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

Incidents per State

State Total
92,076
AK1,880
AL6,345
AR4,151
AS46
AZ14,991
CA66,887
CO12,550
CT8,943
DC1,795
DE2,009
FL42,724
FM4
GA17,031
GU124
HI2,580
IA4,919
ID2,892
IL22,128
IN24,197
KS5,047
KY9,111
LA5,500
MA15,718
MD13,434
ME3,351
MH8
MI20,971
MN13,585
MO10,747
MP30
MS3,198
MT2,477
NC18,051
ND1,501
NE3,109
NH3,218
NJ20,216
NM4,218
NV4,728
NY37,667
OH20,793
OK6,692
OR9,244
PA25,607
PR2,588
QM2
RI2,163
SC7,261
SD1,282
TN10,445
TX39,890
UT4,618
VA15,980
VI67
VT1,830
WA16,071
WI12,042
WV2,571
WY926
XB5
XL1
XV2

ID: 0947019
Sex: F
Age: 32
State: AZ

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Meningococcal Vaccine - patient denied anaphylactic reaction to vaccine, she had pruritic and rash. She also is allergic to fruit, primarily melons and bananas - oral pruritic.

Symptom List:

Symptoms: Patient developed a hoarsenss of voice and tightness of throat and flushed feeling immediately following vaccination. Epi Pen was administered and 50 mg Benadryl given p.o., EMS transport to ED after administration of solumedrol 125 mg - received Pepcid and Zofran and NS IV in the ED. Discharged from ED with prednisone 40 mg daily x 4 day with Epi Pen prescription.

Other Meds: None

Current Illness: Not currently ill

ID: 0947020
Sex: F
Age: 56
State: CA

Vax Date: 01/06/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: started having itching on the 13th swelling red hot to touch this has continued to get worse over time

Other Meds:

Current Illness:

ID: 0947021
Sex: F
Age: 48
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Fever, fatigue. Resolved.

Other Meds:

Current Illness:

ID: 0947022
Sex: F
Age: 36
State: CO

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa

Symptom List:

Symptoms: Symptoms started around 2300 on 01/14/2021. I experienced SOB; sharp and shooting pain throughout my extremities; dull body aches; nausea induced vomiting; dizziness; weakness. I was unable to sleep throughout most of the night. I used tylenol and ibuprofen for my symptoms which didnt seem to alleviate any of the symptoms during the night. Woke up on 01/15/2021 with a rash on my face.

Other Meds: none

Current Illness: none

ID: 0947023
Sex: F
Age: 52
State: NV

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None

Symptom List:

Symptoms: I had my first dose of the vaccine on Monday morning. I woke up Tuesday morning with a very sore arm, which I expected. I was also very tired with a bit of a headache. I teach school, and throughout the day I had very little energy and went to bed early that night. The next day (Wednesday) I felt the same, really wiped out, but also had some gastrointestinal issues and little appetite. Thursday I felt the same. Today is Friday, and I'm still dragging a bit but my appetite is returning. I feel like I'm getting back to normal.

Other Meds: NoneNone

Current Illness: None

ID: 0947024
Sex: F
Age: 55
State:

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Joint aches, and headache

Other Meds:

Current Illness:

ID: 0947025
Sex: F
Age: 63
State: OR

Vax Date: 01/05/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Levothyroxine, previously mfg. formula caused rash and itching; Spinach causes diarrhea.

Symptom List:

Symptoms: 01/14/21 6:00 am noticed lump when running bar of soap over area. later in day it started to turn pink and was slightly warm to touch. 01/15/2021 6:00 am noticed arm itching and upon inspection noticed Hard lump swelling; redness, hot to touch.

Other Meds: Levothyroxine 75 mg; Lisinopril 10 mg; Hydrochlorothiazide 25 mg

Current Illness: none

ID: 0947026
Sex: F
Age: 77
State: MO

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: aspirin, penicillin g, potassium, simvastin, zocor

Symptom List:

Symptoms: The resident has redness and warmth on her LUA from her covid vaccination. The resident states she has a headache and some wheezing. New order received for Benadryl 25 mg po now and in 6 hours then PRN q6h x 3 days.

Other Meds: allopurinol, buspirone, daily vitamin + mineral, diltiazem, duloxetine, eliquis, fentanyl patch, fish oil, furesomide, gabapentin, hydroxychlor, levothyroxin, losartin, melatonin, metoprol suc, omeprazole, oxycodone, ropinirole, senna, spir

Current Illness: N/A

ID: 0947027
Sex: F
Age: 44
State: WI

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Itching/hives over head, ears, no breathing difficulty

Other Meds: Wellbutrin, Citalopram, Singular, Cinnamon, Primrose, Echotrim, Nexium

Current Illness:

ID: 0947028
Sex: F
Age: 32
State: FL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Keflex gives me bad thrush

Symptom List:

Symptoms: Immediate headache and severe nausea, that evening around 12:30am I woke up to my stomach and mouth feeling as if they were on fire. The nausea continued for two days but lightened each day. Very fatigued feeling, pale in color and arms keep falling asleep randomly for 3 days now.

Other Meds: Daily: Multi Vitamin, Allegra 24 hour, Levothyroxine 110mcg, Omeprazole 40mg, Propranolol XR, Probiotic

Current Illness: N/A

ID: 0947029
Sex: F
Age: 71
State: VT

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: History of Anaphylaxis to Flu Vaccine (x2).. (with and without preservatives) and Imitrex

Symptom List:

Symptoms: After Covid Vaccine (Pfizer) administration, immediately complained of tongue swelling. METS team was called and employee was sent to Emergency Room.

Other Meds:

Current Illness:

ID: 0947030
Sex: F
Age: 42
State: MN

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: regalin medication

Symptom List:

Symptoms: Nausea and headache the evening of the vaccine. Chills, headache, aches and pains, nausea late that night into the early morning. Day 6 after receiving vaccine, lymph nodes swollen. Worsened on day 7 and 8. Day 8 after vaccine noticed hives on back. Still have headache and nausea off and on.

Other Meds: None

Current Illness: none

ID: 0947031
Sex: M
Age: 60
State: MD

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: CHILLS, FEVER 101.8, SEVERE HEADACHE

Other Meds: UNKNOWN

Current Illness: NONE

ID: 0947032
Sex: F
Age: 48
State: OH

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Slight rash, itchy all over

Other Meds:

Current Illness:

ID: 0947033
Sex: F
Age: 41
State: NY

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: R arm area of induration/erythema. started 2 days after vaccine now enlarging, seen today at urgent care (9 days post vaccine) with large area of erythema/induration measuring 9 cm x 4 cm around injection site

Other Meds:

Current Illness:

ID: 0947034
Sex: F
Age: 31
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none known

Symptom List:

Symptoms: Small dime size rash on left wrist

Other Meds: None known

Current Illness: none known

ID: 0947035
Sex: F
Age: 30
State: TX

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Macrobid-rash

Symptom List:

Symptoms: Day 1-After immunization on Jan 8, 2021-covid 19 moderna vaccine-no symptoms or concerns on this day Day 2- Woke up at 3am-headache, chills, felt cold, fever 101.4F-took ibuprofen as needed Day 3-Woke up trouble breathing-history of asthma, used inhaler and resolve, temp at 99.7 continued to take ibuprofen as needed Day 4- No signs or symptoms

Other Meds: Albuterol inhaler

Current Illness: none, but positive for covid 19 -6 months ago

ID: 0947036
Sex: F
Age: 64
State: MD

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List:

Symptoms: Employee reported having SOB with chest pains, severe headache (rated pain as 8/10), excessive salivation with nausea, lightheadedness, she has a h/o migraines headaches and was incapacitated for 24 hours, Employee she was treated and sent home by end of her scheduled shift

Other Meds:

Current Illness:

ID: 0947037
Sex: M
Age: 74
State: GA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: none known

Symptom List:

Symptoms: Sore arm for 48 hours, and mild chills and slight fever for 24 hours

Other Meds: daily vitamin, fish oil and BP meds

Current Illness: Covid19 positive test on 12/31/2020

ID: 0947038
Sex: F
Age: 37
State: WA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: eggs, seafood

Symptom List:

Symptoms: pt received injection at her place of employment from a public health employee. Within one hour, pt had high fever, rigors, malaise and felt like throat was swelling. Tmax 103.8. She has had to take tylenol and benadryl around the clock since that time to combat these symptoms. I saw her 4 days after vaccine administration and tested her for covid with NAAT. This came back positive. She had a test 3 days prior to vaccine administration at her work that was negative.

Other Meds: iron, Vit C

Current Illness: none

ID: 0947039
Sex: F
Age: 35
State: AL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Cefaclor

Symptom List:

Symptoms: Complaints of fever, tachycardia after vaccination,myalgias, chest ache, axillary adenopathy and tenderness.

Other Meds: None Listed

Current Illness: Anxiety

ID: 0947040
Sex: M
Age: 66
State: MO

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: hops, barley, nuts,

Symptom List:

Symptoms: Headache, chills, low grade fever which started the evening after vaccination and continued the next day. Symptoms subsided the second morning after vaccination.

Other Meds: NA

Current Illness: NA

ID: 0947042
Sex: F
Age: 29
State: OH

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: None reported

Symptom List:

Symptoms: Wed Jan 13, 2021 13:54 Patient was not feeling well right after she got the vaccine. They had her sit for 15 minutes. She started to feel better and left. Started to feel bad in the car on the way back to work. Her boss is a dentist and advised her to take Benadryl, which she did. Traveling to Hospital now. She has not yet been seen by a physician. Current symptoms are throat constriction, hard time swallowing, and having a hard time concentrating. She is pale and feels unwell. Wed Jan 13, 2021 16:09 Followed up with patient. Patient is currently in the Emergency Room at Hospital. She has so far received steroids and benadryl. Thurs Jan 14, 2021 08:56 Followed up with the patient again. She returned home from the first ER visit at 17:30 last night. About 4 hours after that her heart rate became elevated again (130-140 bpm while lying down) and she was confused, lethargic, and had a HA and backache. She went back to ER last night around 21:30. They gave her more benadryl in IV and toradol for the HA. She is now on PO benadryl every 4 hours for 4 days. Symptoms today include: runny nose, feels like a mild case of flu, HA and backache. Upon awaking this morning, prior to the morning dose of benadryl, her heart rate was a little elevated. She was also told she could alternate Tylenol or ibuprofen prn and use OTC cold remedies but hasn't needed any. The doctor said she is not a candidate for the next the second vaccine dose.

Other Meds: B-12, Phentermine taken prior to vaccine. She takes this every morning.

Current Illness: None reported

ID: 0947043
Sex: F
Age: 79
State: IL

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Sulfa

Symptom List:

Symptoms: chills, low grade fever, weakness overnight and feeling of malaise for two days.

Other Meds: Levothyroxyn

Current Illness: none

ID: 0947044
Sex: F
Age: 49
State: MI

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: dilaudid

Symptom List:

Symptoms: Patient had headache with dizziness about 30" after injection. 90" later had sudden onset left-sided Chest pain with difficulty breathing. Patient's chest pain was so bad she thought she was going to die. Was transported to ER via ambulance, had cardiac workup, blood clot workup (had left leg pain the day before incident). Was discharged home on zanaflex and motrin with diagnosis of Chest Wall pain about 4 hours later. Follow up on 1.15.2021 at 1000 and patient doing better but still has chest pain. Will not be getting 2nd COVID vaccination.

Other Meds: Celexa, Flexeril, ativan, Xanax, motrin

Current Illness: muscle spasms, anxiety

ID: 0947045
Sex: F
Age: 54
State: CO

Vax Date: 01/02/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: clindamycin, non-oxynol 9

Symptom List:

Symptoms: Rash near injection site. I noticed it yesterday at about noon. At that time, it was a large red splotch about three inches round. Not raised or itchy. Today it is a red circle in the same area. Slightly raised - not itchy.

Other Meds: Sertraline 100mg. At night Metronidazole. Am and pm Fluticasone 1 spray each nostril am and pm Calcium 600 mg & D3 800 iu am and pm Osteo Bi-Flex Triple Strength ? am and pm Centrum Silver Women?s - Am Naproxen 220 mg - pm Slow-Mag. Mag

Current Illness: no

ID: 0947046
Sex: F
Age: 35
State: CA

Vax Date: 01/07/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Pistachios

Symptom List:

Symptoms: Vaccine site is swollen and red, and tender lymph node in armpit. Left arm is where injection was given.

Other Meds: Levothyroxine, Nuvaring, allertec, and lexapro

Current Illness: Cold

ID: 0947047
Sex: F
Age: 42
State: MO

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Eggs, and Laytex, Benadryl cream

Symptom List:

Symptoms: Very naushia , diarehha, tingle in both hands and arm 2 days headaches Vomitting and could not eat or drink and felt fatigue.

Other Meds: No

Current Illness: No

ID: 0947048
Sex: F
Age: 42
State: NY

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: codeine, hydrocodone, amoxicillin-clavulanate, pollen, bee sting, dust

Symptom List:

Symptoms: within 10 minutes of injection reported throat tingling and asked for diphenhydramine. reported she normally takes diphenydramine prior to influenza vaccination but did not share any previous reactions to influenza vaccination. observed x30 minutes with no further issues. BP WNL, no SOB, no swelling. at 30 minutes was informed that COVID vaccine did not have any components related to influenza vaccine and fell much better and discharged.

Other Meds: clonidine, escitalopram, lamotrigine, propranolol, topiramate

Current Illness: none

ID: 0947049
Sex: F
Age: 54
State: NC

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Banana, Latex, Penicillin

Symptom List:

Symptoms: Around 1330, approx 11 minutes after receiving her vaccine the EE was in the observation area. She felt a sudden weakness from head to toe and felt an impending sense of doom. She began to feel dizzy and panicked. EE moved to evaluation area at 1333. HR78 BP 174/96 O@ 97%RA. Pt was anxious and noted BP was high for her. FNP continued chatting to EE. EE declined the ED at this time. A&O x4. 1350 HR 75 BP 151/94 O@97%. EE reports feeling much beter. EE opted to wait in the observation area an additional 30 minutes, declining again to go to ED for further evaluation. EE will call if her condition changes.

Other Meds: Vitamin D3; Fexofenadine 180mg QD; Albuterol 2 puff Q4H PRN

Current Illness: N/A

ID: 0947050
Sex: F
Age: 49
State: MI

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: codeine

Symptom List:

Symptoms: redness at site and around site, shooting pain down arm

Other Meds: Sertraline 150mg

Current Illness:

ID: 0947051
Sex: F
Age: 37
State: TN

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Very sore left arm the next day after injection. The next day after injection had chills, hot flashes, and low grade temperature of 99. Was restless and unable to sleep on the night of the 13th. Also had lower back pain as well as low energy and overall tired feeling. These symptoms lasted until the later morning of the 14th. Ibprofun was taken.

Other Meds: Vitamin D Vitamin C Birth Control

Current Illness: none known

ID: 0947052
Sex: M
Age: 0
State: AR

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKDA

Symptom List:

Symptoms: Incorrect administration route of rotavirus vaccine

Other Meds: Penicillin VK, Ibuprofen

Current Illness:

ID: 0947053
Sex: F
Age: 32
State:

Vax Date: 12/24/2020
Onset Date: 01/01/2021
Rec V Date: 01/15/2021
Hospital:

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: NKA

Symptom List:

Symptoms: I received the first dose of the Modera covid vaccine on 12/24/2020. Initially I had tenderness at the injection site. On 1/3/2021 it was discovered that had "massive lymph node enlargement" in my right axillary and breast region. At 32 years old, everyone took this very seriously and I started a FULL work up after being told "this is acting like either breast cancer or lymphoma".

Other Meds: Sertraline 100mg q HS

Current Illness: None

ID: 0947054
Sex: F
Age: 50
State: CA

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

Vax Type:
Manufacturer:
Vax Name:
Lot:
Dose Series:
Vax Route:
Vax Site:

Lab Data:

Allergies: Penicillin

Symptom List:

Symptoms: Headache and Blood pressure decreasing

Other Meds: none known

Current Illness: None known

ID: 0947055
Sex: F
Age: 30
State: NY

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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Symptoms: lump in throat and chest tightness, increased heart rate, patient with hx of seafood allergy. @6:05p received Epi 1:1000 0.3mL IM to left later thigh and Benadryl 25mg IM to right arm. EMS contacted and patient transported to hospital for further evaluation. Patient verbalized feeling better after medication administration. No noted respiratory distress upon EMS transport.

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Current Illness:

ID: 0947056
Sex: M
Age: 70
State: NY

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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Symptoms: This patient received his first COVID-19 vaccine on 12/23/2020 and was vaccinated with the Moderna vaccine. He returned on 1/14/2020 and received the Pfizer vaccine on this day. Per Moderna protocol he was a week early and received the wrong vaccine.

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Current Illness:

ID: 0947057
Sex: F
Age: 83
State: DC

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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Allergies: hayfever

Symptom List:

Symptoms: slight headache, throat tight, tired, very very warm.

Other Meds: amlodipine 5 mg, atorvastatin 10 mg, hydrochlorothiaide 25 mg, irbesartan 150 mg, levothyroxine 150 mcg, nexium 40 mg, zyrtec 10 mg, multivitamins including b, c, d, e, calcium, zinc.

Current Illness: none

ID: 0947058
Sex: M
Age: 32
State: CA

Vax Date: 01/12/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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Allergies: Strawberries Pitted fruits

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Symptoms: Mild chills and joint pain

Other Meds: Excedrin Claritin Flonase

Current Illness: None

ID: 0947059
Sex: F
Age: 47
State: MD

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

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Symptoms: Client stated she felt "light headed" . Blood pressure at 12:07 140/102 pulse 81. Juice offered. 12:20 client stated she felt "fine" Blood pressure 120/102 pulse 78. Client was encouraged to rest and contact physician in case of any adverse reactions. Client left at 12:25pm.

Other Meds: None

Current Illness: none

ID: 0947060
Sex: F
Age: 43
State: CO

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/15/2021
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Symptoms: On 1/9/21, patient reported to urgent care for lower back pain. Patient also reported chills, adenopathy, headache, and hypertension. Patient was given prescription of diclofenac and cyclobenzaprine. No further escalation of care.

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Current Illness:

ID: 0947061
Sex: M
Age: 29
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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Symptoms: tingling

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Current Illness:

ID: 0947062
Sex: F
Age: 84
State: AK

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/15/2021
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Allergies: diltiazem

Symptom List:

Symptoms: Sore arm, fatigue

Other Meds: apixaban lasix

Current Illness:

ID: 0947063
Sex: F
Age: 59
State: AZ

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/15/2021
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Allergies: sulfa

Symptom List:

Symptoms: Injection site soreness 8/10, unable to raise arm laterally more than 25%. Body aches, low posterior head and neck ache, and chills.

Other Meds: none

Current Illness: hypercholesterolemia

ID: 0947064
Sex: F
Age: 71
State: DE

Vax Date: 01/08/2021
Onset Date: 01/11/2021
Rec V Date: 01/15/2021
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Allergies: NKDA

Symptom List:

Symptoms: mild superficial cellulitis left upper arm. Ordered Keflex, TMC ointment 0.1% and cool compresses

Other Meds: Diltiazem Incruse Ellipta Ventolin HFA Ipatroprium

Current Illness: none

ID: 0947065
Sex: F
Age: 80
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/15/2021
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Symptoms: No adverse event report. Only reporting administration of vaccine in possible temperature excursion

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Current Illness:

ID: 0947066
Sex: U
Age:
State: AZ

Vax Date:
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Rec V Date: 01/15/2021
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Symptoms: None stated.

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Current Illness:

ID: 0947067
Sex: F
Age: 35
State: NJ

Vax Date: 01/06/2021
Onset Date: 01/13/2021
Rec V Date: 01/15/2021
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Allergies: None

Symptom List:

Symptoms: White, hard, itchy wheel, progressed to red rash. Now appears mottled over RUE.

Other Meds: Ibuprofen

Current Illness: Psoriatic Arthritis

ID: 0947068
Sex: F
Age: 44
State: PR

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/15/2021
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Allergies: Seafood and strawberries

Symptom List:

Symptoms: After the administration of the COVID-19 vaccine, during the observation period, the patient showed a swollen tongue and shortness of breath

Other Meds: No

Current Illness: No

ID: 0947069
Sex: F
Age:
State: AZ

Vax Date:
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Rec V Date: 01/15/2021
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Allergies: Allergic to raw tree nuts and fruits

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Symptoms: None stated.

Other Meds: Restasis one drop twice per day Simvistatin 10 mg 1/day

Current Illness:

Total 2021 VAERS Injuries: 704,237

Page last modified: 03 October 2021 5:28pm