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: 1247306
Sex: F
Age: 36
State: WV

Vax Date: 04/09/2021
Onset Date: 04/22/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Nauseous, headache, tired

Other Meds: None

Current Illness: None

ID: 1247307
Sex: F
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Hydralyzine

Symptom List: Anxiety, Dyspnoea

Symptoms: Severe headache Fatigue

Other Meds: Escitalipram Spironolactone Chlorothalidone Diltiazem Vitamin B12

Current Illness:

ID: 1247308
Sex: F
Age: 76
State:

Vax Date: 01/25/2021
Onset Date: 02/23/2021
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 and subsequently hospitalized on 2/23/2021, within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1247309
Sex: F
Age: 60
State: TX

Vax Date: 03/26/2021
Onset Date: 03/27/2021
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: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Injection site pain, extreme tiredness, ?hangover? headache/awful headache, joint pain, 101 degree fever, feeling unwell, no appetite (but not nauseous) X 1-1/2 days Sore arm/difficulty raising arm X several days; tolerable

Other Meds: Cymbalta, Linzess, Progesterone, Singulair, Clonazepam

Current Illness: None

ID: 1247310
Sex: F
Age: 45
State: NY

Vax Date: 03/07/2021
Onset Date: 03/07/2021
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: Possible Codeine

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

Symptoms: Dizziness, lightheaded at 12:30 pm, to the point of losing balance. Itchy arm at site of injection. Itchy bumps on arm for days/weeks after at site of injection. Extreme bone and joint pain at 1:00 am following the injection, that lasted for the next few days on and off. Dizzy spells continue sporadically to this date, on and off.

Other Meds: none

Current Illness: none

ID: 1247311
Sex: F
Age: 35
State: FL

Vax Date: 04/13/2021
Onset Date: 04/15/2021
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:

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

Symptoms: 35 years old female called to report an adverse reaction after receiving her first P-fizer dose on 04/13/2021 @1415, patient reported that on 04/15/2021 @0800 she developed arm sore, very tired, next day, throat sore, chest pain and tightness, fever, difficulty breathing, stomach bloating painful, headache. patient denies any allergies, patient reported that she takes omeprazole for acid reflux. patient was instructed to seek medical attention due to the chest tightness and difficulty breathing. consulted with nurse

Other Meds: omeprazole

Current Illness:

ID: 1247312
Sex: F
Age: 43
State: MD

Vax Date: 04/21/2020
Onset Date: 04/21/2021
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: augmentin, bactrim, dogs, cats, dust, mango, Brazil nuts, kiwi, cactus

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Tounge and front upper teeth and jaw became very numb, as if I had a shot of Novocain.

Other Meds: gabapentin, Flonase, azalastin, viberzi,

Current Illness:

ID: 1247313
Sex: F
Age: 34
State: NM

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:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Asp rin, spaghetti squash

Symptom List: Pharyngeal swelling

Symptoms: About an hour after after receiving the injection I started getting a bad headache and became very very tired I laid down for a few hours I got up around 7 p.m. to eat I still had a terrible headache I started getting nauseous and I was having some muscle aches in my legs and arms I went to bed and in the morning when I woke up the next day 4/23 I still felt very exhausted I had a hard time waking up and while I was laying there awake I had paralysis I couldn't open my eyes, talk or move, I fell back asleep after a couple of minutes and when I woke up the second time I was fine just drowsy still

Other Meds: Hydroxychloroquine, levothyroxine, pantoprazole, levocetirizine, norethindrone, Aleve.

Current Illness: None that I know of

ID: 1247314
Sex: F
Age: 41
State: GA

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: Abdominal pain, Chills, Sleep disorder

Symptoms: 4/19/2021 5:30pm: headache 7:30pm: severe headache over right eye. nausea 9:30pm: severe headache over right eye, nausea, vomiting, muscle aches, chills 3:00am: all symptoms as above with a 101.7 fever (took 2 motrin) 8:00am: all symptoms to a mimimum. continued motrin every 4-6 hours. 4/20/2021 headache and nausea came in waves all day with body aches - motrin throughout the day 4/21/2021 headache/ nausea came in waves - motrin twice 4/22/2021 nausea/headache in the morning - motrin once 4/23/2021 no symptoms

Other Meds: zoloft, 50mg zyrtec allergy

Current Illness: none

Date Died: 04/16/2021

ID: 1247315
Sex: F
Age: 73
State: MS

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Death less than 24 hours after vaccine administration

Other Meds: Metoprolol, Trazodone, Rosuvastatin, Norco, Gabapentin, Lexapro, Wellbutrin, Lisinopril, Allopurinol

Current Illness: none

ID: 1247316
Sex: F
Age: 45
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Shellfish Iodine Naproxen

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

Symptoms: HPI: Patient is a * year old * who presents following administration of the first dose of Pfizer COVID19 vaccine in the left deltoid. She states that she started to experience numbness on the left neck, face, and ear. She denies altered sensation in the left arm, left shoulder, and other body parts. She denies muscle weakness and loss of consciousness. She relates that she has never experienced this following a vaccination. She affirms allergies to shellfish, iodine, and naproxen. She denies a past medical history. She denies taking medications on a regular basis. She relates she has only drank coffee this morning, no food or water. She denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. Exam: GEN: Alert and oriented x 4, NAD HEAD: NCAT EYES: PERRL, EOMI ENT: Ears normal, Nose normal, OP normal, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g PULM: Clear to auscultation bilaterally, no accessory muscle use ABD: Soft, no tenderness. SKIN: No rashes, skin warm and dry. No erythema or edema of the injection site. MSK: FROM, MS 5/5 NEURO: Alert and oriented x 4, CN 5 demonstrates decreased touch sensation in the left side. No obvious muscle weakness. CN 2-4 and 6-12 grossly intact, no ataxia, gait steady Clinical Impression/Field Tx: Paresthesias without muscle weakness of the left face and neck region. Patient demonstrated no obvious signs or symptoms of anaphylaxis that required Patient able to adequately control airway and secretions. Thorough neuro exam conducted and was within normal limits with the exception of decreased sensation in the left face/neck compared to the right. Remainder of exam otherwise normal. Vital signs stable. Instructed patient to consult their PCP regarding the post-vaccination reaction. Patient instructed to go to emergency department should they develop muscle weakness, increasing areas of numbness, chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, or cramping abdominal pain with nausea/vomiting. Medications administered: None Disposition: Home

Other Meds: None

Current Illness: None

ID: 1247317
Sex: M
Age: 38
State: KY

Vax Date: 02/12/2021
Onset Date: 02/12/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Had a sore arm for several days

Other Meds:

Current Illness:

Date Died: 04/23/2021

ID: 1247318
Sex: F
Age: 69
State: NE

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: LA

Lab Data:

Allergies: PCN, Morphine; Sulfa Atb, Tetracycline, Keflex, Mandol

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

Symptoms: Death

Other Meds: Abilify; Acidophilus; Albuterol sulfate; Amantadine; Anoro Elipta; Betamethasone; Cyanocobalamin (monthly) Diclofenac; Lomotil (prn); Fluticasone propionate; Furosemide; Ipratropium-Albuterol; losartan Potassium; Mucinex (prn); Namenda; Nor

Current Illness:

ID: 1247319
Sex: F
Age: 81
State: ID

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Sage, Ampicillin, erythromycin, Codeine

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

Symptoms: Pt was given Pfizer Covid immunization (Lot EN6199) on 03-05-2021 and Moderna as second dose immunization (Lot: 041B21A) on 4/23/2021. Pt was made aware of this error.

Other Meds: Excedrin, Melatonin, Promethazine, Tramadol, Vitamin D, Fish Oil, hydroxyzine, Zoloft, Gabapentin, Atorvastatin, Flovent HFA inhaler, Fexofenadine, Singulair, Proventil HFA, Budesonide Inhaler, Pataday eye drops

Current Illness: none

ID: 1247320
Sex: M
Age: 51
State: IA

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: none

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

Symptoms: Pt received Pfizer vaccine, then received Moderna vaccine

Other Meds: atorvastatin, diclofenac

Current Illness: none

ID: 1247321
Sex: F
Age: 78
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: Post vaccine patient reports feeling raised heart rate. Pt was transported to med obs via wheel chair. Pt remained in wheelchair. Pt reports not feeling this way after her first vaccine . Per patient her BP is higher then usual . Pt didn't want anything to drink . Pt reported feeling better and was released at 11:30 with her grandson . Vitals as follow: 1114 BP 168/81 HR 67 RR 18 SpO2 96 1119 BP 157/80 HR 66 RR 20 SpO2 96 1124 BP 168/76 HR 67 RR 18 SpO2 98 1129 BP 158/75 HR 67 RR 18 SpO2 98

Other Meds: Metformin

Current Illness: diabetes

ID: 1247322
Sex: F
Age: 38
State: TX

Vax Date: 04/14/2021
Onset Date: 04/01/2021
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: in spring when I was abroad

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

Symptoms: Headache, pain in eyes feel dizzy more than 10 days acetaminophen 500 Ibprophen 600

Other Meds: I fill this form for second time. still, I have had headache and pain in my eyes and feel dizzy. please help me

Current Illness:

ID: 1247323
Sex: F
Age: 18
State:

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

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Lost consciousness for 1-2 minutes. Dizziness. Vitals stable. Given water, juice, and crackers.

Other Meds:

Current Illness:

ID: 1247324
Sex: F
Age: 59
State: IL

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

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Woke up around 11:30 pm with pins/needles sensation inside my torso, not on my skin. Lasted throughout the night. Gone by 6am. Heart racing, but not sure if that was because of the shot or my reaction to pins/needles sensation. Also had itching on my torso and arms throughout night and next day (4.22). There was no rash at anytime.

Other Meds: Lansoprazole 15mg 2x daily

Current Illness: none

ID: 1247325
Sex: M
Age: 17
State: CA

Vax Date: 04/23/2021
Onset Date: 04/23/2021
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: None.

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

Symptoms: There were no adverse reactions reported by patients post vaccination.

Other Meds: None.

Current Illness: There were no reaction or illnesses post vaccination.

ID: 1247326
Sex: M
Age: 49
State: FL

Vax Date: 04/15/2021
Onset Date: 04/18/2021
Rec V Date: 04/23/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Altered mental status, confusion, aphasia, disorientation, unresponsiveness.

Other Meds: Cetirizine, multivitamin

Current Illness: None

ID: 1247327
Sex: F
Age: 51
State: MI

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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Tetrayline

Symptom List: Unevaluable event

Symptoms: Anxiety

Other Meds:

Current Illness:

ID: 1247328
Sex: M
Age: 52
State: MI

Vax Date: 04/02/2021
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: LA

Lab Data:

Allergies: Keflex, seafood

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

Symptoms: Client reported tingling of the tongue. Denies any other symptoms. HR 64, B/P 140/82, RR 12. Client waited for another 30 minutes with no new symptoms. Instructed him to call 911 or go to ER if new or worsening symptoms develop.

Other Meds: unknown

Current Illness: unknown

ID: 1247329
Sex: M
Age: 60
State: MD

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Patient was administered incorrect dosage of Pfizer (0.1). Vaccinator notified site leader in regards to the above. Site leader contacted patient and advise tp return to facility to receive the remaining dosage of 0.2. 0.2 was administered and patient was fully vaccinated with the correct dosage of 0.3.

Other Meds: none

Current Illness: none

ID: 1247330
Sex: F
Age: 50
State: IN

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: codeine

Symptom List: Injection site pain, Menorrhagia

Symptoms: fever, chills, nausea, body aches, stiff neck. and tenderness at injection site

Other Meds: levothyroxine, lisinopril, hydrochlorothiazide

Current Illness: none

ID: 1247331
Sex: M
Age: 28
State: VA

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

Lab Data:

Allergies: unknown

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

Symptoms: pt reports he has syncopal/near syncopal events when giving blood. Today he was 10mins post-vaccination and felt dizzy/faint. Pt was helped to the floor/no trauma experienced. He was clammy/cool; PERRL, no LOC. Vitals assessed and noted. 0917: BP: 122/62 P 71 Resp 18; 0930: BP 120/76 P 66 Resp 16 98%; BGL 130.Pt reported feeling normal after 10-15mins rest and observation

Other Meds: unknown

Current Illness: unknown

ID: 1247333
Sex: M
Age: 71
State: NH

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: LA

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I developed what appeared to be a severe shingles outbreak, manifesting first on the left side of my trunk, then within 10-12 hours also manifesting on the right side. The rash then spread up into my chest and neck, upper back, and then down both arms.

Other Meds: None

Current Illness: None

ID: 1247334
Sex: M
Age: 73
State: FL

Vax Date: 03/31/2021
Onset Date: 04/07/2021
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:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient stated that about a week after taking the vaccine on 4/7/21, he experienced dizziness the only symptoms (no ear pain). No fever, body aches, chills, headaches, sob and no chest pain. He states the dizziness is getting slightly better but not much. Patient Made an appt for PCP for the 4/22/21 15:20 Advised patient to get Benadryl or get a Transderm patch to place behind ears to help with the vertigo he's feeling. Will follow back up on Monday 4/19/21.

Other Meds: Buproprion Nortriptylline

Current Illness:

ID: 1247335
Sex: M
Age: 43
State: LA

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

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

Symptoms: Shingles on left abdominal region. Rash and blisters present. Pain began the day following the vaccination in back and began to wrap around side to midline over time.

Other Meds: Multivitamin, omeprazole, vegetable/fruit supplement

Current Illness: N/A

ID: 1247336
Sex: F
Age: 39
State: OH

Vax Date: 04/14/2021
Onset Date: 04/15/2021
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: Nausea

Symptoms: Fever, fatigue, body aches, nausea, headache, chills

Other Meds: Pristiq, wellbutrin, lamotrigrine

Current Illness: None

ID: 1247337
Sex: F
Age: 46
State: MO

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: bananas, melon fruits and seasonal allergies to trees, weeds and grass as well as mold

Symptom List: Injection site pain

Symptoms: chills beginning around 11;00 PM that night and lasting almost 24 hours, slight headache and a localized reaction around and adjacent to the injection site that began almost 48 hours later. Arm is swollen with red patches all over that produce heat that is discernable to the touch.

Other Meds: synthroid, Allegra, Monalukastat and Align

Current Illness: none

ID: 1247338
Sex: F
Age: 66
State: MA

Vax Date: 03/20/2021
Onset Date: 03/29/2021
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: Crestor [Rosuvastatin] Rash Periorbital edema. Amoxicillin GI Intolerance Omeprazole GI Intolerance

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

Symptoms: Diaphoresis, abdominal cramping, loose stools, syncope x2 Lactic acidosis, descending colitis on CT felt to be ischemic colitis.

Other Meds: Melatonin, paroxetine, Zetia, letrozole, lorazepam, multivitamin, glucosamine/chondroitin, aspirin, amlodipine

Current Illness: None

ID: 1247339
Sex: F
Age: 29
State: OR

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: RA

Lab Data:

Allergies: Potentially kiwi

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

Symptoms: I felt a tingly itchy sensation about 5 minutes after the initial dose at 8 AM. I started to feel a little lightheaded and anxious. Around 10 AM I noticed hives appearing on my upper chest to under my chin on the right side of my neck. The right side of my jaw where the hives appeared feels slightly tight. It is now 10:50 AM and I'm starting to feel itchy again.

Other Meds: Rae "Rebalance" dietary supplements

Current Illness: None

ID: 1247340
Sex: F
Age: 41
State: WI

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

Lab Data:

Allergies: sulfa and amoxicillan

Symptom List: Tremor

Symptoms: tinnitus - pulsating swooshing in ears

Other Meds: Botox injections and lidocaine nerve block for migraines,

Current Illness: none

ID: 1247341
Sex: F
Age: 19
State: AK

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

Lab Data:

Allergies: NKDA, No food nor product allergies

Symptom List: Erythema, Pruritus

Symptoms: Patient experienced a near syncopal episode within 5 minutes of receiving the vaccine. She was seated in the Observation area and raised her arm indicating she needed help. The RN responded immediately. I was summoned over and was able to move patient to a table in the back of the room. She was complaining of "Stars: in her vision and not feeling well. First set of vitals were completed at 14:27 BP 116/91, P 100, O2 Sat 97%. Patient is a student. She ate a granola (Nature Made fruit and nut) bar that she has in her pocket. She remained with us for just over an hour , during which time she complained of a fast heart rate, mild nausea and "stars" at the edges of her vision. During the hour she drank over 16 oz of apple juice. She called parents friends to come pick her up and deliver her to her dorm on campus. Last vitals taken at 15:35 110/78 P 104, O2 Sat 99%

Other Meds: Lamotrigine 100 mgs, Singular 10 mgs, Allegra 10 mgs, Ferrous Sulfate, Vitamin C, Vitamin D, Vitamin B12

Current Illness: Bipolar DX ~ 1 month prior

ID: 1247342
Sex: M
Age: 55
State: FL

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

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

Symptoms: Injection site red swollen warm red rash pain, Fever, leg and body spasms

Other Meds:

Current Illness:

ID: 1247344
Sex: F
Age: 49
State: GA

Vax Date: 04/06/2021
Onset Date: 04/14/2021
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: NONE

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

Symptoms: ARM REDNESS, SWELLING, AND FEVER ON THE SKIN AT INJECTION SITE & A KNOT AT THE BASE OF MY NECK ON THE LEFT SIDE ABOUT THE SIZE OF A GRAPE. STERIOD SHOT WAS GIVEN AND THE KNOT HAS GONE DOWN SOME IN THE PAST WEEK.

Other Meds: DAILY VITAMIN, XYZAL, TURMERIC

Current Illness: NONE

ID: 1247346
Sex: F
Age: 41
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Body Aches, Fatigue, Chills/Sweats, injection site pain

Other Meds: Claritan (for seasonal allergies)

Current Illness: None

ID: 1247347
Sex: F
Age: 27
State: OH

Vax Date: 04/13/2021
Onset Date: 04/13/2021
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: Very sensitive to antipsychotics, severe jaw clenching from them at low doses. Had a very bad reaction to Invega, Risperdal, Lithium, Cogentin, and Artane.

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

Symptoms: Mood swings that were once controlled by medication returned. Easy aggravation that was controlled by medication returned after the vaccine on the 13th. Depression worsened, focus and interest declined started the 14th. I couldn't sleep the night I received the first dose. I have lost a total of 3 full nights of sleep since I got the vaccine. I am still having mood swings as of April 23rd. I still feel generally ill, fatigued, and all over muscle pain as of April 23rd, it started the 14th. Increase in anxiety after experiencing the mental health side effects of the vaccine. I also experience clear UTI symptoms but had a negative result test.

Other Meds: Propranolol, Prazosin, Strattera, Vyvanse, Trazodone, Ativan, Baclofen, Lamictal

Current Illness: Schizoaffective Disorder Bipolar Type, Rigidity, Chronic-PTSD, Generalized Anxiety Disorder, ADHD attentive type, Dissociative Identity Disorder, Obesity, some kind of undiagnosed movement disorder.

ID: 1247348
Sex: F
Age: 48
State: KY

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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: None

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

Symptoms: 12 hours after the injection I began to feel very weak suddenly, lost consciousness, and fell to the floor. Felt very weak and heard what sounded like rushing water in my hears. Four hours later the same thing happened.

Other Meds: Novolog, Trazadone, Ritalin, Vitamin C, D, Zinc

Current Illness:

ID: 1247349
Sex: F
Age: 56
State: IL

Vax Date: 04/01/2021
Onset Date: 04/11/2021
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: allergy to lisinipril, vicodin, demarol, seasonal.

Symptom List: Pain in extremity

Symptoms: dizziness started 4/11 - 11 days after the vaccnine - followed by nausea and headache. this has gotten worse since then. was seen in ER on 4/13 at ER was then seen at my PCP on 4/12 and again yesterday, 4/22 - had full blood workup , and all blood work came out good / normal ranges, including WBC count - had ultra sound of left leg and normal and ekg as routine, also normal. went back to Dr. 4/23 because of bad dizziness lasting all day in waves and headache in temple area. now being treated with augmentin and prednisone for possible sinus infection, but i have never had this with any other sinus infection i ever had in the past. next step is MRI of the brain, which i really dont want to do. any help would be appreciated to rule out if this is due to the vaccine. very nervous. Thank you

Other Meds: multi vitamin, Ester C, fish oil, iron, B100 complex, magnesium , Vitamin D 5000mg, Benicar, Hydroclathiziad, Lumigan eye drops, Asacol, verapamil, meloxicam, nasal spray.

Current Illness: had sinus infection a month before vaccine.

ID: 1247350
Sex: F
Age: 43
State: NJ

Vax Date: 04/17/2021
Onset Date: 04/18/2021
Rec V Date: 04/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Latex

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

Symptoms: Face and lip swelling. Tightness in throat under jaw. Went to Urgent Care 3 days later, prescribed Steroids.

Other Meds: None

Current Illness: No

ID: 1247351
Sex: M
Age: 55
State: CA

Vax Date: 04/09/2021
Onset Date: 04/18/2021
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:

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

Symptoms: Symptoms are headache, backache, shortness of breath, leg swelling. Symptoms have lasted 6 days.

Other Meds: atorvastatin 20 mg 1 daily

Current Illness:

ID: 1247352
Sex: F
Age: 68
State:

Vax Date: 02/16/2021
Onset Date: 03/28/2021
Rec V Date: 04/23/2021
Hospital: Y

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

Symptoms: Patient presented to the ED on 3/3/21, 3/22/21, and 3/28/21 when she was subsequently hospitalized. These visits were within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1247353
Sex: F
Age: 19
State: OR

Vax Date: 04/18/2021
Onset Date: 04/18/2021
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: eggs, gluten, shellfish, wheat flour (rxn = rash to all)

Symptom List: Vomiting

Symptoms: On 4/18/21, it was reported that the patient had a seizure following the 2nd dose of Pfizer vaccine. This is a 19 year old female patient with a known history of a seizure disorder. She has been under the care of a neurologist x 6 years, is not on any seizure medications, and no diagnosis made. She reports she has a seizure every two weeks, which are triggered by anxiety/stressful events. On this day, 3 minutes after received the 2nd dose in the supine position, she fell unconscious and developed eyelid and arm twitching. Vitals signs remained stable. MD described seizure as 'starting as a sleep state, moving to slight twitching, then tonic clonic. Duration of seizure symptoms was 12 minutes. ' The patient regained consciousness, symptoms resolved, and patient was discharged home with family following increased observation. No medication treatment needed. Upon chart review, it was identified that she has a similar reaction following her 1st Pfizer dose. On 3/28/21, the patient received Pfizer (Lot ER8730 in the left deltoid). Following her 15 minute observation period, she rose from her chair and fell to the ground unconscious. She was taken to the treatment tent and observed to have 'seizure like jerking of upper and lower extremities, fluttering eyelids, unarousable.' Vitals stable (BP=103/68, HR =111, SpO2=98%). Patient and family described this seizure as similar to the ones she experiences due to stress/anxiety. Symptoms resolved, no medication treatment needed. She was advised to follow-up with PCP regarding 2nd dose, and if proceeds, recommended to lie down in treatment tent for 2nd dose (which was then done on 2nd dose). Patient reported that she has not had seizures with other vaccine administrations.

Other Meds: mirtazapine duloxetine

Current Illness:

ID: 1247354
Sex: F
Age: 29
State: VA

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: After receiving 2nd dose of COVID vaccine, while waiting in the car for 15 minutes, client reports feeling her body "feeling hot" face appears flushed progressing to the forehead. Client is oriented and able to speak and denies shortness of breath. 911 was called, engine 205 and medic 203 responded. Client was evaluated and was not taken to the hospital.

Other Meds: unknown

Current Illness: Unknown

ID: 1247355
Sex: F
Age: 22
State: AR

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 04/23/2021
Hospital: Y

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: GUAIFENESIN, CODEINE, COMPAZINE, MORPHINE LATEX

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

Symptoms: 03/08 AT 4PM BEGAN TO HAVE SYMPTOMS. AT 5PM AN EPIPEN .3 WAS GIVEN FOLLOWED BY A EMERGENCY VISIT. GIVEN IV STEROIDS AND BENADRYL. BP WAS NORMAL. ON 03/10, WAS TAKEN BY AMBULANCE FOR FAINTING / LOW BLOOD PRESSURE, CONCUSSION, AND VOMITING. (FAINTING SPELL HAD CAUSED THE CONCUSSION). SPENT 5 DAYS IN HOSPITAL WITH LOW BLOOD PRESSURE UNTIL RESOLVED. CONTINUES TO HAVE BLURRED VISION IN LEFT EYE.

Other Meds:

Current Illness:

ID: 1247356
Sex: F
Age: 37
State: CA

Vax Date: 04/03/2021
Onset Date: 04/12/2021
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: Aspirin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: My menstrual cycle is typically 5 to 6 days long and extremely heavy. Once I was vaccinated my menstrual cycle shortened the next cycle to 3 to 4 days and extremely light. I also had less cramping and less pain from my menstrual cycle

Other Meds: Fluoxetine

Current Illness: No

ID: 1247357
Sex: M
Age: 52
State: MN

Vax Date: 04/01/2021
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: RA

Lab Data:

Allergies: fentanyl

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

Symptoms: Instant funny taste in mouth. tongue swelling, lymph nodes under chin swollen, top of mouth mucousy. Swelling up to eyes. dizzy. dissipated within an hour. Still has swollen arm at injection site. Hard, feels like a golf ball. Headache.

Other Meds: none

Current Illness: none

ID: 1247358
Sex: M
Age: 63
State: CA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Aspirin

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

Symptoms: pt got headaches after the covid vaccination and developed to R carotid occlusion

Other Meds: Coreg 6.25 mg BID, Lasix 20mg BID, Neurontin 300mg TID, Isordil 5mg BID, Lisinopril 2.5mg QD, Risperidone 1mg QD, Aldactone 12.5mg QD, Amiodarone 200mg QD (All po meds)

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm