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: 1234094
Sex: F
Age: 63
State:

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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient felt lightheaded within 15 minutes of dose 2. Had a similar reaction to dose 1. Vital signs remained in normal parameters and she was discharged after 30 minutes observation.

Other Meds:

Current Illness:

ID: 1234095
Sex: F
Age: 40
State: LA

Vax Date: 03/30/2021
Onset Date: 03/01/2021
Rec V Date: 04/20/2021
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: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: PT DID NOT HAVE AN ADVERSE REACTION. PT WAS ADMINISTERED THE 1ST VACCINE ON 3/18/21 AND THE 2ND DOSE WAS ADMINISTERED ON 3/30/21. NO ADVERESE REACTION WAS NOTED DURING THE PATIENT'S OBSERVATION PERIOD AT THE FACILITY NOR DID THE PATIENT CALL OR PRESENT BACK TO THE CLINIC WITH ANY COMPLAINTS.

Other Meds: ALPRAZOLAM 1MG; DIVALPROEX ER 500MG ER; ESCITALOPRAM 10MG; ESCITALOPRAM 20MG; GABAPENTIN 300MG; HALOPERIDOL 5MG; HYDROCODONE 5MG-ACETAMINOPHEN 325MG; HYDROXYZINE HCL 25MG; HYDROXYZINE 50MG; METFORMIN 500MG; OLANZAPINE 20MG; PHENAZOPYRIDINE

Current Illness: NONE

ID: 1234096
Sex: F
Age: 36
State: OR

Vax Date: 03/10/2021
Onset Date: 03/16/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 6 days post vaccine patient started experiencing migraines and almost every morning since. Post vaccine 21 days right eye and right hand started to twitch . April 12th when vaccine paused became worried. Went to the ER on April 16th complaining of increased migraines/head pressure, numbness in right hand and off and on numbness in both legs, stiff neck, dizziness, mood changes, insomnia. April 19th more symptoms flushing burning in legs and numbness. Chest felt weird like someone put vicks on it.

Other Meds: N/A

Current Illness: none

ID: 1234097
Sex: F
Age: 40
State: GA

Vax Date: 03/15/2021
Onset Date: 03/31/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drug allergy

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Herpes Zoster onset at day 15 post vaccination. Rash on left thoracic dermatome. Patient prescribed Valacyclovir 1000MG TID and gabapentin 100 MG TID.

Other Meds: None

Current Illness: None

ID: 1234098
Sex: F
Age: 61
State: PA

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

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

Lab Data:

Allergies: levaquin

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

Symptoms: Pt reports she has a history of herpes and gets occasional outbreaks. Pt states she developed hives last night on right upper arm that resolved itself without intervention prior to going to bed. Pt states she thinks she is having a combination hives/herpes outbreak on arm. Pt noticed another outbreak on right arm in same spot as outbreak last night, shortly after receiving vaccine. Redness and raised bumps are localized to right upper medial arm. No spreading/worsening of symptoms while in medical observation. Pt reports itching at site, but refuses benadryl (spouse at bedside and available to drive). Pt reports she will use hydrocortisone cream at home. No s/s of distress noted. VSS. Pt escorted to exit with staff and spouse. VS are as follows: 1421: BP 159/89, HR 54, RR 17, O2 sat 97% on RA

Other Meds: cymbalta, omeprazole, atorvastatin, synthroid, xanax, trazodone, potassium, furosemide, Vit D, Vit B12, tylenol, aspirin, toradol

Current Illness: none

ID: 1234099
Sex: M
Age: 18
State: MO

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

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

Symptoms: Pt had a vasovagal response to the vaccine. It happened right after administration. Patient started shaking and closed his eyes. Just a few seconds later he woke up and said something along the lines of, "Oh did I pass out?" I caught him in my arms before he could fall to the floor. The same response where he started aggressively shaking and eyes closed happened a few seconds later. His legs straightened out and his head was headed backward. Again I caught him and stabilized him. Afterward, my 2nd pharmacist stopped over and spoke with him. He seemed to be feeling better, but to ensure the same reaction wouldn't happen again, we had him wait 30 min instead of the standard 15. He sat in his chair and did not have any issues. We offered food but he was not interested. I spoke w/ him again this afternoon via phone and he said he was doing fine. Pt said he has had this type of rxn before w/ previous vaccines.

Other Meds: Concerta, mirtazapine, Trintellix, Abilify, Zyrtec

Current Illness: n/a - but does take medications for mood

ID: 1234100
Sex: F
Age: 40
State: GA

Vax Date: 04/12/2021
Onset Date: 04/16/2021
Rec V Date: 04/20/2021
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 drug allergy

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Herpes Zoster onset at day 4 post vaccination. Rash on left thoracic dermatome as well as on right shoulder. Patient prescribed Valacyclovir 1000MG BID.

Other Meds: None

Current Illness: None

ID: 1234101
Sex: M
Age: 20
State: RI

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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 received first pfizer, when it was administered only half of the first dose went into the muscle. Vaccinator requested the medical advice of the PA , PA instructed and ordered the vaccinator to administer a second full dose in accordance to the CDC guidelines.

Other Meds:

Current Illness:

ID: 1234102
Sex: F
Age: 54
State: NJ

Vax Date: 03/28/2021
Onset Date: 04/07/2021
Rec V Date: 04/20/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: I developed shingles as a result of this vaccine. Needed immediate care for my eye.

Other Meds: Warfarin 4mgs and Advair

Current Illness: None

ID: 1234103
Sex: F
Age: 58
State: LA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/20/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient call 6 days post shot to inform pharmacy that her arm still hurts. Under her arm hurts and there is a lump under her arm. Counseled patient to take pain reliever and put ice pack on area to help. told her to see Dr, but she will watch to see how it goes. Just wanted us to send info of her symptoms.

Other Meds:

Current Illness:

ID: 1234104
Sex: F
Age: 61
State: IL

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

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

Lab Data:

Allergies: Not aware of any

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

Symptoms: Patient was given the Pfizer instead of Moderna (2nd dose).

Other Meds: Not aware of any

Current Illness: Not aware of any

ID: 1234105
Sex: F
Age: 36
State: AL

Vax Date: 04/12/2021
Onset Date: 04/18/2021
Rec V Date: 04/20/2021
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: Augmentin; Doxycycline; Cefzil

Symptom List: Rash, Urticaria

Symptoms: After 6 days, I got what felt like a mosquito bite around the injection site - small swelling and an itch. After several hours, the spot got larger and started itching more, and turned red. The next day the spot had gotten larger, itching and swelling stayed the same, and the redness comes and goes depending on heat. No pain in the area. It grew slightly on the 3rd day, maybe 1 inch high by 2 inches across total. Currently still moderately itchy, no soreness, and the swelling has definitely leveled off/subsided slightly.

Other Meds: Estarella birth control; Magnesium; Calcium; Zinc; Vitamin D

Current Illness:

ID: 1234106
Sex: F
Age: 33
State: MD

Vax Date: 04/11/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
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: Severe headaches.

Other Meds: Tylenol

Current Illness:

ID: 1234107
Sex: F
Age: 18
State:

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

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

Symptoms: Patient had continuous coughing start within 10 minutes of dose 2. O2 sat remained normal with clear lung sounds throughout 40 minute observation. Patient coughing did not respond to albuterol inhaler. Patient and her father who was present opted to be transferred to ER via ambulance for further observation.

Other Meds:

Current Illness:

ID: 1234108
Sex: M
Age: 56
State: GA

Vax Date: 03/13/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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: No

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

Symptoms: Went to the hospital with chest pain. They performed a catheter to check for blockages and instead found an extremely rare blood clot that ultimately caused a mild heart attack.

Other Meds: Lysonpril, Vitamin D, Xarelto

Current Illness: None

ID: 1234109
Sex: M
Age: 34
State: MA

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: no known allergies

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

Symptoms: 24 hours post vaccine c/o soreness of the tongue, lower gums and throat still ongoing. C/o painful swallowing

Other Meds: none

Current Illness: none

ID: 1234110
Sex: F
Age: 32
State: CO

Vax Date: 04/08/2021
Onset Date: 04/15/2021
Rec V Date: 04/20/2021
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: None

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

Symptoms: Moderna COVID-19 Vaccine EUA. Severe swelling and redness of injection site one week post-vaccination- approx. 12 cm diameter firm, severely inflamed area at site of injection on right upper arm with severe pain in right axillary region; five day duration of inflamed lesion with slow resolution; pain still present.

Other Meds: Once-daily oral contraceptive- 0.15 mg desogestrel and 0.03 mg ethinyl estradiol

Current Illness: None

ID: 1234111
Sex: M
Age: 74
State: MA

Vax Date: 03/13/2021
Onset Date: 03/27/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Shellfish (anaphylaxis); Sulfa (rash); Lisinopril (cough)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I am submitting this report because of symptom onset relative to vaccination date, and because I have not experienced this cluster of symptoms before. My wife and I received the same lot number of the J&J vaccine on Saturday, March 13. We both had slight fatigue that evening and into the following day and she has had no further symptoms. On Tuesday, March 16, I had a mild ache around injection site with no further symptoms until Saturday, March 27 when I experienced a brief episode of lightheadedness. (CONTINUED BELOW)

Other Meds: Atenolol; Losartan; Atorvastatin; Low-dose Aspirin;

Current Illness: None

ID: 1234112
Sex: F
Age: 46
State: GA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 04/20/2021
Hospital: Y

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

Lab Data:

Allergies: Lexapro CeleXA Paxil Prozac Zoloft Viibryd

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The evening that I took the vaccination I was running a fever body aches and chills the day after taking the vaccination I had the same effects fever body aches chills 5 days after taking the vaccination very sick not feeling well not feeling myself passed out twice at home the sixth day after taking the vaccination I proceeded to work was sent home before I could even get in the building went to ER was treated for an allergic reaction after telling them I was 6 days from vaccination then on 4-9-2021 I was taken by my husband to the ER my entire left side was numb tingling sensation couldn't lift my leg couldn't hold my arm up had no peripheral vision severe headache at the ER I was seen my neurologist and I was told that I had 20 minutes to make a decision whether to take the TPA shot which I chose to take I was released from the hospital on 4/11/2021 I am finally going back to work tomorrow ( 4-21-2021) I am now having more anxiety I've had extreme weight loss I've lost 20 lb since this occurred

Other Meds: Lorazepam

Current Illness: None

ID: 1234113
Sex: M
Age: 64
State: CT

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/20/2021
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: Site of joint replacement swelled for a week. By 7 days it did not support weight. 9 days is was 80% normal.

Other Meds: Diclofenac, Beta blocker, Lasic

Current Illness: No

ID: 1234114
Sex: F
Age: 38
State: OK

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 04/20/2021
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: Avelox, Bactrim, cefazollin, doxycycline

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

Symptoms: Within minutes after 1st shot Pt. lost her voice, c/o tickle in throat, SOB, fatigue, dizziness. She was given 50 mg. Benadryl. VS were normal during her observation. States she had nausea/vomiting/ diarrhea and myalgias for 3 days after 1st and 2nd covid vaccines. States she still feels a little lightheaded at times, but otherwise feels has recovered from the vaccine effects. In July 2020 had series of 4 hospitalizations for ARDS and gastroparesis. States 4 covid tests were negative throughout that time. Has chronic headaches from Chiari Type 1 diagnosed 12 years ago. Had meningitis as a child with lifelong headaches.

Other Meds: Diazepam, tizanidine, methocarbamol, ondansetron,hyosciamine,

Current Illness: ARDS 7/2020 with resultant hoarseness, gastroparesis.

ID: 1234115
Sex: M
Age: 57
State: FL

Vax Date: 04/07/2021
Onset Date: 04/10/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Unevaluable event

Symptoms: Patient stated his back started started hurting approximately 10 days ago. The pain then went to his knee. He stated that a spot on the side of his knee is hard, swollen and warm to the touch. Adivised him to seek immediate medical attention.

Other Meds: None

Current Illness: No illnesses at time of vaccination

ID: 1234116
Sex: M
Age: 74
State: MA

Vax Date: 03/13/2021
Onset Date: 03/27/2021
Rec V Date: 04/20/2021
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: Shellfish (anaphylaxis); Sulfa (rash); Lisinopril (cough)

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

Symptoms: I am submitting this report because of symptom onset relative to vaccination date, and because I have not experienced this cluster of symptoms before. My wife and I received the same lot number of the J&J vaccine on Saturday, March 13. We both had slight fatigue that evening and into the following day and she has had no further symptoms. On Tuesday, March 16, I had a mild ache around injection site with no further symptoms until Saturday, March 27 when I experienced a brief episode of lightheadedness. (CONTINUED BELOW)

Other Meds: Atenolol; Losartan; Atorvastatin; Low-dose Aspirin;

Current Illness: None

ID: 1234117
Sex: M
Age: 55
State: NC

Vax Date: 03/24/2021
Onset Date: 04/07/2021
Rec V Date: 04/20/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Patient had an in-home close contact (daughter) who had symptomatic COVID-19. As a result, patient went to be tested and received a positive test result on 4/7/2021. Subsequently (around the next day), he developed symptoms of diarrhea which lasted for two days and resolved at home without treatment, and he remained in isolation for 11 days.

Other Meds:

Current Illness:

ID: 1234118
Sex: M
Age: 34
State: WA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin; Amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient should have received the second dose as Pfizer, not Moderna. Nurse vaccinator inadvertently gave incorrect 2nd dose vaccine. Follow up with patient today (4/20/21) reports no adverse events other than the expected reaction after 2nd dose.

Other Meds: None known

Current Illness: None

ID: 1234119
Sex: M
Age: 70
State: IL

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/20/2021
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: Penicillin

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

Symptoms: after his second Moderna vaccination (had previously received a Pfizer vaccination with negative antibodies), patient developed fever to 103 for three days, resolved. However, on the night of his second vaccination, he developed severe pain in the right shoulder and upper arm (shot was given on the left) and several days later developed weakness in the arm. Clinically, appears to have evidence of brachial plexitis.

Other Meds: Benicar, metformin, ozempic, crestor, levothyroxine, glimepiride

Current Illness: Prostate issues

ID: 1234120
Sex: F
Age: 55
State: IL

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 04/20/2021
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: Erythromycin Biaxin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: April 9 , red at injection site April 10, Fever 100 degrees. Right arm tender, warm to touch, swollen, itchy, and red 4" x 5" rash down arm. April 12, Rash 7" x 7" down arm and itchy. April 16, Rash still same size. Still itchy. April 17, Itchy. Upper rash at injection gone. but still red lower. April 19, Rash gone, but arm still itchy.

Other Meds: Multi-vitamin, Zinc Picolinate, D3, Magnesium Citrate, Milk Thistle, Digest Ultimate, DGL powder

Current Illness: None

ID: 1234121
Sex: M
Age: 17
State: PR

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
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: Fever between 101-103 degrees for 72 hours, headache, sore throat, cough.

Other Meds: None

Current Illness: None

ID: 1234122
Sex: F
Age: 60
State: FL

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/20/2021
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: Ibuprofen and Codeine

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

Symptoms: Approximately 1 - 2 hrs after receiving the 2nd dose of the Moderna vaccine, I started developing a red rash on my left cheek. It started tingling, and slightly itching, and was warm to the touch. A welt had also started on my left cheek approximately 1 inch down from my left eye. I immediately put Benadryl cream on the whole area and it quickly subsided within an hour. A cold compress helped as well. I also had a severe headache that lasted almost a day and felt extremely weak. I did not have those reactions after the 1st dose. My arm hurt after both doses, but I only felt very tired after the 1st dose.

Other Meds: Telmisartan 20 mg daily

Current Illness:

ID: 1234123
Sex: M
Age: 60
State: IL

Vax Date: 04/14/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
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: Constant tinnitus

Other Meds: atorvastatin 20mg, amlodopine besylate 5mg, vitamin D3 2000iu

Current Illness: None

ID: 1234124
Sex: M
Age: 70
State: MN

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 04/20/2021
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 presented to ED via ambulance after receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1234125
Sex: F
Age: 30
State: IN

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

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

Lab Data:

Allergies: NKA

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

Symptoms: Diarrhea, 4-6 episodes through 48 hours post vaccine

Other Meds: Pseudoephedrine Zyrtec

Current Illness: None

ID: 1234126
Sex: M
Age: 20
State: GA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: After IM injection pt became pale, diaphoretic and reported feeling dizzy. Pt was assisted from chair to floor to lay down and during transfer had positive LOC which resolved in less than 5 seconds. BLEs were elevated on a chair and VS were as follows: BP 86/55, HR 80. Pt was given water, snacks and cold compress was applied to forehead. After 5 mins pt was assisted to seated position and VS were as follows: BP 107/75, HR 85. Pt recovered within 10 mins and ambulated out of clinic in NAD. Was escorted to car by staff and was driven home by a friend.

Other Meds:

Current Illness:

ID: 1234127
Sex: M
Age: 29
State: IL

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: Not aware of any

Symptom List: Tremor

Symptoms: Patient was given the Pfizer instead of Moderna (2nd dose)

Other Meds: Not aware of any

Current Illness: Not aware of any

ID: 1234128
Sex: F
Age: 41
State: MI

Vax Date: 01/27/2021
Onset Date: 02/20/2021
Rec V Date: 04/20/2021
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: Major symptoms are plugged/whooshing/ringing/popping ears. Pressure in my head. Dizziness, especially when I look up after looking down at my phone. My hands and feet get so cold they hurt. I can put my frozen feet by my space heater and they don?t warm up, they just hurt more. Inability to concentrate and foggy brain. During meetings I find myself starting sentences but I can?t finish them, it?s like I stop and wait for my friends/family/coworkers to finish my thoughts. Other symptoms that don?t bother me as much. Constant sinus drainage and occasional sneezing. Dehydration. Insomnia and vivid dreams.

Other Meds: Ibuprofen, adderall

Current Illness: None

ID: 1234129
Sex: M
Age: 63
State: MD

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/20/2021
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: none

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

Symptoms: Within 1 or 2 minutes after getting the vaccine I started to feel like the left side of my face was becoming flushed. Then I felt my face, and especially my lips, tingle; then I seemed to be having a neurological reaction--it was like the left side of my face was becoming numb. For the rest of the day, the left side of my face felt very different from the right-side. There was some pain around the temple. The next day, and even through today, 5 days later, the problem has been mainly around my eye. My eye often feels irritation when I blink and there is some muscular quivering of my lower eyelid. After speaking to my brother who is a radiologist he decided that it was unlikely to be an allergic reaction, and because the feeling of my face on the left side was reminiscent of the feeling I had a year ago when I had shingles around my left eye, he thought the reaction could very well be related to shingles. In other words, there was a activation of a response that resembled my shingles episode. This was bolstered by my speaking with my neighbor who also had the pfizer vaccine who said she had a very similar reaction affecting her face that lasted several days, and she,years before, had shingles on her face (as well as the shingles vaccine).

Other Meds: none

Current Illness: none

ID: 1234130
Sex: M
Age: 61
State: FL

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/20/2021
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: N/A

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

Symptoms: Hematuria. Severely thickened urinary bladder with blood clots in organ and urine . Please note 1st Doze of Covid-19 vaccine was on 03/25/2021 and 2nd doze was on 04/15/2021.

Other Meds: Metformin (800 mg) Lisinopril (10mg) Glipizide (10mg)

Current Illness: None

ID: 1234131
Sex: F
Age: 60
State: CA

Vax Date: 02/17/2021
Onset Date: 03/24/2021
Rec V Date: 04/20/2021
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: Ongoing shoulder pain at shot site and easy bruising, especially on the same side as the shot

Other Meds: Bupropion SR 100 mg BID

Current Illness: None

ID: 1234132
Sex: M
Age: 43
State: NY

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Blood clot in left leg , Found out on April 15 2021

Other Meds:

Current Illness:

ID: 1234133
Sex: F
Age: 61
State: CO

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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: Ampicillin, oxycondone, sulfa, ampicillin

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

Symptoms: Patient called nurse triage line to report the following symptoms: Intermittent chest pressure, symptomatic bradycardia, shortness of breath, dizziness, headache, body aches.

Other Meds: tylenol, xanax elavil, celexa, ambien,

Current Illness: no known illnesses

ID: 1234134
Sex: F
Age: 56
State: GA

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: Day after vaccine bilateral swelling of nose, 2nd day right side facial swelling, each day facial swelling would increase. Went to Urgent Care. Started immediately on Keflex and Deltasone. It took a week for the facial swelling and cellulitis to clear up. At the same time I was experiencing right and left hand numbness and finger tightness at night and AM. Can not make a fist or clench my fist together. The metacarpophalangeal was swollen and causing severe pain. Dr ordered CBC, CMP, Arthritis Profile, and ANA.

Other Meds: Lisinopril, Protonix, D-Mannosse, Lysine, Methenamine

Current Illness: Hypertension

ID: 1234135
Sex: F
Age: 63
State: NY

Vax Date: 04/03/2021
Onset Date: 04/04/2021
Rec V Date: 04/20/2021
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: Went to bed few hours after vaccine woke up with a swollen face and low grade fever . Monday woke up my eyes were swollen shut face was worse went to walk in clinic. And they gave me 50 mg steroids for 3 days . Still puffy for 2 weeks with headache

Other Meds: None

Current Illness: None

ID: 1234136
Sex: F
Age: 55
State: CA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: headache, rating 7/10, pt reports feeling flushed and funny feeling in chest. Pt describes quality of headache as a pounding sensation. o Action(s) taken: Other - Tylenol 650 mg PO, v/s, water, rest Outcome: Pt sent home in good condition

Other Meds:

Current Illness:

ID: 1234137
Sex: F
Age: 30
State: TX

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 04/20/2021
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: septra, clindamyacin

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

Symptoms: I experienced two nosebleeds per day for the three days after receiving the second vaccine. I also experienced the more traditional side effects - chills, fatigue

Other Meds: birth control, zyrtec

Current Illness: parosmia from covid in 10/2020

ID: 1234138
Sex: F
Age: 61
State:

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: 4/20/2021 Patient was observed post Covid-19 immunization for 30 minutes based on pre-vaccination screening . During the observation period, she experienced an adverse reaction with the following symptoms: dizziness. Assessment : Time of assessment 1229 Alert and oriented. Actions taken: Vitals sign taken VAERS form obtained and completed by RN. VS are BP- 155/94, P- 55, O2- 100%. Water given, patient refused food, she reports that she has not eaten today and refuses any food. Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 40 minutes. Discharged home. The Patient was provided with Vaccine Information Sheet and instruction to access the V-Safe system. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 4/20/2021 12:11 PM 0.3 mL 2/25/2020 Intramuscular Manufacturer: Pfizer, Inc

Other Meds:

Current Illness:

ID: 1234139
Sex: M
Age: 21
State:

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received the COVID vaccine (Pfizer dose 1, lot #EW0171, expiration date 8/2021) in his left deltoid at 1437. The client was observed to fall out of his chair in the observation area, fall to the ground, and hit his head. The client made no attempt to protect his head or break his fall. RN, PHN, RN, and RN responded at 1438. PHN called EMS at that time as well. The client was observed to jerk his arms twice. The client was unconscious for approximately 90 seconds, and was turned on his side at this time. When the client regained consciousness, he was alert and oriented, complained of no pain in his head or any dizziness or lightheadedness. No difficulty breathing. Pupils were equal and reactive to light. At 1439, the vital signs obtained were: blood pressure 130/90, heart rate 57, O2 98, respiratory rate 26. The client denied any history of seizures, epilepsy, or any other medical history. The client stated he has no allergies and that he takes no medications. Upon examination, there were no cuts observable on the client's head. The client denied any feelings of dizziness before his loss of consciousness but stated he did not eat any breakfast or lunch that day. At 1443, the repeat vitals were as follows: 128/94 blood pressure, heart rate 60, respiratory rate 22, temperature 98. A manual pulse was 88 and thready. At 1447, EMR responded to the scene and assumed care of the client. Client transported to hospital.

Other Meds: none

Current Illness: none

ID: 1234140
Sex: F
Age: 45
State: VA

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/20/2021
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: No known allergies

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

Symptoms: Got shot noon Thursday no adverse effects besides moderately tired until 3pm Friday. Then fatigue set in, headache, fever of 101, and lymph nodes in left arm very tender and swollen to size of goofball. Night sweats on Friday night and struggling to sleep because of tenderness under arm. Saturday morning adding left lymph node in collarbone area swollen. Both were swollen the size of eggs, warm to the touch and very tender. But no more fever. However still fatigued. The injection site still warm, slightly swollen, and patches of red on left arm. For 5 days my left arm ached, tingling and began to feel numb. Used ibuprofen, Tylenol, cool and warm compresses, and slept a lot. Woke Monday to now adding right collarbone lymph node starting to swell. Called Dr on Monday and went in at 4:30pm. Just continued same home treatment understanding it may take weeks to get back to normal.

Other Meds: Zyrtec, Metoprolol, Levothyroxine, Vitamin D, and CHLORTHALIDONE

Current Illness: None

ID: 1234141
Sex: F
Age: 18
State: MD

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: Dizziness No treatment required

Other Meds: Migraine medication

Current Illness:

ID: 1234142
Sex: M
Age: 51
State: CO

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Pt reports symptoms appearing approximately 1 day after receiving vaccination. Rash covering approximately 90% of body. Skin felt like "sandpaper".

Other Meds: Aspirin 81mg, Lamotrigine 150mg BID

Current Illness:

ID: 1234143
Sex: F
Age: 73
State: KY

Vax Date: 04/07/2021
Onset Date: 04/12/2021
Rec V Date: 04/20/2021
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: Penacylin

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

Symptoms: Pain in right and left leg. Pain started at hip and run down to toes. Pain was not shooting pain but was a constant pain. On a pain scale of 1-10, pt reports pain was around 20. Pain woke patient up from sleep and was strong enough that patient muscles locked up. Patient began trembling from the pain. Pain lasted about about 24 hours. Pain was so strong that patient could not think. Pain caused patient to become weak and lethargic.

Other Meds: Metformin 1,000mg , Gabapentin 800mg, Celexa 20mg, Lasinopril 20/25mg. Tylenol 1,000mg. No dietary.

Current Illness: No.

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm