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: 1237218
Sex: F
Age: 17
State: ID

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fell to floor from chair in observation area. OC related to vaccine administration. Pain in right cheek. Pain level 2.5/10. Vaso-vagal response post vaccine injection. Vital Signs: BP 100/60 HR 85 Resp 20 O2Sat 98 , Skin Signs: Cool and dry, Clammy, Circulation: Cap refill <2sec, Respiratory: Breath sound clear bilaterally, Initial Treatment: Water/observation/elevated les bilateral. Assessed/evaluation by Dr. 10:25 AM, Vital Signs: BP 100/72 HR 85 Resp 20 O2Sat 72, Skin Signs: Cool and dry, clammy, Circulation: Cap refill <2sec, Respiratory: Breath sound clear bilaterally Follow up Treatment: Mask Oxygen administration for 10 min. 10:25-10:35 AM. Ice pack to right cheek, approx. 4 L and reduced to 2 L/min\, 10:35 AM\, Vital Signs: HR 98 Resp 20 O2sat 99, Skin Signs: Cool and dry, clammy, diaphoretic Circulation: Cap refill <2sec, Respiratory: Breath sound clear bilaterally 10:45 AM, Vital Signs: BP 120/82 HR 76 Resp 20 O2Sat 97, Follow up Treatment: 10:45 skin warm and dry, alert and oriented x3. Cap refill <2sec ,Notes: Recommended parent to contact peds office for injury to right cheek. Continue to maintain good hydration at home the rest of the day. Home with father at 10:55 AM

Other Meds: None

Current Illness: None

ID: 1237219
Sex: F
Age: 61
State: NY

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/21/2021
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: codeine

Symptom List: Anxiety, Dyspnoea

Symptoms: I have severe dizziness when I am laying down/sleeping. Each time I wake up 1-2 times per night) my head is spinning. When I am awake and standing I don't have the spinning, but I do have a faint headache/fog and with that, nausea.

Other Meds: Levemir, Trulicity, Invokamet, simvastatin, Lisinopril, aspirin

Current Illness: none

ID: 1237220
Sex: F
Age: 64
State: AZ

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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 KNOWN

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

Symptoms: I WAS NOT EXPECTING SYMPTOMS WITH THE FIRST SHOT, WAS TOLD IT "NORMALLY" DIDN'T HAPPEN, BUT TO EXPECT SYMTOMS WITH 2ND DOSE. I WENT BED FEELING FINE, WOKE UP ABOUT MIDNIGHT WITH BODY ACHES IN EVERY PART OF MY BODY, CHILLS, FEVER, NAUSEA. ARM IS VERY SORE, NOT EXPECTING THAT MUCH PAIN AT INJECTION SITE. I AM NOT ABLE TO WORK TODAY WITH THESE SYMTOMS WHICH HAVE SUBSIDED A LITTLE BIT, BUT NOT MUCH.

Other Meds: LISINOPRIL, METMORPHIN, BUPROPION, ROSUVASTATIN CALCIUM

Current Illness: NONE

ID: 1237221
Sex: F
Age: 72
State: IL

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: My arm has a huge bump at the needle point. It is red and itchy. I don't know if she just didn't get it in the muscle or injected it just under the skin. It has not gone down at all in 48 hrs.

Other Meds: Daily women's vitamin, magnesium, turmeric, B complex, C, D3, Calcium, Potassium, Rosuvastatin, baby aspirin, Qunol w/Umbiquinol

Current Illness: None

ID: 1237222
Sex: M
Age: 45
State: FL

Vax Date: 04/14/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin

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

Symptoms: Noticed a quarter sized yellowish green spot on my abdomen and then on Tuesday 4/20/2021 I had a vision incident where I saw images of lines in the fire ground that lasted about 1 minute

Other Meds: Lexapro generic 20 mg

Current Illness: N/A

ID: 1237223
Sex: M
Age: 41
State: NC

Vax Date: 01/08/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
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: Positive PCR covid test on 4/18/21

Other Meds: none

Current Illness: none

ID: 1237224
Sex: F
Age: 34
State: IN

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
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: 4/19/21 my left arm hurt and was numb/tingling from my shoulder to my finger tips. 4/20/21 I started to feel nauseated and extremely tired. Later in the day the nausea went away and a headache started. 4/21/21 my left shoulder, wrist, and the bend hurt. Still extremely tired with a slight headache.

Other Meds: Montelukast Sodium 10MG daily, Errin .35 MG Daily, Omeprazole 40mg daily, Melatonin 5mg daily, Cetirizine 10mg Daily

Current Illness: Asthma, Seasonal allergies, Gerd

ID: 1237225
Sex: M
Age: 60
State: IN

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Nka

Symptom List: Pharyngeal swelling

Symptoms: My tinnitus symptoms have been raging since I have received my second dose of phizer covid-19 vacination. I can not say 100% that the vacine is the the sole reason for the extreme symptoms but can tie nothing else to the change. The ringing, screeching and high pitch sounds are louder than I have ever e,peri encased in my 15 years with tinnitus. I TS constant, unnerving, stressful, and never ending. Difficult to impossible to sleep and if I do happen to fall asleep the symptoms wake me up within an hour. Kinda at my wits end at this piint.

Other Meds: Pepcid Vitamin b12 Vitamin d3 Coq10 Morphin sulphate 60m

Current Illness:

ID: 1237226
Sex: M
Age: 57
State: MN

Vax Date: 03/12/2021
Onset Date: 03/14/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Dexamethasone Keflex

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Itching head to toe Chills fever Metal taste Vomiting Down two weeks after first shot and two weeks after second shot

Other Meds: Testosterone, Meloxicam 15mg Quetiapine 50mg Tamsulosin .4mg Atorvastatin 20mg Pregabalin 150mg Pain pump Dilauid and Clonidine

Current Illness:

ID: 1237227
Sex: F
Age: 0
State: TX

Vax Date: 04/21/2021
Onset Date:
Rec V Date: 04/21/2021
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: no

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient felt anxious after vaccine administration about 5 minutes after dose given. Tremors in hands. No difficulty breathing or swelling. Patient states she gets anxious every now and then. Patient monitored for about 30 minutes. She felt "better" and was able to get up and leave when she felt comfortable.

Other Meds: no

Current Illness: no

ID: 1237228
Sex: F
Age: 37
State: CT

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs Dust

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

Symptoms: Increased heart rate for 3-4 hours (120-150 bpm at baseline) Fluctuating heart rate upon getting up or moving slowly Irregular ECG at 2.5 hours after vaccination

Other Meds: Buspirone Sertraline Melatonin Biotin Multivitamin

Current Illness:

ID: 1237229
Sex: F
Age: 67
State: OH

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: allergy to a perfume called love spell

Symptom List: Rash, Urticaria

Symptoms: After the 15 minutes, we left and I started coughing and felt like I was having a asthma attack. I didn't have my rescue inhaler with me so when I got home I got the inhaler and my oxygen was at 96, I took a Benadryl and I felt like i was going to die and my oxygen was down to 86. I called 911 and when they got there, everything was back to normal, but I feel like I feel after having a bad asthma attack and there is flehm that I cannot cough up. I went to the ER and I guess I got scared.

Other Meds: Centrum silver vitamin, 81mg aspirin, omeprazole 20mg, potassium chloride 10mg, enalapril 5mg and maxide 37.5-25

Current Illness: no

ID: 1237230
Sex: F
Age: 55
State: OH

Vax Date: 04/03/2021
Onset Date: 04/12/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Iodine, Shell fish

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

Symptoms: Shingles ( Still active) I had shingles on August 11, 2020 The shingles came in same area and other spots this time they are more severe than before.

Other Meds: Levothyroxine

Current Illness:

ID: 1237231
Sex: M
Age: 81
State:

Vax Date: 02/24/2021
Onset Date: 03/26/2021
Rec V Date: 04/21/2021
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: pt was hospitalized within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1237232
Sex: M
Age: 35
State: NE

Vax Date: 03/20/2021
Onset Date: 03/28/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Swollen spleen, blood clot in spleen, splenal infarct.

Other Meds: Fenofibrate 54 mg Bupropion XL 150mg Rosuvastatin 10mg Lisinopril-HCTZ 20/12.5mg

Current Illness:

ID: 1237233
Sex: F
Age: 16
State: MO

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 04/21/2021
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: NKDA

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

Symptoms: MODERNA VACCINE GIVEN TO UNAUTHORIZED AGE GROUP (16 Y/O AT TIME OF VACCINATION). WE DID NOT REALIZE UNTIL AFTER VACCINE WAS ADMINISTERED. PT AND GUARDIAN WERE CONTACTED AND PT HAD NO ADVERSE EFFECTS. PT WILL RECEIVE 2ND DOSE 28 DAYS AFTER 1ST DOSE AS PER CDC GUIDANCE AND PER PT AND GUARDIAN WISHES. PT DID NOT FILL OUT ONLINE SCREENER WHEN SHE REGISTERED THAT CONFIRMED THAT SHE WAS CORRECT AGE TO RECEIVE THE VACCINE. WE HAVE NEW STORE POLICIES IN PLACE TO PREVENT THIS FROM HAPPENING AGAIN (CHECKING ID'S AND MATCHING WITH DOB ON INTAKE FORMS)

Other Meds: NONE KNOWN

Current Illness: NONE

ID: 1237234
Sex: F
Age: 33
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/13/2021
Rec V Date: 04/21/2021
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: Latex, shellfish

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

Symptoms: The day of the injection i broke out in hives. 3/9/21 My period started early and lasted for 8 days. It normally lasts for 3. Then I ended up starting early again and am currently and actively bleeding. It has been 8 days again. This started the weekend after I got the vaccine. Also. In the muscle around the injection site when I lift heavy things it feels like I'm being pinched or hurt. This started April 17th ish.

Other Meds: Birth control (tri-sprintec), aleve, Claritin

Current Illness: N/A

ID: 1237235
Sex: F
Age: 49
State: IN

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fever, chillness, sore arm

Other Meds: Atorvastatin, lisinopril, metoprolol, amlodipine, levothyroxine, vitamin D

Current Illness: N/A

ID: 1237236
Sex: F
Age: 49
State: FL

Vax Date: 03/28/2021
Onset Date:
Rec V Date: 04/21/2021
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: 49 yo female had 2nd dose of vaccine, about 1-2 days developed tinnitus which persisted and getting louder; also developed joint pains to elbow and fingers. I referred to get checked with PCP. 4/19-49 yo female had 2nd dose of vaccine, about 1-2 days developed tinnitus which persisted and getting louder; also developed joint pains to elbow and fingers. I referred to get checked with PCP.

Other Meds: Prozac 20mg daily Xanax 1mg 3x/day as needed temazepam 30mg bedtime Advil, APAP as needed general aches and pains

Current Illness:

ID: 1237237
Sex: F
Age: 73
State: AL

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Codeine

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

Symptoms: I am a Covid survivor (January, 2021) and the reaction to the vaccine was exactly the same as my Covid symptoms. Extreme lethargy, headache, sleepiness. I could hardly make it across the room and was not able to go into work. This lasted about 24 hours. I will not be taking the second shot.

Other Meds: Citalopram, Omeprazole

Current Illness: None

ID: 1237238
Sex: F
Age: 65
State: WA

Vax Date: 04/03/2021
Onset Date: 04/17/2021
Rec V Date: 04/21/2021
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: Penicillin Sulfa

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

Symptoms: On 4/17/21 (14 days after 2nd dose of vaccine), developed diffuse maculopapular, pruritic rash on torso and extremities, sparing face, palms, soles. Some, but not all, of the lesions blanch. No fever. Does not feel ill. Thorough history is negative for other possible triggers (no new meds, no recent illness, no other vaccines, no new soaps/lotions/topicals, no new/unusual foods). No history of atopy.

Other Meds: vitamin D3 2000 IU daily Mg citrate Multivitamin once daily Omega-3 fatty acids Paroxetine 20 mg daily

Current Illness: none

ID: 1237239
Sex: F
Age: 63
State: MO

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Unevaluable event

Symptoms: Client called yesterday in regards to symptoms after having 2nd covid vaccine. Client's 2nd Moderna Covid vaccine admin. on 04/17/2021.

Other Meds: NA

Current Illness: Cancer

ID: 1237240
Sex: M
Age: 19
State: MI

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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: NKDA

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

Symptoms: Pt reports pain as soon as injection happened. Reports Numbness in Right shoulder and area around injection site. Denies any redness or swelling. No other symptoms of covid 19. Discussed cold compress for 20 minutes and reaching out to PCP. Advised on s&s to monitor for and when to seek further medical treatment or call 911.

Other Meds: Vibramycin

Current Illness: NA

ID: 1237241
Sex: F
Age: 59
State: IN

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: chills, muscle aches, fever, fatigue

Other Meds: None

Current Illness: None

ID: 1237242
Sex: F
Age: 23
State: MN

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Injection site pain, Menorrhagia

Symptoms: reddened area with raised pustule

Other Meds: NONE

Current Illness: NONE

ID: 1237243
Sex: F
Age: 34
State: SC

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: Environmental allergies only

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

Symptoms: 12 hours post vaccine nausea body aches headaches 101.3 fever chills lasting 24 hours followed by more nausea and diarrhea

Other Meds: Lamictal Lexapro Ambien

Current Illness: None. Allergies only

ID: 1237244
Sex: F
Age: 54
State: VT

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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: codeine and latex

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: NUMB FACE, TINGLING LIPS, LIGHT HEADED AND DIZZY

Other Meds: none

Current Illness: No

ID: 1237245
Sex: F
Age: 62
State:

Vax Date: 03/12/2021
Onset Date: 04/05/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1237246
Sex: F
Age: 73
State: SC

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/21/2021
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: Iron: SOB, diarrhea, vomiting

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

Symptoms: Pt received vaccine at 10:10 AM, at 10:22 AM pt then reported some itchiness and hives to bilateral hands. The observation nurse alerted staff. Pt reported her throat also felt itchy, initially denying any feelings of SOB or difficulty breathing. Pt BP taken at 10:22 AM 168/84. 50 mg Benadryl administered IM to R. deltoid. Pt then began stating that she felt difficulty breathing. At this time 0.3 mg Epi administered to r. thigh. EMS was called and en route during this time. Blood pressure taken multiple times and remained hypertensive. EMS arrived at 10:32 AM. Pt vitals 98% oxygen on room air, PR 67 96.9 temp, 20 RR 152/82. Pt then transported by EMS to local hospital.

Other Meds: Unknown

Current Illness: Unknown

ID: 1237247
Sex: F
Age: 40
State: NE

Vax Date: 04/10/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies

Symptom List: Nausea

Symptoms: I have a rash on my stomach and skin sensitivity all across my left side. This started on April 20, 10 days after inoculation. I have not deviated from my normal routines in any other way than receiving the vaccine. The rash is small and the pain is minimal, it feels like the kind of pain that directly precedes a muscle spasm, only it's been constant since onset. I am not personally concerned, but wanted to add to all data that is being collected.

Other Meds: Flonase and claritin

Current Illness: None

ID: 1237248
Sex: F
Age: 18
State: MN

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: no known allergies

Symptom List: Injection site pain

Symptoms: Within minutes of pt receiving covid vaccine, verbalized to 'not feel well' and fainted. A friend and staff members gently assisted pt to the floor. Immediate assessment of vital signs and pt taken to private area for monitoring. Pt may have had vasovagal response due to anxiety.

Other Meds: celexa, wellbutrin XL, ritalin

Current Illness: unknown

ID: 1237249
Sex: F
Age: 54
State: PA

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 04/21/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: The next day I had very limited energy/felt like a shell of myself. Day 3 I woke up with extreme sinus cavity pain on my left side and a stye in my eye which progressed to get very severe to the point of on day 4 the top part of my face swelling and being hot. I called HCP and did a virtual visit and was placed on an antibiotic and eye ointment for 7 days. At the end of the antibiotic being completely taken the stye was completely gone but there was a still an aching in the sinus cavity. A week later it became severe again and my left eye started swelling underneath so I had another tele appointment with HCP and was given a 10 day antibiotic - Augmentin and antibiotic eye drops

Other Meds: None

Current Illness: stye in my eye prior week but it had healed

ID: 1237251
Sex: F
Age: 70
State: NE

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/21/2021
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: penicillin and quinolones

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

Symptoms: Body aches started Saturday evening. Ran a temperature of 101 to 102.5 for 4 days. She had lower back pain "ovary pain" she describes worse than labor pains

Other Meds: amlodipine, liothyronine, estradiol, progesterone, simvastatin

Current Illness:

ID: 1237252
Sex: F
Age: 43
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
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: Hives on my neck, came out around 4 hour post shot mark. Itchy and red.

Other Meds: Fluoxetine 10mg Docusate Ferrous Sulfate Allegra 24-d Atorvastatin

Current Illness:

ID: 1237253
Sex: M
Age: 61
State: CA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/21/2021
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: Slight petechiae to face and neck and light headed. BP 118/76. Per wife pt experiences rash like symptoms with each new medication. After observation pt discharged home with wife.

Other Meds:

Current Illness: none

ID: 1237254
Sex: F
Age: 48
State: FL

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/21/2021
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: penicillin, dog danger, fish, peanut, dust

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

Symptoms: Patient had bleeding gums within about 12 hours of having the vaccine. Bleeding gums lasted about 48 hours. She also had a nose bleed which started about 24 hours after the vaccine was given and lasted 2-4 hours

Other Meds: Aspirin; Amlodipine, Lisinopril; Montelukast; atorvastatin; levothyroxine; vitamin D; vitamin E; cetirizine; vitamin B12; Flonase

Current Illness: none

ID: 1237255
Sex: F
Age: 51
State: AZ

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/21/2021
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 known

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

Symptoms: Chills, body aches, extreme exhaustion, headache, soreness at injection site, swollen lymph glands in armpit of injection arm

Other Meds: Synthroid Cytomel Vitamin c Vitamin d Vitamin b Calcium-manganese Probiotic Testosterone Progesterone Estrogen

Current Illness: N/a

ID: 1237256
Sex: M
Age: 45
State: CA

Vax Date: 04/16/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
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: Developed bumpy rash on LEFT (received injection in RIGHT arm due to being left handed) upper arm/shoulder with smaller rashes on forearm and inner elbow. Does not itch. Minor pain from clothing rubbing it. Taking Advil.

Other Meds: None

Current Illness: None

ID: 1237257
Sex: M
Age: 72
State: MA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/21/2021
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: Penicillin

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

Symptoms: "Symptoms began on same day as vaccination. Symptoms were identical to when I actually had the COVID infection in January-2021. No energy, hot and cold chills, headaches, arm ache, etc., all of which lasted 5-7 days.

Other Meds: Jaylyn

Current Illness: none

ID: 1237258
Sex: M
Age: 77
State: CO

Vax Date: 02/06/2021
Onset Date: 02/27/2021
Rec V Date: 04/21/2021
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: Ciprofloxacin Lisinopril

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

Symptoms: Pt to ED on 3/1621 with : "pt c/o left sided chest and rib pain. pt states that other symptoms along with the pain started today. Pt is c/o SOB, numbness and tingling in bilateral upper extremities, bodyaches and "feeling cold." PT dx with PE of unknown origin

Other Meds: Diltiazam, Finasteride, Flomax, Pravastatin

Current Illness: N/A

ID: 1237260
Sex: F
Age: 78
State: TX

Vax Date: 03/09/2021
Onset Date: 03/11/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Tetanus shot medication

Symptom List: Pain in extremity

Symptoms: with several days of receiving the shot the following symptoms occurred: severe headache backache severe pain in your abdomen or stomach pain in your chest leg pains joint pains shortness of breath

Other Meds: Simvastatin 40mg Vitamin D-3 Iron 65mg Aspirin

Current Illness: none

ID: 1237261
Sex: M
Age: 17
State: IL

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Unknown

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

Symptoms: Patient experienced syncope post vaccination, recovered and released

Other Meds: Unknown

Current Illness: Unknown

ID: 1237262
Sex: F
Age: 48
State: MS

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 04/21/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Patient complains of hearing loss in left ear since receiving vaccine-referred to ENT

Other Meds: Apixaban, Lisinopril, Gabapentin, Ferrous Sulfate, Detemer Insulin, Novolog Insulin, Pantoprazole

Current Illness:

ID: 1237263
Sex: F
Age: 33
State: CA

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/21/2021
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: Aspirin

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

Symptoms: No treatment needed by health officials. Stayed home, rested and symptoms eventually subsided.

Other Meds: None

Current Illness: None

ID: 1237264
Sex: F
Age: 16
State: MD

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
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: NA

Symptom List: Vomiting

Symptoms: PATIENT ONLY 16 YEARS 6 MONTHS RECEIVED MODERNA VACCINE APPROVED FOR 18 YEARS OR OLDER

Other Meds: NA

Current Illness: NA

ID: 1237265
Sex: F
Age: 71
State: WA

Vax Date: 03/13/2021
Onset Date: 04/19/2021
Rec V Date: 04/21/2021
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: Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Severe chills and lethargy on Monday - slept all day. Moderate chills and slight headache on right rear in the morning on Tuesday. A little lasting lethargy today.

Other Meds: Hydro chlorothiazide Atorvastatin

Current Illness: None

ID: 1237266
Sex: F
Age: 56
State: NY

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/21/2021
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: sulfa medications

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

Symptoms: 4/10/21 awoke 0600 with severe headache, injection site sore along with entire upper arm, aching muscles in both shoulders and neck, severe dizziness, eye "fatigue" and burning, feeling of "fog head" (difficulty concentrating)

Other Meds: OTC vitamins

Current Illness: N/A

ID: 1237267
Sex: M
Age: 36
State: TN

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/21/2021
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: Severe Nausea, Fever, Chills, Backache, Headache, Sore injection site. Worst I've ever felt except when I had the flu. Symptoms lasted one day, except for fever and sore injection site. Those lasted 2 days.

Other Meds: none

Current Illness: none

ID: 1237268
Sex: M
Age: 37
State: FL

Vax Date: 04/10/2021
Onset Date: 04/13/2021
Rec V Date: 04/21/2021
Hospital:

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

Lab Data:

Allergies: Hydrocortisone

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

Symptoms: Itchy Measles-like rash started on the injection site and spread across my body (Sides and Chest) and to my right arm. Rash also spread to my legs. I was prescribed Fexofenadine (1 tablet by mouth every morning for 10 days) and triamcinolone (apply to affected areas for two weeks Monday through Friday). The rash slowly reduced from being severely itchy to mild itchiness, and some hyper pigmentation and reduced swelling after a week of appearing.

Other Meds: None

Current Illness: None

ID: 1237269
Sex: M
Age: 17
State: MO

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/21/2021
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:

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

Symptoms: PT WAS IN UNAUTHORIZED AGE GROUP TO RECEIVE THE MODERNA VACCINE (17 AT TIME OF 1ST VACCINATION) WE DID NOT REALIZE THE ERROR UNTIL PT HAD RECEIVED THE 1ST DOSE OF VACCINE. HE AND HIS GUARDIAN WERE CONTACTED AND HE DID NOT HAVE ANY ADVERSE EFFECTS. HIS PARENT HAD FALSIFIED HIS DOB ON OUR ONLINE REGISTRATION TO GET HIM AN APPT AND WE DID NOT REALIZE THIS UNTIL AFTER THE DOSE WAS ADMINISTERED. WE HAVE NEW POLICIES TO PREVENT THIS FROM HAPPENING AGAIN (CHECKING ID'S IN STORE, VERIFYING DOB MATCHES INFO PROVIDED). PT WILL BE 18 WHEN HE IS DUE FOR HIS 2ND DOSE.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm