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: 1238454
Sex: F
Age: 56
State: VT

Vax Date: 04/07/2021
Onset Date: 04/10/2021
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: Only aware of seasonal allergies, dust, and allergies to animals

Symptom List: Dysphagia, Epiglottitis

Symptoms: Achy legs starting with tight prickly feeling behind knees and thighs and progressing to achiness in entire leg from below buttocks and into feet. Finally contacted doctor on day 8 after feeling symptoms and heard back from him on day 11 (today). Use of 2-3 tablets of Advil twice a day with food for 3 - 4 days was recommended. This will only be started later this evening since I had tried taking Motrin this morning which did not seem to help.

Other Meds: Loratadine, Flonase, B-Complex Vitamin, Magnesium 500mg, Singulair Montelukast

Current Illness: None

ID: 1238455
Sex: F
Age: 50
State: CA

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: morphine

Symptom List: Anxiety, Dyspnoea

Symptoms: cervical and supraclavicular lymphadenopathy , confusion, rigors or seizure like shaking

Other Meds: Levothyroxine 50mcg, Ferrous sulfate 325mg, Colace 100mg , IBU 600mg, Flexeril 5mg

Current Illness: left shoulder pain , cervical lymphadenopathy left side

ID: 1238456
Sex: M
Age: 16
State: NC

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

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

Lab Data:

Allergies: None.

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

Symptoms: Presented with chest pain, found to have diffuse ST elevation, elevated troponin/CRP/pro-BNP and echo concerning for low normal left ventricular systolic function. Ultimately diagnosed with myopericarditis.

Other Meds: Albuterol

Current Illness: None.

ID: 1238457
Sex: F
Age: 49
State: OH

Vax Date: 04/19/2021
Onset Date: 04/21/2021
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: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever, body aches, fatigue, vomiting, diarrhea, headache 5:00 am til 4:30 pm. Arm pain ongoing.

Other Meds: Birth control

Current Illness: None

ID: 1238458
Sex: F
Age: 79
State: OH

Vax Date: 03/25/2021
Onset Date: 04/09/2021
Rec V Date: 04/21/2021
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: penicillin allergy

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

Symptoms: Patients daughter states that about a week and a half after receiving the vaccine, patient started having trouble catching her breath. On April 9th, she called the squad and they administered a breathing treatment. She showed improvement and was not transported. On April 19th, she went to hospital to be seen in the ER. She was kept in observation status and was discharged home on April 20th. She went home on prednisone of levofloxacin.

Other Meds: furosemide, hysingla, vitamin D3, losartan, hydroxyzine pamoate, hydroxyzine hydrochloride, linzess, amitiza

Current Illness: nothing acute, per her daughter

ID: 1238459
Sex: F
Age: 55
State: OH

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

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

Symptoms: Metallic taste in mouth and tongue numbness. Gets better then starts again. Administered 25mg Benadryl and monitored

Other Meds: Aldactone, Glucophage, Lipitor

Current Illness: N/a

ID: 1238460
Sex: F
Age: 32
State: IL

Vax Date: 04/09/2021
Onset Date: 04/09/2021
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: Unknown

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient experienced a syncopal episode, hypotension post vaccination, recovered and released

Other Meds: Unknown

Current Illness: Unknown

ID: 1238461
Sex: F
Age: 43
State: NY

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: N/A

Symptom List: Pharyngeal swelling

Symptoms: Within a few hours of receiving my second vaccination, I felt itchy and my face became very flushed. As the day has progressed, my face has developed little bumps on my forehead, and remains very flushed, I also have a few bumps on my arm, and my equilibrium feels off.

Other Meds: Enbrel 50mg 1xpw; Hydroxychloroquine 200mg 2x daily; Omeprazole 20mg 1x daily; multi-vitamin; Move Free joint supplement.

Current Illness: N/A

ID: 1238462
Sex: U
Age: 10
State: IN

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received 2 dose series of Pfizer covid vaccine with no adverse events, however, did not meet age eligibility requirements.

Other Meds: unknown

Current Illness: unknown

ID: 1238463
Sex: M
Age: 58
State: MN

Vax Date: 03/12/2021
Onset Date: 03/26/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 3/26 office appointment: New onset right and left sided chest pain with associated shortness of breath, fatigue and intermittent lightheadedness. Labs drawn. CT scan showed Scattered small occlusive and nonocclusive emboli within small distal pulmonary artery branches bilaterally. Started on apixaban. Has appointment with Hematology on 4/29

Other Meds:

Current Illness:

ID: 1238464
Sex: M
Age: 17
State: MI

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: cholestatin

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

Symptoms: Pt under 18 years of age administered Moderna COVID - 19 vaccine outside of EUA criteria

Other Meds: cetirizine fluticasone olopatadine nasal spray omeprazole ondansetron miralax

Current Illness: GERD static encephalopathy allergic rhinitis reactive airway disease

ID: 1238465
Sex: M
Age: 78
State: OK

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:

Symptom List: Rash, Urticaria

Symptoms: Pt was given 3rd dose of COVID-19 (Moderna). Pt scheduled an appt. for the vaccine. Pt did not inform us that he had the series of vaccine.

Other Meds:

Current Illness:

ID: 1238467
Sex: F
Age: 33
State:

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: penicillin

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

Symptoms: Pt reported feeling like the back of her tongue was swollen. Nothing seen on physical exam. No edema of oral pharynx or uvula seen on physical during the next 45 minutes of observation. No other worrisome symptoms and able to drink and breathe normally. We monitored for over 30 minutes while her father went and got her some benadryl. No progression and no other symptoms. She was released home with family observation and instructions to call 911 or go to the ER if she felt like her symptoms were worsening

Other Meds:

Current Illness:

ID: 1238468
Sex: F
Age: 29
State:

Vax Date: 03/10/2021
Onset Date: 03/10/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Not on file

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

Symptoms: Patient reported feeling lightheaded and some blurry vision. Patient reports that she always feels lightheaded after getting vaccines. Patient usually takes Zoloft daily for anxiety but missed her dose that day. Patient appears slightly pale. Patient was offered snacks, juice, and water but declined. 30 minutes later patient reports feeling a lot better and denies all prior symptoms.

Other Meds:

Current Illness:

ID: 1238469
Sex: M
Age: 33
State: CO

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: Sulfa, Ceccor, Penicillin, Aspirin

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

Symptoms: Patient states he was hot, dizzy, lightheaded. Attending nurse states patient was diaphoretic upon his arrival to observation area. Vital signs normal. Patient had cool pack applied to back of neck, drank a juice, ate a snack and said he felt much better. Patient states all symptoms resolved prior to leaving.

Other Meds:

Current Illness:

ID: 1238470
Sex: F
Age: 47
State: WA

Vax Date: 04/01/2021
Onset Date: 04/07/2021
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: PORK

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

Symptoms: Symptoms include: vaginal spotting (blood) (not on period at the time), headache, urinary tract infection

Other Meds: WOMEN'S VITAMINS, VITAMIN D, FISH OIL SUPPLEMENT

Current Illness:

ID: 1238471
Sex: F
Age: 50
State: MA

Vax Date: 04/10/2021
Onset Date: 04/21/2021
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: Pollen

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

Symptoms: Patient called COVID Nurse Hotline with c/o headache for 3-4/days with pressure, positional and accompanied with nausea. This is day 11 post vaccine

Other Meds:

Current Illness: On 4/21/2021 patient has called healthcare provider to report symptoms of severe headache lasting 3/days which is worse with position and c/o nausea

ID: 1238472
Sex: F
Age: 88
State: MA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies: streptomycin, amoxicillin, lactose intolerant

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Later on the day of the vaccine, I developed difficulty speaking and walking. My son brought me to the ER the following day. They ran tests and ruled out stroke and other known causes of my neurological problems. I showed improvement the next day so they sent me home. My symptoms continued and worsened over a few weeks. My children called the ambulance on March 17. My body temp was 88 when I arrived at the ER and heartrate in 30s. I stayed in the hospital for 7 days but have no memory of that or the week before. As the Drs could not find a cause or remedy to symptoms, I was discharged to hospice care. I have improved at home with a lot of assistance but am not back to my pre-vaccine strength, energy, or coordination.

Other Meds: Prevacid, Norvasc, Metamucil

Current Illness: none

ID: 1238473
Sex: F
Age: 43
State: MT

Vax Date: 03/23/2021
Onset Date: 03/24/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Moderna COVID-19 Vaccine EUA Patient presented to Pharmacy around 3:30pm on 3/24/21 complaining of anxiety, confusion, bilater lower leg edema and erythema, and dizziness. Her blood pressure was WNL and her heart rate was >100bpm (I did not record BP and HR so I am not reporting exact numbers). I monitored her for about an hour, after which she stated she was feeling better. I instructed her to seek medical attention should any of her symptoms worsen or return. On the evening of 3/24/21 she presented to Hospital ER department. The provider that treated her reports erythematous rash involving bilateral lower legs and ankles as well as her face. Also reports lightheadedness.

Other Meds: Adderall, Vyvanse, Percocet

Current Illness: None

ID: 1238474
Sex: F
Age: 54
State: PA

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: PCN, Valium, Ativan, Bee sting

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

Symptoms: 14:33 99% RA, HR 88. Epi given @ 14:34 L leg, 14:35 99% RA, HR 81, BP 130/76. 14:41 HR 77, Resp 22, BP 103/64 O2 99% RA. 14:54 BP 104/67, 99% RA HR 70. EMS arrived @ 1500. Pt refused. Education given. 15:03 escorted Pt to car.

Other Meds: gabapentin, seroquel, prilosec, claritin. climara, flonase, albuterol hfa inhaler

Current Illness:

ID: 1238475
Sex: F
Age: 37
State: CA

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Pencillian/Amoxicillian

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

Symptoms: Dizziness started about 30 minutes after receiving the vaccination. It does come and go.

Other Meds: None

Current Illness: None

ID: 1238476
Sex: M
Age: 56
State: FL

Vax Date: 03/31/2021
Onset Date: 04/02/2021
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:

Symptom List: Unevaluable event

Symptoms: Patient states that after receiving his first Pfizer COVID19 vaccine, a previous cut that had already scabbed over and was healing on his arm started to swell and become infected. The initial wound has not healed and has become painful. Now, after receiving his second Pfizer COVID19 vaccine the patient has a total of 3 wounds, all circular and approximately 3/4" diameter on his arms. The additional two wounds were the same as the first, previous cuts that were healing and then turned into these identically sized & shaped wounds.

Other Meds:

Current Illness:

ID: 1238477
Sex: M
Age: 66
State: VA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
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: None

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

Symptoms: Shortness of breath on drive home from 2nd vaccine while on the phone.

Other Meds: Glipizide/Lipitor/Lantus/Blood Pressure

Current Illness: Type II Diabetic

Date Died: 04/16/2021

ID: 1238478
Sex: M
Age: 63
State: IL

Vax Date: 04/07/2021
Onset Date: 04/14/2021
Rec V Date: 04/21/2021
Hospital: Y

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: He was healthy before vaccine. After vaccine a small amount of chills for a couple days. He was sicker and was exposed to COVID 19, so went to hospital 4/14/2021 tested neg for influenza and + Coronavirus. Died on 4/15/2021

Other Meds: anti convulsants antilipidemics antihypertensives

Current Illness: none

ID: 1238479
Sex: F
Age: 48
State: PA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
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: egg yolk

Symptom List: Injection site pain, Menorrhagia

Symptoms: starting post injection day one, I had a fever , severe body aches and lethargy for 3 days. joint pain and impaired ROM in fingers and toes began post injection day 4. since that time, joint pain has continued and spread to wrists and ankles.

Other Meds: none

Current Illness: none

ID: 1238480
Sex: F
Age: 52
State: OR

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

Lab Data:

Allergies: mushrooms; bananas; morphine; latex

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

Symptoms: No pain or anything right after. They kept me an hour to observe due to past adverse event after vaccine. Body aches the next day - I took care of them with Tylenol. On Sunday, A rash started on my feet - little red dots. It didn't itch. Dr. on Tuesday. Thursday, I was super tired and the rash was continuing to get worse. My doctor called and said the labs were normal. I was getting scratchy throat, runny nose, rash moved to stomach, my back (mainly in my shoulder blades) my upper arms; and my face was bright red -looked like it was peeling, and rash was on my scalp (in my hair). The inside of my lips were swelling and my eyelids were swelling and I felt like I needed to cough. I called the doctor and she told me to go to ER - Thursday, the 15th. I did. They gave me: Epi shot - IV with Benadryl, steroids, and Pepcid. I was there for about 3 hours. Everything worked with my reaction. Epi -Pen prescription; More steroids, Benadryl and Pepcid and I have been taking this through today (today is my last day of the steroids - I have two days of Benadryl left). My face is cleared up now, it's still super dry. I still have the rash all over my body. It looks like I rolled around in a fire ant hill. I was told to carry the Epi-Pen with me for two weeks.

Other Meds: No

Current Illness: No

ID: 1238481
Sex: F
Age: 33
State: LA

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: Ciprofloxacin, sulfa

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Hives and feeling of throat closure.

Other Meds: Depakote

Current Illness: None known

ID: 1238482
Sex: F
Age: 54
State: OH

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received vaccine and reported a feeling of chest discomfort, dizziness, and shakiness. BP 138/84 HR 101 O2 sat 100%. 11:25 am BP 137/77 HR 105 O2 Sat 100. Patient continues to report chest discomfort. 11:34 Given Allegra. 60 mg PO. 11:39 152/77 HR 108 O2 Sat 100% Patient states that she still has numbness in her mouth and jaw. Her chest discomfort is better. She is requesting to be evaluated at the ER. Squad was called. 11:43 Squad arrived and patient taken to hospital.

Other Meds:

Current Illness:

ID: 1238483
Sex: F
Age: 43
State:

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: NKDA

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

Symptoms: Pt. experienced syncopy post the administration of Moderna vaccine at 13:15 hours - At approximately 13:30 hours, episode was reported. B/P 98/63 - Pulse 80 - Felt better lying down - EMS called post assessment by Dr. Repeat B/P by EMS was 120/XX Transported Ambulance.

Other Meds:

Current Illness:

ID: 1238484
Sex: F
Age: 69
State: NJ

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: Allergic to Augmentin, and Mobic., Wasp sting, black fly bite, and gets rash from cortisone shot in knees, pompitations from novacaine, gets rash from latex bandages, had bells palsy in 2016, gets cold sores

Symptom List: Nausea

Symptoms: Severe pain in left arm (not at injection site) - on side near breast, also severe pain in neck and left shoulder, but more severe in my back (left side below shoulder). Pain was only in arm on 4/3, 4, 5 & 6. Then reoccurred in arm, neck, shoulder and back on 4/15/21. Been taking 600mg Ibuprofen 4/18, 19 & 20. Can't take anymore since it bothers my stomach.

Other Meds: Creator, Spironolactone, Estradiol, Nexium, Provide, Glucosamine and Chondroitin, Vitamin E, Caolcium with D, magnesium, and zinc.

Current Illness: None

ID: 1238485
Sex: F
Age: 34
State: CO

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: Penecillin/sulfa

Symptom List: Injection site pain

Symptoms: Minutes after my injection I walked to sit in observation area (I almost drove home and skipped observation). I felt flushed and noticed my heart start to race. I thought that walking around may help, but it didn't. I asked the nurse to take my vitals and my pulse was 115 and didn't come down. My BP was also pretty high. I went and laid down in the ER and was released without any intervention an hour or so later. A week later my vitals were still abnormally high and I went back to the ER and was treated with some fluids (my endocronologist prescribed beta blockers, but at this point they did not help). It has been three weeks now and I am still dealing with high heart rate, and am now having to take beta blockers to regulate my pulse. I was dealing with some on and off low grade fevers which have subsided. I am not able to sleep and have also noticed some numbness in my right foot. I did not have any of this before 3/29.

Other Meds: Zonegran, prenatal, folic acid, d3, had received methotrexate injection for ectopic pregnancy on 3/11

Current Illness: Ectopic pregnancy treatment 3/11 - HCG was 5 3/17

ID: 1238486
Sex: M
Age: 18
State: NJ

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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:

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

Symptoms: Pt. just received first Moderna vaccine dosage. He had just sat down in the observation area when he began to feel flushed and lightheaded. NP was present and soon afterwards his head went backwards and he syncopized. He was caught by the NP and he was still sitting in the chair. NP proceeded to perform a sternal rub. Pt did not become conscious or aware for approximately 2-3 minutes. He never fell to the ground. On further questioning after patient was responsive, he states that he had not eaten prior to coming for his vaccination. He has only received a handful of vaccines and has never had the flu vaccine so he is unsure of his reaction. As per NP patients face became very pale PE: O2sat-96% on room air BP- 110/86 Pulse 60 Pt is pale in color Pupils slightly dilated Responds to sternal rub only After 2-3 minutes pt is more alert EMS was called but patient who is also here with his father refused to be transported to the ER. Repeat vitals 0pulse ox - 96 % room air BP- 105/65 HR-57 Pt. alert and able to respond to conversation Heart rate regular and easy Lungs CTA bilaterally Respiration regular and easy A/P 1-Gave patient water and 2 juices Symptoms have responded well to water and juice and sitting for a few minutes 2. EMS was called but patient refused to go to the ER 3. Discussed possible side effects of vaccine and when to call 911 or go to the closest ER 4. Patient left for home with father after being observed for 40 minutes

Other Meds:

Current Illness:

ID: 1238487
Sex: F
Age: 32
State: CA

Vax Date: 04/07/2021
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Chills, tiredness, muscle pain, nausea, red itchy left eyebrow with skin that flakes off, flu-like symptoms

Other Meds:

Current Illness:

ID: 1238488
Sex: F
Age: 81
State: MD

Vax Date: 03/14/2021
Onset Date: 03/28/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies: NONE REPORTED

Symptom List: Tremor

Symptoms: Patients daughter reported her mother had a stroke (cerebral thrombosis). Patient was admitted to hospital on 3/28/21. Patient has surgery and was admitted to the ICU. Patient also has rehabilitation. Patient is currently recovering at home .

Other Meds: NONE REPORTED

Current Illness: NON REPORTED

ID: 1238489
Sex: F
Age: 37
State: CA

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

Lab Data:

Allergies: Aripiprazole, lamotrigine, gabapentin

Symptom List: Erythema, Pruritus

Symptoms: Patient came in for 1st Moderna Covid vaccine. Patient filled out vaccine questionnaire form. Patient stated she has had no allergic reaction to another vaccine or injectable medication. Patient did state that she has allergic reactions to Wheat, corn, eggs, and nuts and does carry an epi pen. Patient stated she was nervous and did have anxiety problems. When going over paperwork with patient nurse again asked patient is there were ANY medication allergies to which patient replied ?no?. Patient was instructed to wait for 30 minutes in her car after vaccine administration to be observed for any adverse reactions and to honk car horn should she need assistance. Patient agreed and vaccine was administered at 1305. Very shortly after, patient honked horn of car. Nurses went to car with wheelchair. Patient stated her lips were tingling and she felt like she was having anxiety. Patient assisted into WC. While patient was being wheeled back to east entrance, vaccine clinic staging area, patient stated that she was feeling nauseated and felt like vomiting. Patient then threw her head back, eyes closed and patient started to slide from the WC. Nurse assisted patient to the ground. Patient then started to seize and became unresponsive. 911 called at 1309, patient became responsive. First set of vitals taken at 1310. Privacy screen placed, tent canopy was moved over patient and team, linen placed on ground under patient to try and protect her from the hot pavement. Cooling measures taken. Second set of vitals taken at 1316. Patient verbal, alert, responsive, answering questions. Patient drank a small amount of water. Ambulance and fire arrived at 1320. Patient called mother on phone. Nurse secured patients car. Left in ambulance at 1338.

Other Meds: SIngulair, Astelin, Xopenex, Flonase, Buspar, Proamatine, Luvox, Klonopin, Vistaril, Prozac, Trileptal

Current Illness:

ID: 1238490
Sex: M
Age: 53
State: DE

Vax Date: 04/20/2021
Onset Date: 04/21/2021
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: Anesthesia

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

Symptoms: Arm pain at site of injection Chills Headache Tiredness

Other Meds: Lisinopril 20mg Crestor 5mg Zyrtec 10mg

Current Illness: None

ID: 1238491
Sex: F
Age: 51
State: WA

Vax Date: 04/12/2021
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: Only know reaction was to a sulfa based antibiotic.

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

Symptoms: Swelling in the face. Started to notice swelling around lips about an hour after shot. About 3 hours later swelling had spread to nose, cheeks, under chin, and roof of mouth. At 3 hours I took 2 Benadryl and 2 again about 5-6 hours later. Visually noticeable swelling was confined to the day of the shot. A week later I still have minor swelling, mostly around the lips.

Other Meds: None that morning. Usually take an Allegra for runny nose allergies. Acetaminophen or naproxen sodium when need. I have a hormonal IUD.

Current Illness: None beyond ongoing runny nose allergies.

ID: 1238492
Sex: F
Age: 52
State: OR

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: mushrooms; bananas; morphine; latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: No pain or anything right after. They kept me an hour to observe due to past adverse event after vaccine. Body aches the next day - I took care of them with Tylenol. On Sunday, A rash started on my feet - little red dots. It didn't itch. Dr. on Tuesday. Thursday, I was super tired and the rash was continuing to get worse. My doctor called and said the labs were normal. I was getting scratchy throat, runny nose, rash moved to stomach, my back (mainly in my shoulder blades) my upper arms; and my face was bright red -looked like it was peeling, and rash was on my scalp (in my hair). The inside of my lips were swelling and my eyelids were swelling and I felt like I needed to cough. I called the doctor and she told me to go to the ER - Thursday, the 15th. I did. They gave me: Epi shot - IV with Benadryl, steroids, and Pepcid. I was there for about 3 hours. Everything worked with my reaction. Epi -Pen prescription; More steroids, Benadryl and Pepcid and I have been taking this through today (today is my last day of the steroids - I have two days of Benadryl left). My face is cleared up now, it's still super dry. I still have the rash all over my body. It looks like I rolled around in a fire ant hill.

Other Meds: no

Current Illness: no

ID: 1238493
Sex: M
Age: 67
State: FL

Vax Date: 03/26/2021
Onset Date: 04/02/2021
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:

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

Symptoms: Shingles

Other Meds: Probenicid/Colchicine Tamsulocin

Current Illness:

ID: 1238494
Sex: F
Age: 76
State: FL

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

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: no known

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

Symptoms: Patient presented EKG consistent with anterior ST elevation MI with chest pains. Due to the presentation I feel she should undergo urgent cardiac catheterization.

Other Meds: vitamin D 50,000 units weekly triamterene/hctz atorvastatin diltiazem ER 180 mg omeprazole 20 mg aspirin 325 mg hydrochlorothiazide 25 mg levothyroxine 88 mcg

Current Illness: no known

ID: 1238495
Sex: F
Age: 61
State: NC

Vax Date: 04/03/2021
Onset Date: 04/07/2021
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:

Symptom List: Pain in extremity

Symptoms: No immediate side effects except for a slightly sore arm. Extreme fatigue began 4 days from date of injection and lasted to day 16. Dizziness and nausea began about 10 days from date of injection but were intermittent. Nausea and dizziness finally resolved around day 16. No lasting side effects to-date.

Other Meds:

Current Illness:

ID: 1238496
Sex: F
Age: 51
State: CO

Vax Date: 04/16/2021
Onset Date: 04/16/2021
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: Penicillin (rash)

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

Symptoms: Patient became diaphoretic, complained of midsternal chest pain and nausea; vomited small amounts. Patient agitated and not answering questions. Assisted patient to cot- attempted to administer oxygen, but patient removed. Unable to obtain BP; 911 called. 0947 EMS on scene and assumed care (gave epi and benadryl and transported at 0955).

Other Meds:

Current Illness:

ID: 1238497
Sex: M
Age: 54
State: CA

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

Symptoms: Patient was given 2nd Moderna vaccine at about 7:30. Patient was pale and diaphoretic and was lowered to the floor by RN and another patient receiving the vaccine who was a cardiologist. He had several beats of clonus and then woke up. He was awake when his first vital signs were obtained. HR 110, BP 190/96, O2 sat 100%. When he was more awake he was assisted in to a reclining chair. BP monitored every few minutes and dropped as low as SBP 104, HR 70-80s. Pt reported that he periodically syncopizes, last 6mo ago. He reported feeling lightheaded after seeing his arm bleed and be swollen after vaccination. After about 1 hours the patient's vital signs were stable but he continued to have symptoms of lightheadedness which worsened when I sat him up (though BP was stable). EMS was called and he was transported to the ED.

Other Meds:

Current Illness:

ID: 1238498
Sex: F
Age: 30
State: CA

Vax Date: 04/01/2021
Onset Date: 04/13/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: PATIENT DEVELOPED LOWER EXTREMETY SWELLING 3 DAYS POST VACCINATION, JOINT PAIN, MOSTLY IN RIGHT KNEE, GENERALIZED MYALGIAS, SHORTNESS OF BREATH, CALF PAIN RIGHT MORE THAN LEFT, LOW GRADE FEVER WHICH NOW RESOLVED, EXTREME GENERALIZED WEAKNESS AND FATIGUE.

Other Meds: none

Current Illness: none

ID: 1238499
Sex: F
Age: 67
State: GA

Vax Date: 04/07/2021
Onset Date: 04/12/2021
Rec V Date: 04/21/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: STROKE, left frontal

Other Meds: Aspirin, Amlodipine, alendronate, atorvastatin,

Current Illness: None

ID: 1238500
Sex: M
Age: 53
State: VA

Vax Date: 03/27/2021
Onset Date: 04/13/2021
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: NKMA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Left Bell's Palsy.

Other Meds:

Current Illness:

ID: 1238501
Sex: M
Age: 58
State: NC

Vax Date: 03/11/2021
Onset Date: 03/18/2021
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: Grass, Lisenpril.

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

Symptoms: Red spots all over my body, arms, legs, stomach, back, just a few the first week after, but has continued with more and more each week. 6 weeks after and I'm covered with red spots, and yes they itch as well, all over.

Other Meds: Blood Pressure Medicines, Equiax(Blood thinner), Metformin.

Current Illness:

ID: 1238502
Sex: F
Age: 57
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Nodules to L axilla consistent with lymphadenopathy

Other Meds: none

Current Illness: none known

ID: 1238503
Sex: F
Age: 68
State: CT

Vax Date: 04/21/2021
Onset Date: 04/21/2021
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: Lidocaine - "I was in a catatonic state, I had to go to the ER twice after receiving nerve blocks" Peanut-containing drug products - itching, shortness of breath Shellfish - hives

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

Symptoms: 15-20 minutes after the injection, the patient began to become tremulous. Vital signs showed elevated HR and BP. Within a few minutes patient began to experience slurred speech, followed shortly by seizure-like activity - clonic movements. Pt dis not lose consciousness but had intermittent difficulty responding to questions. Patient was brought by EMS to nearby emergency department.

Other Meds:

Current Illness:

ID: 1238504
Sex: F
Age: 54
State: MD

Vax Date: 04/14/2021
Onset Date: 04/14/2021
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: Percocet

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

Symptoms: I received my vaccine around 11 am on 04/14/2021. Before I left the I did notice my left arm was starting to get sore. By the time I got home around 3:30pm the soreness had gotten worse and had moved up my arm and across my shoulder and up neck and across the middle of my back on the left side of my body. I took 2 tylenol extra strength tablets and went to bed around 9 pm. I was awakened in the middle of the night to very itchy skin across my shoulders, back and neck on both sides front and back. That last until I went back to sleep about 15 mins later. I really don?t know. I woke up on the 15th with only sight soreness in my left arm at the injection site however, later that night while asleep I was awakened again to itchy skin in the same area as the previous night and with the itchiness traveling down my left arm almost to my wrist. This time I also experience hives and redness on my arm. Maybe I had redness and hives the night before I don?t know because I didn?t get out of my bed to check. When I awoke on the 16th, I still had the redness on my arm, but the hives had gone away. The soreness at the injection site was barely noticeable. On 04/21/2021 I awoke to the same soreness up my arm, shoulder and neck with the addition of soreness going down my arm to just past my elbow. The level of discomfort being the same as the first day I received the injection on the14th. It hurts and makes me very cranky

Other Meds: Metformin, Atorvastatin

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm