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: 1246947
Sex: F
Age: 43
State: TX

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

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient complain of tongue tingling and itchy throat, on assessment noted small raised bumps on tongue, redness of face, patient denies any shortness of breath, Benadryl 25mg po given, tolerated well . Was reassessed after 20 minutes, denies any discomfort in throat, no raised bumps noted, member was notified to pick up patient for home, Left at 9:28 accompanied by staff to car with family, no shortness of breath noted.

Other Meds: no

Current Illness: NO

ID: 1246948
Sex: F
Age: 56
State: FL

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 04/23/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Date and time adverse event started: 3/10/2021 at approx. 12:30pm, a few moments after rcvding the vaccine. Pt reported that a few moments of rcvding the vaccine she felt pressure in her whole head, ears were clogged up, and had lumps in her throat; these symptoms lessen as the days goes by and she felt better by day 3. On day 4 (3/13/2021), pt reported she felt like she had a bad cold which turned into bronchitis and that lasted for 2 weeks that was accompanied by symptoms of stuffy head, stuffed up sinus and drainage, had low grade fever, and coughed up phlegm). Pt reported that she have history of tinnitus and post-nasal drips, the ringing in her left ear and the post-nasal drip was still ongoing prior to rcvding the COVID vaccine and these symptoms seems to have been exacerbated after she got the vaccine because she felt like it has gotten worse. Pt reported that she took otc Mucinex and Claritin on the 5th or 6th day from rcvding the vaccine. She went to see her PCP and got a chest x-ray (results: negative for any infections). Pt also reported she got tested twice for COVID-19 on 3/17/2021 & 3/23/2021 (results on both dates: negative). Pt reported that her PCP had advised her against getting the second dose. Advised pt that per her ADEs these are not a contraindication to getting the 2nd dose per CDC guidelines and per consulted Dr. The decision to get the second dose is up to her and her PCP. Advised pt that there is not knowing if the 2nd dose will make her tinnitus worse or if she will experience any ADEs. Also advised per CDC guidelines, "if it is not feasible to adhere to the recommended interval, the second dose of BioNTech COVID-19 vaccines may be scheduled for administration up to 6 weeks (42 days) after the first dose. There are currently limited data on efficacy of mRNA COVID-19 vaccines administered beyond this window. If the second dose is administered beyond these intervals, there is no need to restart the series". 4/18-Patient feeling much better, symptoms have resolved with the exception of weakness and fatigue. Patient has taken Advil to help alleviate migraine. No longer has migraines. Caller called back to adv that she is still having tinnitus and post nasal drip from the 1st shot.

Other Meds: Vitamin D3 daily Ibuprofen PRN Ativan PRN Tums PRN Gas-X PRN

Current Illness:

ID: 1246949
Sex: F
Age: 66
State: ND

Vax Date: 02/25/2021
Onset Date: 03/19/2021
Rec V Date: 04/23/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient presented to the ED on 2/19/2021. Patient again presented to the ED on 3/19/2021 and was subsequently hospitalized for 4 days.

Other Meds:

Current Illness:

ID: 1246950
Sex: M
Age: 32
State: PA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: No known Drug Allergies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 2nd dose of Moderna Vaccination (Lot Number:020B21A) given at 23 days after first dose administered. First dose given 04/01/2021. Second Dose Given 04/23/2021

Other Meds:

Current Illness:

ID: 1246951
Sex: M
Age: 72
State: KS

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 04/23/2021
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 listed

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

Symptoms: This man was given his Covid 19 vaccinations at a drive thru clinic held at a local fairgrounds event. He was given the vaccine by a RN. The adverse reaction was an extremely sore arm and neck that this man states happened immediately after he got the vaccine and cont to hurt up his neck. It continues to hurt today 4-23-21. His wife is the person to report this and she has been giving him ibuprofen, muscle spray, and using cold and heat on the site to help the pain.

Other Meds: was taking steroids at the time of vaccination

Current Illness: Covid 19 infection on 1-1-21

ID: 1246952
Sex: M
Age: 27
State: OH

Vax Date: 04/20/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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: 22 hours after after I experienced chills and nausea 60 hours after I experienced a large rash on left arm below injection site

Other Meds: Cipeofloxacin

Current Illness: Prostitis

ID: 1246953
Sex: F
Age: 48
State: CA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/23/2021
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: Nuts

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Hives, no SOB noted

Other Meds: Benadryl 25mg Given

Current Illness: None

ID: 1246954
Sex: F
Age: 63
State: FL

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/23/2021
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: Pharyngeal swelling

Symptoms: Right arm had pain at injection site, and lymph node under right arm was bothering me. I was tired, and had a headache, chills, fever, both knees hurting, nausea. I put cold tile on arm, and ice pack on hear, then took Ibuprofen, and I started to feel better around 4PM on the 22nd, then my head stopped aching around 9:00PM

Other Meds: Vitamin C

Current Illness: none

ID: 1246955
Sex: F
Age: 72
State: TX

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/23/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient fell due to weakness in her legs and unable to stand. She felt like her legs gave out. Pt then came to the ER and was admitted. Pt was transferred on 4/10/21 to a different Hospital. Pt was discharged on 4/22/2021.

Other Meds: Celexa, Lasix, Glimepiride, Dyazide, Lantus, Lisinopril, Metoprolol, Nitroglycerin prn, omega essential, pravastatin, Januvia, warfarin

Current Illness:

Date Died: 04/15/2021

ID: 1246956
Sex: F
Age: 73
State: TX

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/23/2021
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: Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Stroke and blood clot in right leg.

Other Meds: Glimepiride

Current Illness:

ID: 1246957
Sex: M
Age: 73
State: SC

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 04/23/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: Pulmonary embolism dx by CTA

Other Meds: MVT, vitamin D, zinc

Current Illness: sinus congestion, given methylprednisolone by ENT about a week prior

ID: 1246958
Sex: F
Age: 57
State: ME

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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: Tramadol, penecillin, naproxin, Severe adverse reaction to Cortisone shots

Symptom List: Rash, Urticaria

Symptoms: The right side of my face became numb like novocain as I was driving home from the clinic. It stayed completely numb for about 3 hours before it began to subside. The next day, I still have discomfort on my cheekbone, temple, and eyelid. This is same location I had shingles about 10 years ago. Much of the sensation is very similar to the shingles. There is currently a bit of soreness on the right side of my neck under my ear, also tingling on my scalp. Last night around 6:30 pm I had a sudden onset headache that was easily controlled by aspirin. I still have the nerve discomfort on the right side of my face. This is the first shot of Moderna. I am concerned about if it is safe to have the 2nd shot

Other Meds: None

Current Illness: None

ID: 1246959
Sex: F
Age: 61
State: FL

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, Cafergot, Lamictal (lamotrigine), Topamax (topiramate), Depakote (valproic acid), Demerol (meperdine)

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

Symptoms: Approximately 24 hours after receiving second vaccination (1000 am 4/21/2021), I developed a temperature (99.6 degrees), body aches - primarily low back/kidney area, and feeling tired. Took 2 Excedrin Migraine. Slept most of the day and temperature remained. Approximately 10:00 pm I took 2 more Excedrin Migraine. Awoke at 3:30 am, temperature reduced to 97.9 degrees (approximately 18 hours after onset of first experiencing symptoms). All symptoms gone by 3:00 pm 4/23/2021.

Other Meds: Levothyroxine .088 mg; Atenolol 25 mg; Fluoxetine 40 mg; Atorvastatin 20 mg; Venlafaxine ER 37.5 mg; Omega 3 Fish Oil 1000 mg; Multi Vitamin; Preser Vision AREDS 2

Current Illness: None

ID: 1246960
Sex: F
Age: 65
State: SC

Vax Date: 03/23/2021
Onset Date: 04/07/2021
Rec V Date: 04/23/2021
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: chest pains

Other Meds:

Current Illness:

ID: 1246961
Sex: M
Age: 30
State: IN

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Body aches, chills, significant pain at the injection site.

Other Meds: Buproprion

Current Illness:

ID: 1246962
Sex: F
Age: 18
State: TN

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/23/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient came to vaccine clinic, immediately after vaccination, hypotensive 80/60, nauseated, but no other side effects

Other Meds:

Current Illness:

ID: 1246963
Sex: F
Age: 56
State: GA

Vax Date: 04/15/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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:

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

Symptoms: Shingles recurrence, had previously 10/19. Beginning course of acyclovir.

Other Meds: Setraline, Gabapentin, Verapamil, Pantoprozole

Current Illness:

ID: 1246964
Sex: F
Age: 48
State: MI

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient with immediate burning in arm from injection sight down her left arm to all fingers and into neck, chest and left leg. Burning pain in left chest and neck lasted 1-2 day. Burning in left arm has been present since 4/8/21 and still present as of today. in last 2 day now weakness in the left arm.

Other Meds: oral contraception,

Current Illness: non

ID: 1246965
Sex: F
Age: 65
State: CA

Vax Date: 01/05/2021
Onset Date: 01/16/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: Statins Latex Seasonal Allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Ten days after the vaccine I noticed that my arm was aching. I had a big red circle coming up around the site of the shot. It was very hot to the touch. It started at the top of the injection site and went most of the way down to my elbow. My upper arm was still swollen. It was a little itchy. I took some Benadryl. It lasted for eight days but went down slowly until that time. I had the second dose and got it in the other arm and had no swelling or redness.

Other Meds: Amlodipine Protonic Plavix

Current Illness:

ID: 1246966
Sex: M
Age: 55
State: MD

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: PCN, seafood, Fexofenadine Hcl

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

Symptoms: Got 1st Moderna COVID vaccine 415pm 4/22/21 At 5pm started with hives +tingling in lips + lips swelling Took benadryl and about 30 mins later went away

Other Meds: None Zyrtec normally but did not take day of

Current Illness: None

ID: 1246967
Sex: M
Age: 43
State: SD

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/23/2021
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: None

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

Symptoms: Today afternoon/evening I started to get sore and have a headache (which is normal from what I hear.) I could only sleep a couple hours Tuesday night into Wednesday morning because I kept tossing and turning. When I woke up Wednesday morning (4-21-21) around 6:00 am, I couldn't move as I normally could and when I tried to walk I found it very painful. The whole area between my knees and my shoulders were completely numb yet it felt as if it were on fire. I slept most of the morning and a little in the afternoon as it was very painful to move, talk, laugh, etc... Finally in the late afternoon (3:00-4:00ish) the numbness wore off but the burning sensation persisted. I felt progressively better throughout Thursday (4-22-21) and about the same time in the afternoon (3:00-4:00ish) the burning wore off as well. That evening I felt perfectly normal except for the typical achiness that tends to occur with vaccines. Today (Friday 4-23-21) I feel rested and back to my normal self.

Other Meds: Meloxicam (7.5mg), FLUoxetine (60 mg), buPROPion (450mg), Melatonin

Current Illness: No illnesses However, I did take one Tadalafil tablet on 4/4/21. (Don't know if that makes a difference)

ID: 1246968
Sex: F
Age: 56
State: CA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: The shot hurt upon injection and then for 15-20 seconds afterward. I bruised for almost 3 weeks and I still have some pain in the arm, 3 weeks later.

Other Meds: Lexapro 10 mg/day.

Current Illness:

ID: 1246969
Sex: F
Age: 23
State: PA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: the patient fainted 5 minutes after receiving the vaccine. She hit her head on the floor when she fainted. We laid her on her back and elevated her feet. We put ice packs on her wrists and the back of her neck. we continued to monitor her for 30 minutes. She felt better when she left, however her head did hurt. We recommended that she seek further medical care to be evaluated since she did hit her head.

Other Meds: unknown

Current Illness: unknown

ID: 1246970
Sex: F
Age: 56
State: FL

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/23/2021
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: Microdantin

Symptom List: Injection site pain, Pain

Symptoms: Woke up morning after the vaccine with a fever of 101.4, head pounding and all over body aches; primarily in my back. Later that day I started having sharp stabbing pains in different locations in my legs. This continued for 2 days. I medicated with 3 motrin (200 mg pills) every 6 hours and piggybacked 2 tylenol (200 mg pills) at the 3 hour mark in between motrin dosages; my fever never came down. I remained achy, feverish, with headache and stabbing pains in my legs for entire 2 days. In the middle of the night, 3rd day after the vaccine going into the 4th day, I woke 5 times drenched in sweat. By the morning on the 4th day after the vaccine, my fever had finally broke and I felt better. A slight dry cough started the 4th day and has persisted into the 5th day. Additional note: I was diagnosed CoVid Positive (with symptoms) in October 2020.

Other Meds: Zocor Famotidine Amlodipine ellura (cranberry supplement) olly (skin supplement) Omega-3 Vitamin D Fish Oil

Current Illness: UTI - one month prior

ID: 1246971
Sex: F
Age: 28
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: bee stings

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received dose 1 of the COVID Moderna vaccine (lot 041B21A, exp 5/6/2021) at 1430. At 1500, EMT approached patient who was crying and sweaty. Patient complained of anxiety, itching, chest tightness, feeling sweaty, and shortness of breath. Vital signs: O2 99%, pulse 106, blood pressure 140/90, respirations 20. Allergies to bee stings. Medical condition includes severe anxiety disorder. Medications: Lexapro, Ativan as needed. PHN approached to help assess the patient. Patient reported having the same reaction as when she has previously had anxiety and panic attacks. At 1507, vital signs: O2 99%, pulse 87, blood pressure 128/80, respirations 18. Patient reported symptoms had mostly resolved except for lingering itching. PHN offered Benadryl but patient declined. At 1516, patient reported all symptoms had resolved. Vital signs: O2 99%, pulse 74, blood pressure 118/78, respirations 18. Patient stood up with PHN and EMT nearby, reported no symptoms. Patient left walking with steady gait at 1520.

Other Meds: Lexapro, Ativan as needed

Current Illness:

ID: 1246972
Sex: F
Age: 43
State: CA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/23/2021
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: N/A

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

Symptoms: Numb left arm, intense headaches, inability to coordinate a fraise, pinches on the brain, blurred vision, problems to be focus. (attention problem)

Other Meds: N/A

Current Illness: N/A

ID: 1246973
Sex: F
Age: 73
State: VA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/23/2021
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: Client stood up to make 2nd dose appointment, she stated "Where am I? I feel funny." She was escorted to the observation area to lie down. Vitals stable. Clients friend arrive to observation area and informed us that client has history of seizures and takes daily Keppra. Clients friend stated" she becomes confused, stares off, and doesnt know where she is" Client is seeing a neurologist for seizures. Client was able to provide home, DOB, address, phone number, etc. Clients friend stated "I will drive her home" Vitals stable. Client was escorted out to car with friend at 10:45am

Other Meds: Keppra

Current Illness:

ID: 1246974
Sex: F
Age: 35
State: GA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: "Pfizer-Bio-Tech COVID-19 Vaccine " Individual received the Pfizer Covid-19 vaccine. She began to feel throat tingling, lip numbness, and flush at 11:15 am. Patient denied SOB of breath, dizzy, and was swallowing well. Her vitals were 146/98,99, 20, 72, 90/% at 11:17 am. She was given Benadryl 50 mg IM in right Deltoid at 11:18 am. B/P 122/96,20, 88 P, 99 RA. 11:25 am. Individual reported the numbness and tingling has decrease. 11:30 am 128/82 99% RA 86,20. Individual stated that she no longer has any symptoms. 11:45 pm vitals 124/74, 20, 71, 99% RA no noted distress, flush feeling, tingling or numbness. 11:58 am 110/70, 99, 71, 18 Individual was escort to car with no noted distress and sent home with Additional information for Item 18: with family. .

Other Meds: unknown

Current Illness: unknown

ID: 1246975
Sex: M
Age: 20
State: WA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Pt. experienced a near syncopal episode within 5 mins of receiving COVID #1 vaccine. Felt sweaty, light headed and like he might pass out. Cold compress to neck, vitals completed as follows. Vitals as of 12:45 were BP 138/89, P68. O2 98%, @13:03 BP 123/90, P69, O2 99%. Pt had driven 30 mins at ~12:30pm for his appt. Pt ate 2 eggs at ~7:30am. He had an early lunch of turkey sandwich and apple at ~10:30am. Was given 4.6oz apple juice box which he consumed rapidly. Received 2nd juice box and crackers. Pt has history of essential tremor, diagnosed ~ 2yrs prior. Pts father picked him up to drive back, Instructed to rest and report to on clinic, UC or ER if he became symptomatic. 2nd dose on 5/20.

Other Meds: none

Current Illness: none

ID: 1246976
Sex: F
Age: 35
State: NC

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/23/2021
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: Started having Heart Palpitations the evening after the vaccine. Also started to get fatigued at that time. Fatigue was gone by Sunday morning(two days after shot) but I have been having the Heart Palpitations on and off since the 17th. They don?t really hurt but I do feel like when they are strong, my chest feels heavy. I have not been to a doctor because the consistency changes. I will wait another week and see if the symptoms get better and go away.

Other Meds: Gabapentin

Current Illness: Recent finished a miscarriage.

ID: 1246977
Sex: M
Age: 17
State: RI

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/23/2021
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: Patient received vaccine at age 17

Other Meds:

Current Illness:

ID: 1246978
Sex: F
Age: 41
State: WA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/23/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Injection site pain, tiredness, headache, muscle & joint pain, chills, nausea, feeling unwell and cloudy.

Other Meds: Vit D 3 5,000 Zyrtec Tri-Nessa Kesimpta Baclofen

Current Illness: None

ID: 1246979
Sex: M
Age: 73
State: VA

Vax Date: 03/06/2021
Onset Date: 03/18/2021
Rec V Date: 04/23/2021
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: Shingles, Acyclovir 800 MG, Prednisone, First pain 3/18/2021, blisters appeared 4/1/2021

Other Meds: Bupropion HCL XL 150 MG, Tamsulosin HCL 0.4 MG, Oxcarbazepine 150MG, Magnesium, Glucosamine, Chondrotin, Mens Vitamine

Current Illness: None

ID: 1246980
Sex: F
Age: 47
State: CA

Vax Date: 04/14/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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: PCN

Symptom List: Tremor

Symptoms: Pain and swelling on day 8 with a hives-like rash, there is a red swollen area now at the injection site but the blisters have subsided. It looks exactly what the internet is referring to as covid arm. No fever or other symptoms. Is still itchy and the swelling was the approx size of a tennis ball but has gone down slightly today. I emailed my primary care physician and he said not to worry.

Other Meds: Levothyroxine 75MCG, Calcium, Fish Oil, Multi Vitamin

Current Illness: none

ID: 1246981
Sex: F
Age: 52
State:

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/23/2021
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: Cypro

Symptom List: Erythema, Pruritus

Symptoms: Nasal bleeding then I expelled a quagle down my throat, only one time

Other Meds: None

Current Illness: None

ID: 1246982
Sex: F
Age: 59
State: GA

Vax Date: 04/16/2021
Onset Date: 04/19/2021
Rec V Date: 04/23/2021
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: Fish oil, Iodine, seasonal

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

Symptoms: Started with the chills, could not get warm. By the next day had chills , with body aches, sore throat, runny nose and cough. Cough has gotten worse each day. This is now 5th day of feeling like a mild case of the flu. Have taken Tylenol multiple times a day to help with achiness in joints.

Other Meds: Daily Vitamin, Claritin, Estrogen patch, Lisinopril

Current Illness: None

ID: 1246983
Sex: F
Age: 58
State: FL

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 04/23/2021
Hospital: Y

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

Lab Data:

Allergies: no

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

Symptoms: After vaccination, at 10pm I started feeling flu like symptoms, fever chills shakes feeling miserable and this lasted 3 days straight, I also had diarrhea, nausea and vomiting. I woke up with a swollen juggler vein that ended up being a blood clot, 10 days later my arm was swollen up twice the size of my leg, the juggler was still swollen. I call the urgent care nurse they said to go to ER. I went to hospital got a CAT scan and ultrasound, I was given a shot of warfarin that was supposed to last for 12 hours. I went home and the next morning instead of going to the hospital, I went to hospital and they found 2 blood clots in brain, arm and leg and neck. I have had no history of blood clots and this all happened after the J&J vaccine. They did a procedure where they tried to put a balloon to relieve the pressure. The blood clots in the brain cannot be removed because of their location and it would be dangerous to remove and I am on blood thinners for the rest of my life. Multiple blood clots in body brain, arm and shoulder.

Other Meds: no

Current Illness: no

ID: 1246984
Sex: M
Age: 65
State: FL

Vax Date: 03/05/2021
Onset Date: 03/15/2021
Rec V Date: 04/23/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: TIA Stroke

Other Meds: Metformin, Crestor Percocet, Furosemide Gabapentin, alprazolam but/aminophen caffine Benazepril,

Current Illness: no

ID: 1246985
Sex: M
Age: 69
State: FL

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 04/23/2021
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: 102 fever and flu symptoms.

Other Meds:

Current Illness:

ID: 1246986
Sex: F
Age: 55
State: CA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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: Rochephine

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

Symptoms: When I arrived at facility, I asked what vaccine they were giving, they said Pfister. I asked if I could get Moderna and the said yes. I was lead into a room that was divided by Pfister and Moderna. I was seated in the middle of the Moderna section. I was given my shot and noticed that my return date for my second shot says 5/13. Moderna second vaccine is 28 days after the first vaccine and Pfister is 21 days after. I had spoke with my diabetes PA that day for a routine call and I asked her about the wrong date being put on my card. She looked into my medical record and it shows that I was given Pistzer. How am I suppose to know what I really received?? What about the other elderly that were in my row that are going to go and get their second shot on 5/13 only to have their vaccines mixed. This is extremely scary and very unprofessional by the facility.

Other Meds: Metformin, Lisinopril, Glipizide, Actos and Norvasc

Current Illness: N/A

ID: 1246987
Sex: F
Age: 49
State: WI

Vax Date: 04/14/2021
Onset Date: 04/22/2021
Rec V Date: 04/23/2021
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: Pain in extremity

Symptoms: Rash at injection site- about 2 inches in diameter. Looks and feels like sunburn. Does not itch.

Other Meds: levothrydroxine Paxil (generic) multi-vitamin- women's vitamin D gylocosamine chondroitin cranberry extract

Current Illness: none

ID: 1246988
Sex: F
Age: 63
State: MN

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 04/23/2021
Hospital: Y

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: Patient presented to the ED and was subsequently hospitalized within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1246989
Sex: M
Age: 55
State: MA

Vax Date: 04/09/2021
Onset Date: 04/16/2021
Rec V Date: 04/23/2021
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: tinnitus in right ear

Other Meds: Praluent 75Mg

Current Illness: no

ID: 1246990
Sex: F
Age: 52
State: OR

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NONE

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

Symptoms: About 8 hours after vaccine: significant chills, headache, muscle aches - which all continued for approximately 24 hours, and then severity lessened (but effect continued) About 10-12 hours after vaccine: fever, fatigue - which continued for approximately 36 hours, and then fever ended but fatigue continued About 36 hours vaccine: fainting - which happened twice in a 12-hour period

Other Meds: LEVOTHYROXINE 0.25 MG (1x DAILY) TRIAMTERENE 37.5 MG/HCTZ 25 MG (1x DAILY)

Current Illness: NONE

ID: 1246991
Sex: F
Age: 60
State: NC

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/23/2021
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: Penicillin (anaphylaxis)

Symptom List: Vomiting

Symptoms: Patient with PMH type 2 DM, cataracts and dry eyes and allergy to penicillin (anaphylaxis) recevied Pfizer Covid19 vaccine at 1529 3/31/21 (lot #ER8733) in left deltoid. No known sequela after first shot. Patient received her second dose of Pfizer vaccine (lot #EW0162) in her left deltoid on 4/21/21 at 1556. During initial observation period, she felt dizzy. At 1614, she felt tingling in her throat and tongue. VSS and no other symptoms. Patient was given juice and monitored x10 additional minutes without resolution of symptoms. Provider was made aware and assessed the patient. 25 mg IM diphenhydramine was given via right deltoid. Patient monitored an additional 30 minutes and symptoms resolved.

Other Meds: alendronate 70mg tablet every 7 days; aspirin 81mg po daily; b

Current Illness:

ID: 1246992
Sex: F
Age: 55
State: IN

Vax Date: 04/19/2021
Onset Date: 04/21/2021
Rec V Date: 04/23/2021
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: NA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Headache, small temperature (up approx. 2 degrees) and fatigue. Minimal acetaminophen taken and extra sleep. Headache began 1.5 days after vaccine and lasted for approx. 1.5 days. Elevated temperature was noticed on night of the second day and gone by morning. Headache for 1.5-2 . Must note: living in Indiana, this could easily be springtime allergies at work.

Other Meds: Lisinopril, Zyrtec (5mg)

Current Illness: NA

ID: 1246993
Sex: F
Age: 32
State: DC

Vax Date: 03/31/2021
Onset Date: 04/02/2021
Rec V Date: 04/23/2021
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: Family history of penicillin allergy. I've never had it. Seasonal allergies.

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

Symptoms: Patch of skin on right forearm became very dry, red, and a inflamed for several days post-injection. My period also came approximately 7 days early and was unusually heavy (leaking through a super tampon in only 2-3 hours). It lasted for 2 days, as opposed to my usual 4 days.

Other Meds: Isotretonin, Claratin

Current Illness: None.

ID: 1246994
Sex: M
Age: 64
State: AK

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/23/2021
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: Low grade fever, chills, bilateral hip pain/stiffness, left arm pain/stiffness. Symptoms still occurring 16 days after second injection. I usually hiked 5-10 miles/day prior to vaccination. Now I hike 5 minutes and have to rest due to fatigue and hip pain. Have difficulty using left arm due to shoulder pain stiffness.

Other Meds: none

Current Illness: none

ID: 1246995
Sex: F
Age: 54
State: IL

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/23/2021
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: 12 hrs after injection experienced chills, muscle and joint pain, fever, inability to sleep comfortably, tired but restless, headache, stomach upset

Other Meds: Multi vitamin, Hair Skin and Nails supplement, immune C gummies

Current Illness: None

ID: 1246997
Sex: M
Age: 52
State: WI

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/23/2021
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: Client received Moderna first dose, then Pfizer second dose. Client reported having received no COVID vaccine before, when getting Pfizer dose.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm