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: 0946810
Sex: F
Age: 43
State: TX

Vax Date: 01/09/2021
Onset Date: 01/12/2021
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: Headache that began on 4 days later. Treatment was ASA with mild improvement and report hives on face after taking ASA lasting for 30 minutes and resolved. Outcome: Continue working did not interfere with ADL's.

Other Meds:

Current Illness:

ID: 0946811
Sex: F
Age: 32
State: MA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: DELAYED reaction including hives and bulging eye.

Other Meds: None

Current Illness: None

ID: 0946812
Sex: F
Age: 34
State: MA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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:

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

Symptoms: Covid19 second vaccination adverse reaction: Received vaccination at 0815am Tuesday 1/12. By 6pm, onset of rigors/chills, body aches, generalized malaise, fatigue, headache which lasted until Wednesday 1/13 ~11:30pm (only x1 low grade fever 99.2 ~6pm Wednesday). Thursday 1/14 called out sick from work residual exhaustion/fatigue and minor headache, body aches dissipated. Able to return to work Friday 1/15.

Other Meds:

Current Illness:

ID: 0946813
Sex: F
Age: 32
State: MO

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: At approximately 5 minutes into the 15-minute monitoring window, I became severely dizzy, flush, and light-headed while simultaneously experiencing right-sided tingling, the altered sensation from my forehead to collarbone (right side only). At approximately four hours post-vaccination my right eye had mild blurriness to my vision. The vision resolved within a few hours but the altered right-sided sensations continued for 6 days, gradually improving. The lightheadedness and dizziness that required cool clothes and elevated feet resolved enough to stand after 30 minutes.

Other Meds: Pre-natal vitamin and 72mg of magnesium bisglycinate.

Current Illness: none

ID: 0946814
Sex: F
Age: 38
State: FL

Vax Date: 01/07/2021
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: NA

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

Symptoms: 8 days after 1st dose, noticed the injection site was warm and raised up. very itchy.

Other Meds: NA

Current Illness: NA

ID: 0946815
Sex: F
Age: 27
State: CO

Vax Date: 12/31/2020
Onset Date: 01/01/2021
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: None

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

Symptoms: Fever, chills, mild body aches, feeling tired. Started at 3am on 1/1/21, was resolved by morning of 1/2/21.

Other Meds: Occasional ibuprofen

Current Illness: None

ID: 0946816
Sex: M
Age: 32
State: MD

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: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I was sitting down at work when out of the blue I experienced heart palpitations, lightheadedness, weakness and shortness of breath that lasted for about an hour. I went to the Emergency Room and by the time I was triaged the symptoms went away. My blood pressure was 150/90 at triage with other vitals within normal limits. I did get an EKG which was negative. I was given Valium 5mg and discharged with a diagnosis of Panic Attack.

Other Meds: Dextroamphetamine

Current Illness: None

ID: 0946817
Sex: F
Age: 50
State: IN

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: NKA

Symptom List: Pharyngeal swelling

Symptoms: 2nd dose- Fever, joint pain, severe neck and chest pain for 36 hours

Other Meds: Birth control

Current Illness: No

ID: 0946818
Sex: F
Age: 44
State: NY

Vax Date: 12/23/2020
Onset Date: 01/10/2021
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: cephalosporins - erythema multiforme

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I am a doctor. I think the nurse went a little subcutaneous in retrospect (she pinched up on my skin). I developed left supraclavicular lymphadenopathy on 12/25 and that is still present and unchanged. I reported that prior. I developed a rash similar to pityriasis rosea on 1/11. This is progressive and still present. I do currently also have fatigue and possible conjunctivitis.

Other Meds: imitrex prn

Current Illness: none

ID: 0946819
Sex: F
Age: 37
State: IL

Vax Date: 01/05/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
Hospital: Y

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

Lab Data:

Allergies: penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient developed headache and nausea on 1-11-2021. She was hospitalized on 1-14-2021 at Hospital. Found to have dural sinus thrombosis of the superior sagittal and right transverse/sigmoid sinus on MRV brain. Currently admitted to ICU at Hospital, getting injectable blood thinners. Neurology and hematology have been consulted.

Other Meds: -Altavera 0.15-30 -Lexapro 10 mg

Current Illness: none

ID: 0946820
Sex: F
Age: 39
State: MA

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: Serotonin

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

Symptoms: DIZZINESS, HEART RACING

Other Meds:

Current Illness:

ID: 0946821
Sex: F
Age: 50
State: GA

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: SYR
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: Approximately 10 minutes after receiving the second dose of the Pfizer Covid-19 vaccine, patient began coughing. Patient reported throat tingling and itching that spread to her face as well. Patient reported a severe headache as well.

Other Meds: Bactrim DS 3x a week pantoprazole

Current Illness: N/A

ID: 0946822
Sex: F
Age: 59
State: KY

Vax Date: 01/12/2021
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: Macrobid, Toradol, avelox, Levaquin, ketorolac, moxifloxacin

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

Symptoms: Resident had facial swelling this morning along with uncontrolled muscle movements and tremors. Residents blood pressure was elevated as well and she complained of nausea. Resident was fine this morning and the past several days with no complaints. This resident has a history of muscle spasms and tremors as well as some catatonic states in the past.

Other Meds: Atorvastatin 20 mg daily, Fludrocortisone 0.1mg tablet daily, Folic acid daily, Levothyroxine 75 mcg daily, magnesium oxide 400 mg daily, mirtazapine 15 mg daily, pantoprazole sodium 20 meq daily, Potassium CL ER 20 mEq daily, Ropinirole HC

Current Illness: Resident had covid 19 on 11/9/2020.

ID: 0946823
Sex: U
Age:
State:

Vax Date:
Onset Date:
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:

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

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 0946824
Sex: F
Age: 75
State: PA

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

Lab Data:

Allergies: flagyl, neosporin

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

Symptoms: extreme nausae, fever, chills, sweats, aches and pains

Other Meds: Valsartan, HCTZ. famotidine, paxil, synthroid

Current Illness: none

ID: 0946825
Sex: M
Age: 68
State: CA

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

Lab Data:

Allergies: None.

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

Symptoms: Rash over about 1/2 of my trunk: lower belly, sides of chest, armpits, upper legs, mid back.

Other Meds: Daily vitamin, anti-oxidant, and CoQ-10.

Current Illness: None.

ID: 0946826
Sex: F
Age: 72
State: MI

Vax Date: 01/09/2021
Onset Date: 01/09/2021
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: pennicillin, ingested IODINE , PTU, sulfa, darvon, diludid

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

Symptoms: At facility - tingling & numbness on lips and tongue - predominantly on the left side - this has continued with occasional spreading to nose & eyes & sometimes on other side of face - it waxes & wanes Same day - headache, dizzy, exhausted - lasted 2 days Next day - nausea, intestinal discomfort - continuing mildly Mild headache continuing

Other Meds: Synthyroid, Linipril, allegra, prometirum, pulmicort, patanese, nasonex, boulardi, calcium

Current Illness: none

ID: 0946827
Sex: M
Age: 33
State: WI

Vax Date: 01/13/2021
Onset Date: 01/14/2021
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: Mild fever beginning 12hrs after injection improved over the next 12hrs. At time of this submission 40hrs out with very mild to nil fatigue.

Other Meds: None

Current Illness: None

ID: 0946828
Sex: F
Age: 42
State: OR

Vax Date: 01/06/2021
Onset Date: 01/06/2021
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: Shellfish and Fish, Dairy

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Intermittent headache, intermittent nausea and vomiting. Swelling of toes on both feet. Pain, redness, swelling, itchiness and hot to the touch at injection site.

Other Meds: Zrytec, Vit D, B12, Pepcid

Current Illness: None

ID: 0946829
Sex: F
Age: 26
State: MA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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:

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

Symptoms: Complained of tingling entire left arm. No other symptoms.

Other Meds:

Current Illness:

ID: 0946830
Sex: F
Age: 40
State: AR

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

Lab Data:

Allergies: SULFA, ORANGE

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

Symptoms: fever, body aches, cold symptoms

Other Meds: NO

Current Illness: NO

ID: 0946831
Sex: F
Age: 72
State: MI

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: Unevaluable event

Symptoms: Sore throat, cough, injection site pain with redness and swelling. Pt. tested for Covid-19 along with influenza A & B (both negative) and throat culture complete. Reviewed use of CPAP machine for possible cause of sore throat and cough, PRN cough drops initiated.

Other Meds: Acetaminophen 650mg q 4 hours PRN, Amiodarone 400mg daily, Amldipine 5mg daily, Apixaban 5mg BID, ASA 81mg daily, Atorvastatin 10mg daily, Claritin 10mg, daily, Docusate Sodium 100mg PRN, Gabapentin 300mg TID, Levothryoxine 150mcg daily, Ma

Current Illness: Covid positive on 9/25/2020

ID: 0946832
Sex: F
Age: 30
State: IN

Vax Date: 01/06/2021
Onset Date: 01/07/2021
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: NKA

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

Symptoms: After I received the vaccine I noticed there seemed to be a knot where I was stuck. Over the next week that small knot seemed to turn to a red welt that has gotten bigger, starting to look more pale in the middle and itchy.

Other Meds: Sudafed -OTC ( morning of)

Current Illness: N/A

ID: 0946833
Sex: F
Age: 66
State: WV

Vax Date: 12/31/2020
Onset Date: 01/14/2021
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: No known allergies (information taken from EPIC hospital computer system)

Symptom List: Injection site pain, Pain

Symptoms: Patient received 1st dose of vaccine on 12/31/20 @ 1332. On 1/14/21 @ 0800, patient reported to Employee Health Nurse that she awoke with a rash around the injection site. She described the rash as a circular rash around the injection site, with a smaller circle nearly on the injection site.

Other Meds: Aspirin 81mg po daily; atenolol / chlorthalidone 50mg/25mg po daily; atorvastatin 40mg po daily; Vitamin D 1000 units po daily; meclizine 25mg po daily as needed for dizziness. (information taken from EPIC hospital computer system)

Current Illness: Unknown

ID: 0946834
Sex: F
Age: 47
State: CA

Vax Date: 12/30/2020
Onset Date: 01/04/2021
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: lisinopril

Symptom List: Injection site pain, Menorrhagia

Symptoms: Red , minimally raised, across widest part of upper arm,hot to the touch,sore, slight bruise.

Other Meds: hydrochlorothiazide, losartan, escitalopram.

Current Illness: n/a

ID: 0946835
Sex: F
Age: 38
State: DE

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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: no

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

Symptoms: Site: Itching at Injection Site, Site: Redness at Injection Site, Systemic: excessive itching which was controlled be Benadryl 25mg, -Medium; symptoms lasted 1 day

Other Meds:

Current Illness:

ID: 0946836
Sex: F
Age: 41
State: MD

Vax Date: 01/04/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: side effects appeared a week after (1/11/21) from getting the vaccine. Left arm injection site develops redness, swelling (hardness), itchiness and warmth. It continues to spread until 01/15/21 but redness and swelling subsides and it appears to look like phlebitis.

Other Meds: VITAMIN C VITAMIN D VITAMIN B12 TRI-LO-MARZIA AMLODIPINE 5MG ATORVASTATIN 10MG

Current Illness:

ID: 0946837
Sex: F
Age: 33
State: IL

Vax Date: 12/30/2020
Onset Date: 12/31/2020
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: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Estimate due date: 07/13/2021 I had arm soreness it started that evening, but next morning I had severe morning sickness, nausea and vomiting, fatigue started 12/24 at night. The morning sickness and fatigue continued for about 2 days after the vaccine. I started to feel better in my pregnancy and then after the vaccine and it all came back. It lasted 3 days and I took the Zofran and felt fine.

Other Meds: Zofran (take as needed), prenatal vitamins

Current Illness: No

ID: 0946838
Sex: F
Age: 59
State: OK

Vax Date: 01/07/2021
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: NKDA

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

Symptoms: Patient received her first dose of Moderna vaccine on 1.7.2021. At a routine anticoagulation visit 7 days later (1.14) her INR was supratherapeutic at 5.5. Patient denied any changes in medications/diet/activity. The only change was receiving her first dose of the COVID vaccine. Patient only has a history of 1 supratherpeutic INR in 2019 due to accidentally doubling warfarin dose. Patient and spouse both report that there is no chance of a duplicate dose in this case. Patient's dose adjusted and INR will be checked more frequently per protocol.

Other Meds: Amiodarone 200mg - 1 tablet daily Atorvastatin 20mg tablet - 1 tablet daily Protonix 40mg - 1 tablet daily Synthroid 50mcg - 1 tablet daily Furosemide 40mg - 2 tabs BID PRN Singulair 10mg - 1 tablet daily Sertraline 100mg - 1.5 tablets da

Current Illness:

ID: 0946839
Sex: F
Age: 41
State: CO

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

Symptom List: Nausea

Symptoms: Within 12 hours of receiving second dose of Pfizer COVID-19 vaccine, patient developed fever 39.5, chills, body aches and headache. Tylenol and ibuprofen did not help with fever much. No notes on further escalation of care or resolution.

Other Meds:

Current Illness:

ID: 0946840
Sex: F
Age: 42
State: CA

Vax Date: 12/31/2020
Onset Date: 01/07/2021
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: None

Symptom List: Injection site pain

Symptoms: Day 1 & 2: pain at injection site, fatigue, body aches. Symptoms resolved. Day 7: swelling and itchy at injection site, body aches. Injection site warm to touch. Days 10-12 rash near injection site and itchy small beginnings of skin irritation on several other areas of body.

Other Meds: Hydrchlorothiazide, vitamin D3, turmeric, DHA-500, iron-free multivitamin, biotin, Aurovela Fe 1.5/30, ibuprofen

Current Illness: None

ID: 0946841
Sex: F
Age: 60
State: NJ

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:
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: this was my second shot for covid, experienced chills fever bad headache

Other Meds:

Current Illness:

ID: 0946842
Sex: M
Age: 25
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: parasthesia in the left arm and then hand and then then the left leg and foot, the symptoms were strong for about 1.5 hours and then subsided and 7 hours after the vaccine the symptoms had completely resolved.

Other Meds: none

Current Illness: none

ID: 0946843
Sex: F
Age: 34
State: IL

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

Lab Data:

Allergies: Codeine and dust mites

Symptom List: Tremor

Symptoms: Days 1-3 Moderate right arm pain; Days 1-2 Moderate chills; Days 2-5 low grade fever- Mine normally runs 97.6 and my temperature was consistently 99-99.8; Day 3-4 Bright, red, patchy non-raised rash on both hands (mainly the fingers) with slight swelling and what felt like a bump on two spots on separate fingers; Day 7-today's date- Lump developed on my chest, just under my collar bone. A virtual appointment was had today (1/15) with my Dr and she wants me to come in for an office visit (which is scheduled for Tuesday 1/19). My temperature was taken after the appointment and it is 99.3. My blood pressure was also unusually high today (159/109 HR 81 and 150/92 HR 76).

Other Meds: Flovent and Zyrtec

Current Illness: None

ID: 0946844
Sex: U
Age: 49
State: NY

Vax Date: 01/04/2021
Onset Date: 01/09/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: Ear pain, lymphadenopathy, sinus congestion, headache, injection site swollen, painful x 3 days

Other Meds:

Current Illness:

ID: 0946845
Sex: F
Age: 58
State: MA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: Pt stated that she felt her heart racing. She denied any other symptoms. She was walked over to the EMS area and placed on heart monitor and monitored for another 20 minutes.

Other Meds:

Current Illness:

ID: 0946846
Sex: F
Age: 33
State: UT

Vax Date: 12/30/2020
Onset Date: 01/01/2021
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: Celebrex - rash

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

Symptoms: Rash with redness and scaling on torso 48 hours following Pfizer-BioNTech COVID-19 vaccine 0.3 mL in right deltoid. No vesicles or pustules and no other features that suggest a erupting case of herpes zoster. Some are flat. There is no perilesional pallor. Provider examined skin. Assuming patient improved since there are no notes of worsening in the chart.

Other Meds:

Current Illness:

ID: 0946847
Sex: F
Age: 49
State: MO

Vax Date: 12/31/2020
Onset Date: 01/05/2021
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: sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Bell's Palsy left side

Other Meds: topiramate, repaglinide, paroxetine, simvastatin, meloxicam, metformin, lansoprazole

Current Illness: None

ID: 0946848
Sex: F
Age: 29
State: CO

Vax Date: 01/08/2021
Onset Date: 01/08/2021
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: Sulfa (cough, itching, swelling, hives, shortness of breath)

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

Symptoms: Pt received dose second Pfizer COVID vaccine. Reported pruritus all over her body - patient was noticeably scratching herself. Patient was given 12.5 mg benadryl and was observed for an additional 15 minutes. Patient reported still having pruritis and was given an additional 12.5 mg benadryl, and was observed again for an additional 15 minutes. At the end of the 15 minutes she reported feeling much better and was sent home.

Other Meds:

Current Illness:

ID: 0946849
Sex: F
Age: 15
State: VA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
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: Error: Booster Given Too Early

Other Meds:

Current Illness:

ID: 0946850
Sex: M
Age: 41
State: IN

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: pcn

Symptom List: Pain in extremity

Symptoms: pins and needles throughout body. started 3 days post vaccination and continues 1 week after. had low grade fever and fatigue in 24hrs post.

Other Meds: none

Current Illness: none

ID: 0946851
Sex: F
Age: 34
State: WI

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Hives that gradually spread over the entire body. Began 12-24 hours after the vaccine was given and has progressively gotten worse over the a 2 day period. Was directed to contact PCP for possible treatment

Other Meds:

Current Illness:

ID: 0946852
Sex: M
Age: 0
State: AZ

Vax Date: 01/18/2021
Onset Date: 01/15/2021
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:

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

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 0946853
Sex: F
Age: 24
State: OH

Vax Date: 12/30/2020
Onset Date: 01/07/2021
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: None known

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

Symptoms: 8 days after injection as noted above, pt developed red, raised, warm area over her right deltoid, approx. 5x9cm

Other Meds: N/A

Current Illness: None

ID: 0946854
Sex: M
Age: 75
State: MI

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: none

Symptom List: Vomiting

Symptoms: Headache,chills,fever,pain at injection site, Muscle pain joint pain, tiredness Started approx. 1 hr. after injection and lasted about18 hrs. took Tylenol and drank a lot of water.

Other Meds: mens vitamin, fish oil, omeprazole magn.,Caltrate +D Tamsulosin Hydrochloride,,Atoruastatin , Tylenol

Current Illness: Paget's disease

ID: 0946855
Sex: F
Age: 29
State: CA

Vax Date: 01/11/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Covid vaccine on 1/11/2021. Tested positive for covid 1/13/2021. Developed lip swelling, hand/feet swelling and itching on 1/14/2021. Improved with benadryl.

Other Meds:

Current Illness:

ID: 0946856
Sex: F
Age: 45
State: MI

Vax Date: 12/18/2020
Onset Date: 12/23/2020
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: Erythema, raise, pruritic, rash on upper thigh, and arms. Presented to urgent care for steroid administration.

Other Meds:

Current Illness:

ID: 0946857
Sex: F
Age: 57
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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Systemic: Exhaustion-Mild; symptoms lasted 1 day

Other Meds:

Current Illness:

ID: 0946858
Sex: F
Age: 54
State: IL

Vax Date: 01/12/2021
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: RA

Lab Data:

Allergies: penicillin

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

Symptoms: Dizziness at first. Warm red enlarged knot at injection site for 4 days now. Next day fever, chills and fatigue

Other Meds: Vitamin

Current Illness: none

ID: 0946859
Sex: F
Age: 55
State:

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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: Reaction delayed - self-care: Day 1 body aches, bad headache, Day 2 sore feet and heel especially, rash on right arm. Lymph nodes sore on neck on Day 2.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm