, denies history of ICH, denies bleeding issues in the past, denies ever having had a prior stroke. BG 122 on arrival. BP initially 121/84 then increased requiring some labetalol.

Other Meds: Medications: Current outpatient prescriptions: 1) Amlodipine besylate 5 mg or tabs, 1 tablet daily 2) Finasteride 5 mg or tabs, 1 tablet daily 3) Losartan 25 mg tablet, take 25 mg by mouth daily. 4) Meloxicam 7.5 mg tablet, take 7.5 mg by m

Current Illness: None

ID: 1229251
Sex: F
Age: 52
State: CA

Vax Date: 02/13/2021
Onset Date: 02/14/2021
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: zoloft

Symptom List: Injection site pain, Pain

Symptoms: After the first shot, headache started the next morning and has not stopped, it gets worse with exercise, or work, goes up and down in intensity depending on what I am doing. After the second shot, the headache got worse. It pushed my borderline high blood pressure from 135/80 to 158/80 and now I am on blood pressure meds to bring it down. Ibuprofen 800 does nothing to the headache, it's just always there. It's over 2 months now, and I can't get rid of this headache. Fingers and Toes also "ache", like a bone ache, weird feeling I have never had before, that also started the day after the first dose. I also got the fever, nausea, but those went away after 72 hrs. The headache and the finger/toe bone ache have not.

Other Meds: Vitamin D, Probiotic,

Current Illness: None

ID: 1229252
Sex: F
Age: 17
State: IA

Vax Date: 03/19/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Just sore arm. Patient was underage for the vaccine.

Other Meds:

Current Illness:

ID: 1229253
Sex: F
Age: 18
State: AL

Vax Date: 04/07/2021
Onset Date: 04/07/2021
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:

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

Symptoms: 1328 - Father stated daughter didn't feel well - walked to stretcher and fainted. 1330 - Patient awake, VS taken, on stretcher, color improved, talking. BP = 98/53, HR = 74, RR = 22, O2 Sat = 100% 1335 - Patient sitting up. 1340 - Patient talking, drinking soda. BP = 117/76, HR = 80, RR = 22, O2 Sat = 100% 1350 - Patient's color pink, in no apparent distress. BP = 129/71, Hr = 83, RR = 16, O2 Sat = 98% 1351 - Patient ambulated out of clinic with father.

Other Meds:

Current Illness:

ID: 1229254
Sex: F
Age: 46
State:

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: In conjunction with temporary VAERs # 414873 submitted on 7Apr21. My fever lasted nine days and required a trip to the ER. Was 104.3 on 9Apr21 and was 102.9 14Apr21. My normal temperature is 97.4. Took mostly Acetaminophen and some Ibuprofen. Was well hydrated.

Other Meds:

Current Illness:

ID: 1229255
Sex: F
Age: 42
State: MI

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

Lab Data:

Allergies: MRI dye, nsaids, vicodine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Immediately after injection i became nauseous followed by dry heaving, head fog, and aggressive corse tremors

Other Meds: vitamin D, Zofran, estradiol Patch, entyvio

Current Illness:

ID: 1229256
Sex: F
Age: 22
State: MI

Vax Date: 04/16/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Around 5 min after injection patient became very pale, sweaty, and dizzy. She was given water and laid flat on the ground which seemed to help. Patient was accompanied by mom, dad, and brother. These symptoms seemed to last 10-15min and then she completely recovered.

Other Meds:

Current Illness:

ID: 1229257
Sex: F
Age: 21
State: SC

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

Lab Data:

Allergies: Codeine, nuts, Lamictal, Cipro

Symptom List: Nausea

Symptoms: Patient felt dizzy and had a headache after vaccination

Other Meds: n/a

Current Illness: n/a

ID: 1229259
Sex: F
Age: 53
State: NY

Vax Date: 03/18/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Cipro, Bactrim, benedryle

Symptom List: Injection site pain

Symptoms: With in 5 mins. of taking pm meds(10pm) ...the top of my tongue went numb and then I started feeling my lips swell It lasted for about 3 hours but didn't get any worse so didn't call doctor or go to hospital.

Other Meds: Am meds: Sertraline hcl tab 100mg, Prednisone tab 5mg, Vitamin D3, Folic Acid, Calcium Citrate + D3 Pm meds: Atorvastatin tab 20 mg (2x), Centrum silver, Cranberry 4200 mg (2x) , Aspirin 81mg, stool softener (2x) ******I had reaction

Current Illness: none

ID: 1229260
Sex: F
Age: 74
State: FL

Vax Date: 02/10/2021
Onset Date: 02/13/2021
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: cipro, contrast dye, tramadol, morphine

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

Symptoms: on 2/11/2021 I experienced general lethargy and muscle aches. On 2/13/2021 in late morning, I suffered shortness of breath, with increased intensity and had to enter the ER.

Other Meds: eliquis, ozempic, carvedilol, amiodarone, benazapril, isosorbide, pravastatin.

Current Illness: none

ID: 1229261
Sex: F
Age: 38
State: NV

Vax Date: 03/11/2021
Onset Date: 03/14/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: RASH, SEVERE HEADACHES, EXCESSIVE BRUISING, FEVER-FROM TIME SHE RECEIVED VACCINE UNTIL PRESENT

Other Meds:

Current Illness:

ID: 1229262
Sex: F
Age: 82
State: NC

Vax Date: 04/02/2021
Onset Date: 04/16/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: 4/16/21 short of breath while gardening. Came to ER, diagnosed with Bilateral Pulmonary Emboli

Other Meds: Calcium, Vit. D3

Current Illness: None

ID: 1229263
Sex: F
Age: 46
State: CA

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

Lab Data:

Allergies: STEROID TOPICAL

Symptom List: Erythema, Pruritus

Symptoms: TONGUE AND THROAT SWELLING AND TINGLING OF THE TONGUE

Other Meds: CLARITIN-D, MULTIVIT, BIOTIN, B-12, FISH OIL

Current Illness: NO

ID: 1229264
Sex: F
Age: 41
State:

Vax Date: 04/16/2021
Onset Date: 04/17/2021
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:

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

Symptoms: Received 2nd vaccine on 4/16/21 & developed hives all over with a burning feeling on 4/17/21. Went to ER and received IV Benadryl and Solumedrol. Sent home on oral prednisone. Feels much better today 4/19/21

Other Meds:

Current Illness:

ID: 1229265
Sex: F
Age: 80
State: OR

Vax Date: 03/13/2021
Onset Date: 03/14/2021
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: No

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

Symptoms: Next day pain to right tempel. 3 short violent stabs of pain. Couldnt move, scared I get to the phone to call for help. Then it was gone.

Other Meds: Multi vitamin, Vit C, losartan

Current Illness:

ID: 1229266
Sex: F
Age: 50
State: GA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Numbness in hands and legs, chest tightness, dizziness, difficulty breathing (very mild)

Other Meds: none

Current Illness: none

ID: 1229267
Sex: F
Age: 53
State: MD

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: Ihave no allergies to anything except thisadverses crazy Swelling and redness and itchin all over my body which I got after taking the secon dose of PFIZER COVID-19 VACCINE.

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

Symptoms: after the first shot I had some severe headache, muscle ache, fatigue, injection site pain, sleepy, and a little chills for a couple of days. But at the time of taking second shot the injection was very painful, after the second shot I had very bad headache, chills, real drowsy, muscle ache, fatigue, sleepy feeling, vomiting feeling for 3 days and also after about 20 hours of injection, on my right leg startedto have rashand itching . Itried to drink a lot of water, but evvery day it got worse and worse and after 6 days my whole right leg and part of my left leg was badly andseverwlt swelled up and my leg was filled up with my body fluid and was veryyy blacked and violet, and was itching crazily. I was rushed to the ER and received the treatment and it was recognized as the adverse and severe reaction and allergy to the stupid PFIZER COVID-19 VACCINE.

Other Meds: 1. Doxycycline (VIBRAMYCIN) - PRESCRIBED 2. FAMOTIDINE (pepcid) - PRESCRIBED 3. methyIPREDNISSolone (MEDROL PAK) - PRESCRIBE 4. Benadryl 50 Mg. every 6 hours - it was prescribed by the ER doctor but I bought over thecounter 5. Prednison -P

Current Illness: NO.

ID: 1229268
Sex: F
Age: 46
State: NY

Vax Date: 04/06/2021
Onset Date: 04/07/2021
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: codine

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

Symptoms: FEVER RASH SHINGLES ON RIGHT BACK, HIP AND GROIN AREA FATIGUE SWOLLEN EYES

Other Meds: n/a

Current Illness: n/a

ID: 1229269
Sex: F
Age: 67
State: AZ

Vax Date: 04/15/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Sudden tunnel vision, high blood pressure, lasting for five hours.

Other Meds:

Current Illness:

Date Died: 03/23/2021

ID: 1229270
Sex: M
Age: 79
State: CA

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 04/19/2021
Hospital: Y

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

Lab Data:

Allergies: None known

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

Symptoms: Fever and diarrhea following a couple days after the vaccine Being administered. The day prior to hospital emergency admission uncontrollable throwing up extreme side/Stomach/chest pain. Was taken by ambulance to emergency.

Other Meds: Diabetic insulin, Water pills to thin blood, Stool softeners, Breathing treatments twice a day,

Current Illness: A weakening of the heart was being looked into, Blood thinners to help his blood not clot and make it easier for his heart.

ID: 1229271
Sex: F
Age: 25
State: IN

Vax Date: 04/16/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: cinnamon

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

Symptoms: 105 degree fever the next day chills body aches fever low grade fever nausea (including vomiting)

Other Meds: escitoalphram 20 mg daily

Current Illness: none

ID: 1229272
Sex: M
Age: 52
State: FL

Vax Date: 03/13/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Both of my feet started to really hurt, my right lower abs started to hurt.

Other Meds: Rosuvastatin 5mg Lovethyroxine 50 MCG

Current Illness: none

ID: 1229273
Sex: F
Age: 58
State: TX

Vax Date: 03/27/2021
Onset Date: 03/29/2021
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: pcn, cefdinir, nitrofurtin

Symptom List: Vomiting

Symptoms: pain left side in back

Other Meds: Tylenol 3, tramadol er

Current Illness: none; issues from total knee replacement from Oct 2020

ID: 1229274
Sex: F
Age: 54
State:

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was given second dose of Pfizer. First dose was Moderna. Patient reported no adverse effect. None was noted by staff. Lead nurse was notified . She was taken to the observation room and cleared by onsite doctor after no adverse report was reported and noted.

Other Meds:

Current Illness:

ID: 1229275
Sex: F
Age: 45
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: none known

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

Symptoms: Reported raid heartrate 5 minutes after vaccine. Heartrate 132-144 on initial assessment, BP 128/78, RR18, o2 sat 99 on RA. Had patient lie down and heartrate decreased every 5 inutes- 99/84/88/75. BP stable 120's/80's. No signs of anaphylaxis. No CP or SOB. Reports some nervousness with injections and vaccine.

Other Meds: claritin-d

Current Illness: none

ID: 1229276
Sex: M
Age: 36
State: IN

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: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Woke up at 2am (Sunday) after getting the shot at 0837am Saturday with severe chills and body aches.

Other Meds: None

Current Illness: None

ID: 1229277
Sex: M
Age: 63
State: VA

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

Lab Data:

Allergies: none

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

Symptoms: swelling at site, headache, fatigue, body ache, chills, nausea

Other Meds: Allegra D Metformin Losartan Xigduo mens multivitamin Fluiticasone

Current Illness: Diabetese Sleep apnea hypertension

ID: 1229278
Sex: F
Age: 73
State: MI

Vax Date: 04/16/2021
Onset Date: 04/18/2021
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: penicillin, demerrol

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

Symptoms: In the area of the 2nd, injection, a wide irregular red rash that is hot to the touch.

Other Meds: folplex; sumatriptin succinate; valium; armour thyroid; amlodipine besylate; venlafaxine

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm