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: 0946606
Sex: F
Age: 31
State:

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/15/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Edema, warm to touch, redness, mild discomfort at injection site with swollen lymph node axilla area of left arm. No treatment at this time.

Other Meds:

Current Illness:

ID: 0946607
Sex: M
Age: 17
State: IL

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna vaccine administered off label to 17 year old.

Other Meds: Unknown

Current Illness: Unknown

ID: 0946608
Sex: F
Age: 40
State: TX

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Heart palp. started about hour after inj. BP was up and down. Pulse was very high. Tired, stomach cramps.

Other Meds: Adderall

Current Illness: no

ID: 0946609
Sex: F
Age: 58
State: SC

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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 chills lethargic body aches. Decreased mentation dizzy soreness at injection site, erythema at injection site

Other Meds: Micardis, Lipitor, maxalt

Current Illness: None

ID: 0946610
Sex: M
Age: 29
State: IN

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Significant headache, body fatigue, and diarrhea. I took tylonel and watched my diet, symptoms are for most part gone as of this moment.

Other Meds: B-12

Current Illness: None

ID: 0946611
Sex: F
Age: 22
State:

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/15/2021
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:

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

Symptoms: Fever of 104.3 Fahrenheit, chills, body aches, headache, soreness at injection site.

Other Meds:

Current Illness:

ID: 0946612
Sex: M
Age: 51
State: RI

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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: asa, pcn, nsaids

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 0757 - c/o itchy eyes, Benadryl given 25 mg oral. 0820 - 133.76, 80, states itching gone. Discharged home in stable condition.

Other Meds: Lantus, Humalog,

Current Illness:

ID: 0946613
Sex: F
Age: 51
State: FL

Vax Date: 01/10/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Pharyngeal swelling

Symptoms: 2nd dose: chills, fever 100., body aches, flu like symptoms. 1/13/21 injection site redness, swollen as a rock, hot to touch and sore. 1/15/21 injection site redness, swollen as a rock, hot to touch and sore; skin temp taken 100.0 at injection site, localized in area, not feeling well, weakness, neck stiffness, headaches Midrin taken for intense headache. Pt has been resting all week, off work returned today no fever. 1st dose: no ae to report

Other Meds: Birth control, Topamax 100mg, Cholestyramine powder, allergy medicine, Aleve prior to medication, Prilosec

Current Illness: N/A

ID: 0946614
Sex: F
Age: 24
State: FL

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/15/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Body aches and fatigue treated with Tylenol and rest

Other Meds:

Current Illness:

ID: 0946615
Sex: F
Age:
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: muscle spasm in back and went to arms and legs throughout the day twitching

Other Meds:

Current Illness:

ID: 0946616
Sex: F
Age: 60
State:

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

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

Lab Data:

Allergies: Anaphylaxis to Bees

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

Symptoms: About 15 minutes after injection c/o mild tingling to lips. No other symptoms. VSS (BP 103/68, O2 99%, RR 17, HR 68). no wheezing, SOB, swelling, chest pain, dizziness, abd pain, NV. about 15 minutes later, lip tingling improved but began c/o generalized urticaria with mild erythema to left upper chest. patient well appearing at that time, A&Ox3, no increased WOB, SOB, hives, facial swelling, facial redness. Patient reports she experienced same urticaria about 24-48 hours after 1st COVID vaccine dose, treated at home with po benadryl with improvement. Placed on continuous monitoring and administered 25 mg Benadryl po with improvement in symptoms. About 30 min after benadryl administration symptoms resolved. Offered ER evaluation to which patient declined. She works within hospital and agrees to seek emergency medical care should symptoms return or worsen. can continue to take benadryl at home and monitor closely.

Other Meds:

Current Illness: hx generalized urticaria following 1st dose of pfizer vaccine starting 24-48 hours after injection self treated with benadryl at home.

ID: 0946617
Sex: F
Age: 55
State: IL

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: left side sore throat, symptoms started 2 days after vaccine received.

Other Meds: none

Current Illness: none

ID: 0946618
Sex: F
Age: 41
State: FL

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: Spiders, latex, Sulpha, Neurontin, Depakote, Paxil,

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

Symptoms: I was really tired and not hungry. Went to bed and at 4am I woke up burning up hot and took off my shirt and threw up with diarrhea the rest of the night and half the next day...then it was just diarrhea, loss of appetite and I slept all day the next day missing work. Feel better today Friday 1/15/21.

Other Meds: Oxycodone 5 mg, Lisinipril, Clonazepam 2mg, Hydroxizine- as needed, Trazadone (for sleep)

Current Illness: Nope- just post concussion from car accident 10/23/20

ID: 0946619
Sex: F
Age: 42
State: IL

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
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: penicillin, erythromycin, ceclor, keflex, CT contrast dye, tetanus vaccine, soy, peanut, shellfish, cats and other small mammals, bee stings

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

Symptoms: Red blotchy rash to face and chest

Other Meds: prenatal vitamin, claritin, zyrtec, singulair, levothyroxine, metformin, zoloft

Current Illness:

ID: 0946620
Sex: F
Age: 46
State: OH

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/15/2021
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: N/K/A

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

Symptoms: I immediately had pain at the injection site, it did bleed enough to fill a bandaid and over the next two days was very sore and painful and red. The next morning I had a lot of swelling severe heat radiating from the injection site, severe redness and pain. this lasted until Saturday when it appeared to have ben gone, no more redness, nothing. The following Tuesday morning January 12th when I woke up I had a terrible headache, body aches sore throat, by noon, I had an itch on my arm where the vaccine was given and discovered severe swelling, itchiness, redness and extreme heat coming off the site all worse than the prior week. I went to urgent care that evening after work and was given prednisone, antibiotics and was told to also take Benadryl. The diagnosis was cellulitis and was also rapid tested for covid which was negative. Physician found me wheezing, slightly enlarged lymp nodes, a stuffy nose and I was told to get retested if the symptoms don't improve. I have no headache today but am very groggy still and have a sore throat. The arm is still red, still warm and still has little blisters in the center which is new. I am taking meds as prescribed.

Other Meds: NONE

Current Illness: NONE

ID: 0946621
Sex: F
Age: 28
State: MI

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: Pediazole

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

Symptoms: Headache, body aches, nausea, chills, fever - 48 hours

Other Meds: amitriptyline

Current Illness: None

ID: 0946622
Sex: F
Age: 56
State: CT

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/15/2021
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: No

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

Symptoms: Mental confusion,shakes, foggy brain , things did not make sense to me, driving confusion

Other Meds: Tylenol,serteraline,minocycline,ibuprophen

Current Illness: No

ID: 0946623
Sex: F
Age: 27
State: CO

Vax Date: 12/22/2020
Onset Date: 12/30/2020
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: She received the Moderna COVID vaccine on 12/22/2020. She had no initial problems with the vaccine. Had a little soreness in the arm of the injection, but otherwise fine. Today, she has noticed itching and redness around the injection site. Located on the left shoulder.

Other Meds: None

Current Illness:

ID: 0946624
Sex: F
Age: 53
State: GA

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: Codeine; Fresh Fruit; Latex

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Staff member reports body aches, malaise, and diarrhea to the point of dehydration

Other Meds: HCTZ; Gabapentin

Current Illness: n/a

ID: 0946625
Sex: M
Age: 58
State: NJ

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Minor soreness in left upper arm

Other Meds: Metformin Metoprolol Welchol

Current Illness: None

ID: 0946626
Sex: F
Age: 42
State: GA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital: Y

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: Latex, Decadron, Tramadol, Lortab, Hydrocodone, Sulfa

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

Symptoms: Patient received Pfizer COVID-19 vaccine without any immediate complication on 1/14/21approx 1455, was then escorted to observation area for a 30 minute observation time. Pt had previously had a known reaction to contrast media. Approximately 5 -8 minutes into observation, pt had one audible cough. Nurse asked patient if this was a new onset cough. The patient stated she would try to "manage" cough. Pt escorted to bay for monitoring. Pt developed shortness of breath and wheezing rapidly. Rapid response team called and local 9-11 also called. Pt received albuterol nebulizer treatment, placed on O2 at 8L. O2 sat 99%, HR 115-120. Respiratory therapy assisted and Rapid Response Team monitored pt while waiting for EMS. Physician order to give Epinephrine 0.3 mg IM in right deltoid, given as directed at approx 1515. Second epinephrine 0.3 mg IM given approx 1530-1535. HR 144, O2 sat 99%. Patient transported to local ER, pt intubated approx 1927.

Other Meds: Zoloft, Nexium, Synthroid, Multivitamin, Levothyroxine

Current Illness: unknown

ID: 0946627
Sex: F
Age: 33
State: ME

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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: Tachycardia (Heart rate 134-160), flushing, reporting facial tingling. Resolved spontaneously after 45 minutes observation with no interventions

Other Meds:

Current Illness: None

ID: 0946628
Sex: M
Age: 34
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: Pencillin

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

Symptoms: Approximately two hours after receiving the second dose of the COVID-19 vaccine, the patient complained of shortness of breath, feeling flushed, throat burning, tongue swelling and numbness, elevated heart rate, diaphoresis, dry mouth, weakness, and reddened skin. Patient was still in the facility where he received the vaccine and was immediately taken to the Emergency Department. The patient received Pepcid 20 mg by mouth, Benadryl 25 mg by mouth, and Predisone 40 mg by mouth.

Other Meds: Albuterol HFA Inhaler 2 puffs every 4 hours as needed for shortness of breath Robitussin 10 mL every 6 hours as needed for cough and/or congestion

Current Illness: Unknown

ID: 0946629
Sex: F
Age: 61
State: NE

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/15/2021
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: DEVELOPED SORE ARM THAT LASTED 1 DAY. ALSO HAD BAD FATIGUE AND HEAD PAIN LASTING UNTIL MORNING OF 1/10/21.

Other Meds:

Current Illness:

ID: 0946630
Sex: F
Age: 30
State: NJ

Vax Date: 01/04/2021
Onset Date: 01/12/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: Watermelon, honeydew, cantaloupe, banana, mango, pineapple, coconut, almond, apple skin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Redness, warmth, and swelling at injection site 8 days post injection. Increased swelling, warmth, and itchiness day 10 post injection.

Other Meds: Blisovi, zyrtec, fluoxetine

Current Illness:

ID: 0946631
Sex: M
Age: 27
State: AZ

Vax Date: 01/07/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
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: sensitive skin to lotions, soaps

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

Symptoms: Patient developed full body, pruritic rash 4 days after vaccine given; no new soaps, detergents, food, medications

Other Meds: none

Current Illness: no

ID: 0946632
Sex: M
Age: 32
State: TX

Vax Date: 01/10/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 01/11/21: MOnday: Chills, feverish, headache, bodyache 01/12/21:Tuesday: Chills, fever (99.9), bodyache 01/13/21:Wednesday: chills, feverish, bodyache 01/14/21: Thursday: Hives all over body, itchy, Chills, feverish. Went to clinic. abbot now test done. NEgative for corona virus. allegra and benadryl taken. 01/15/21: Friday: Hives

Other Meds: none

Current Illness: none

ID: 0946633
Sex: F
Age: 62
State: KS

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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: 62 y.o. female who was seen at COVID Vaccine Clinic today for her first dose of the COVID 19 vaccination. She denied any history of previous adverse reactions to vaccines. She was given the Pfizer vaccination in the left deltoid muscle. During her 15 minute waiting period after the injection, the patient began to experience funny taste in her mouth (somewhat metallic like). She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, lightheadedness, dizziness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and she was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to abdominal pain, blood pressure abnormality , chest pain, collapse, drooling, hypotension, increased swelling, rapid progression of symptoms, respiratory distress, skin changes, tongue swelling and vomiting. ALLERGY REVIEW OF SYSTEMS Previous Reactions: This is patient's first vaccine (Pfizer). Does report previous reaction to influenza vaccine many years ago, states it caused her to get really sick. Objective Vitals Vitals: 01/15/21 0932 BP: (!) 145/83 Pulse: 76 SpO2: 98% Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is not ill-appearing or diaphoretic. Cardiovascular: Rate and Rhythm: Normal rate. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Neurological: Mental Status: She is alert. Assessment/Plan Treatment included: antihistamines. Follow up response to treatment: good. Patient discharge: Stable to go home and follow up with PCP. Patient doing well upon discharge. Reports some improvement in change in taste prior to discharge/leaving. She was escorted out via wheelchair only due to reports of difficulty ambulating long distances due to being disabled but is otherwise at baseline.

Other Meds:

Current Illness:

ID: 0946634
Sex: M
Age: 48
State: WA

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
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: Cat dander

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

Symptoms: Headache - migraine

Other Meds: Telmisartan

Current Illness: N/a

ID: 0946635
Sex: F
Age: 25
State: KY

Vax Date: 01/04/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Ceclor, Sulfa

Symptom List: Nausea

Symptoms: Infraclavicular lymphadenitis ipsilateral to site of injection

Other Meds: Zoloft 50 mg daily, Blisovi Fe 1/20 daily

Current Illness: None

ID: 0946636
Sex: F
Age: 58
State:

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: Injection site pain

Symptoms: vomiting, headache, nausea, joint pain. called in sick to work.

Other Meds:

Current Illness:

ID: 0946637
Sex: F
Age: 51
State: CA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, Sulfa, Opiates

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

Symptoms: At approximately 1:55pm LR received the covid-19 vaccination by Moderna. Around 2:00pm patient showed signs of allergic reaction during which she developed a rash on face. 911 was called and diphenhydramine 50mg IM was adminstered per protocol. Paramedics arrived on scene at 2:10pm where I ceded treatment.

Other Meds: Unknown

Current Illness: None reported

ID: 0946638
Sex: F
Age: 49
State: NJ

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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: fever, chills, body ache, joint pain.

Other Meds:

Current Illness:

ID: 0946639
Sex: F
Age: 41
State: IL

Vax Date: 12/19/2020
Onset Date: 12/20/2020
Rec V Date: 01/15/2021
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: Codeine

Symptom List: Tremor

Symptoms: Toothache across the entire lower jaw, which lasted for about 12 hours. Treated with ibuprofen.

Other Meds: Reclipsen, aspirin, claritin

Current Illness: None

ID: 0946640
Sex: F
Age: 32
State: NJ

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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: Food allergies, nuts and peanuts Allergies to Birch and other pollen allergies

Symptom List: Erythema, Pruritus

Symptoms: swollen red face, hot red ears, patches of red on stomach and back. Reaction subsided slowly after the consumption of allergy medication.

Other Meds: Allergy medication, prenatal vitamins , Eliquis

Current Illness: DVT one month ago

ID: 0946641
Sex: F
Age: 49
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: left arm pain, generalized body aches, chills and fatigue. Treatment included Tylenol the next day. Outcome: Moderate improvement has continued c/o of mild fatigue and generalized body aches that does interfere with ADL's currently working.

Other Meds:

Current Illness:

ID: 0946642
Sex: F
Age: 26
State:

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: fever, vomiting. called in sick to work.

Other Meds:

Current Illness:

ID: 0946643
Sex: F
Age: 55
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Moderna COVID-19 Vaccine EUA - Diarrhea , nausea, headache, chills, fever, 100.5, flush face, very sore arm at site of injection

Other Meds: N/A

Current Illness: N/A

ID: 0946644
Sex: M
Age: 74
State: GA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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: sore arm, fever, chills, muscle pain, fatigue, headache

Other Meds: Eliquis, Cartia. Metoprolol, Lisinopril vitamin D and B12, probiotic, Ocuvite, zinc

Current Illness:

ID: 0946645
Sex: F
Age: 24
State:

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: I experienced extreme pain in my left upper arm at not only site of injection but, down to my elbow and up into my neck. I had swelling and site was hot to touch. I also had a mild headache.

Other Meds:

Current Illness:

ID: 0946646
Sex: F
Age: 39
State: TX

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: Pain in extremity

Symptoms: 2ns shot -- headache that started shortly after the shot that worsened and was not alleviated with tylenol. headache lasted about 1.5 days. chills started at about 3 am on 1/13/2021 and lasted for about 1 day. body aches lasted for one day on 1/13. fatigue started on 1/13 and lasted through 1/14. painful left axillary lymph node swelling starting on 1/13 and continuing to present day. 1st shot -- sore arm, painful left axillary lymph node swelling

Other Meds: losartan, spironolactone, montelukast, zyrtec, fish oil, vit b12, vid D

Current Illness: n/a

ID: 0946647
Sex: F
Age: 51
State: OH

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/15/2021
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: 24 hrs later: severe headache. 5 days hrs later: chills, body aches. fatigue. This has not resolved. As of today , 10 days later still have severe fatigue. Nausea started yesterday (day 9) No respiratory symptoms. No loss of taste or smell.

Other Meds: Metoprolol, Maxide, Estrace, Tricor, Neuriva Brain Supplement, Vitamin D3, Calcium, Magnesium, Pepcid , multivitamin, Spring Valley Immune Plus Gummies

Current Illness: None

ID: 0946648
Sex: F
Age: 34
State: AZ

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/15/2021
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: no

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

Symptoms: 12/22 evening I had severe arm soreness and light body aches, the next morning I felt congestion, runny nose , severe headache, mild palpitations, my whole body hurt. 12/24 I couldn't breathe through my nose at all , no taste or smell for 24 hours, 1 week after I wasn't getting better my lungs sounded junky , 12/31 I went to the urgent care, I got tested and was negative, I had pneumonia , I was sent home with antibiotic, steroids, inhaler.

Other Meds: multivitamin, zyrtec

Current Illness: I had some allergies and runny nose when I went outside but I've had allergies my whole like I'm not sure

ID: 0946649
Sex: M
Age: 33
State: CO

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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: N/a

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

Symptoms: Moderna COVID-19 Vaccine Reactions to the Moderna vaccine included dizziness, weakness, body aches, fever (102*), fatigue and headache.

Other Meds: N/a

Current Illness: N/a

ID: 0946650
Sex: F
Age: 42
State: MT

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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: Imitrex, Toradol, Vicodin

Symptom List: Vomiting

Symptoms: Pt felt constriction in back of throat ,tongue within 5 min of receiving shot. "It felt like a tight turtle neck was around my neck". She felt like she had a elevated HR. This was followed by a feeling of being flushed and her whole body was itchey. Para-medics attended her and noted Elevated heart rate, and BP. O2 sats were good. No epinephrine was given. She went home and took some Benadril.

Other Meds: Claritin, Flonase, IUD

Current Illness: None

ID: 0946651
Sex: F
Age: 28
State: NY

Vax Date: 12/27/2020
Onset Date: 12/28/2020
Rec V Date: 01/15/2021
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: IV contrast

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Malaise and headache x 1 day. Redness surrounding injection site x 2 weeks

Other Meds: Birth Control, Uceris, Folic Acid

Current Illness:

ID: 0946652
Sex: F
Age: 22
State: NY

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Parasthesia of bilateral hands, fever, fatigue, body aches, headache

Other Meds:

Current Illness:

ID: 0946653
Sex: F
Age: 48
State: AZ

Vax Date: 01/12/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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: no know allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Resident has pain, swelling, warmth, and redness at injection site measuring 13.5inx85in. Resident is currently receiving benadryl with no relief.

Other Meds: Please call facility. resident is a long term care resident

Current Illness: none

ID: 0946654
Sex: F
Age: 40
State: CO

Vax Date: 01/06/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Rash/irritated skin one week after injection. Warm to touch, skin feels tight. Slight itch.

Other Meds: melatonin, fluoxetine

Current Illness: None

ID: 0946655
Sex: F
Age: 70
State:

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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: fever, aches. called in sick to work.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm