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: 1258843
Sex: M
Age: 57
State: NJ

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/26/2021
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: sudden onset swelling and pain at injection site. Strength, sensation, warmth of RUE intact. Passive range of motion intact. Mild tingling in R fingers. Recommended Tylenol, warm compress; Recommended going to ED if symptoms worsen.

Other Meds: None

Current Illness: Had COVID-19 in February 2021

ID: 1258844
Sex: F
Age: 76
State: MS

Vax Date: 04/20/2021
Onset Date: 04/25/2021
Rec V Date: 04/26/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: PCN

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient received her 2nd dose of the Moderna Covid-19 vaccine on 4/20/2021 at 0935. On 4/25/2021, patient presented to the ER with SOB and mild CP that began after she walked a 1/2 mile to her nephew's home. Pt was diagnosed with bilateral PEs and admitted to the hospital for treatment. At this time patient is stable, improving , and remains admitted to the hospital.

Other Meds: Aricept, Ativan, Aspirin, Calcium+D, Colace, Flonase, Levothyroxine, Miralax, Namenda, Norvasc, Omeprazole, Promethazine DM, Risperdal, Singulair, Ventolin inhaler

Current Illness: Sinus Congestion, Bacterial Sinusitis

ID: 1258845
Sex: F
Age: 0
State: IN

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: PCN, Septra, Darvocet, Morphine, Gralise, Lyrica, cherries, Chantix, Enbrel, Methocarbinol

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

Symptoms: Rash/itching all over body

Other Meds: Albuterol Sulfate (2.5 MG/3ML) 0.083% Nebulization Solution 1 vial Inhalation q4-6hrs prn cough/wheeze Azelastine HCl 0.05 % Solution 1 drop into affected eye Ophthalmic Twice a day Breo Ellipta 100-25 MCG/INH Aerosol Powder Breath Ac

Current Illness: Chronic pain

ID: 1258846
Sex: F
Age: 26
State: AZ

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: none reported

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient described arm tingling after 15 min, following by itching in throat after 30min. patient left at 5:30 declining emergency services and Benadryl administration due to additional observation time needed. Patient stated she would seek emergency care if needed.

Other Meds: none reported

Current Illness: none reported

ID: 1258847
Sex: F
Age: 61
State: NJ

Vax Date: 04/22/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Meds - codeine Food -N/A

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

Symptoms: After 2nd shot within 24 hours my arm swelled up and became itchy , achy and red . As the night progressed it became worse and now 3 days later my arm is swollen, itchy, achy, and red from my elbow up to my shoulder at the place of injection. Went and seen my Dr. today.

Other Meds: N/A

Current Illness: N/A

ID: 1258848
Sex: M
Age: 44
State:

Vax Date: 01/26/2021
Onset Date: 02/16/2021
Rec V Date: 04/26/2021
Hospital: Y

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: Patient presented to the ED and was subsequently hospitalized for gastroenteritis and dehydration. He also was admitted on 3/15/21 for below the knee amputation due to recurrent cellulitis.

Other Meds:

Current Illness:

ID: 1258849
Sex: F
Age: 56
State: MN

Vax Date: 01/29/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Patient reported a positive test result on the Abbot BinaxNow antigen test 4/22/21 through the University. Completed COVID vaccine series 1/29/21. Symptom onset 4/21/21. Recently attended a wedding 4/17/21.

Other Meds:

Current Illness:

ID: 1258850
Sex: F
Age: 60
State: NH

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/26/2021
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: AT 2:00 A.M.HAD THE SWEATS BURNING UP NEEDED TO TAKE SHOWER TO COOL DOWN THAN HAD CHILLS AND BODY ACHES, AND HEADACHE STARTED, HAD A HARD TIME FUNCTIONING. THIS WENT ON FOR TWO DAYS THEN HEADACHE FOR A WEEK AND LEGS WERE PAINFUL TO WALK STILL ARE HEADACHE GONE BUT PAIN IN LEGS, STILL TAKING ADVIL ITS BEEN TWO WEEKS SINCE THE SHOT.

Other Meds: CALCIUM 1200MG,VITAMIN C WILD ROSE HIPS 500 MG, ALIVE WOMEN'S 50 PLUS COMPLETE MULTIVITAMINS

Current Illness: NONE

ID: 1258851
Sex: F
Age: 35
State: VA

Vax Date: 04/01/2021
Onset Date: 04/25/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: not provided

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Caller's husband called the call center on the morning of 4/26 to ask about symptoms that his wife (the patient), who was 24 days post vaccination with Johnson & Johnson COVID-19 vaccine, had experienced the evening of 4/25. He reported that she had developed a severe headache and vomited. She c/o leg and chest pain as well and he reports that she has a history of blood clots but no h/o migraine headaches. At the time of the call his wife was feeling fine. I advised that they discuss with PCP. Having none I advised that she discuss with Urgent Care. I called him back about 6 hours later. They had decided that since since she continued asymptomatic they were not going to seek clinical evaluation. They believe that the symptoms were musculo-skeletal after "spending the whole weekend laying a patio".

Other Meds: not provided

Current Illness: not provided

ID: 1258852
Sex: F
Age: 72
State: NJ

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Anxious and dizziness

Other Meds:

Current Illness:

ID: 1258853
Sex: M
Age: 30
State: NY

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: was noticed falling out of his chair in the 15 min waiting area. At that moment I surrounded him and noticed he had passed out. It looked as if he had slightly hit shoulder first with no obvious head injuries. He came to in about 5 seconds in which he mentioned the fact passing out had happened to him before and was common with shots. The paramedics quickly attended to him and took blood pressure which came back normal. He denied transport by ambulance.

Other Meds: None

Current Illness: None

ID: 1258854
Sex: F
Age: 74
State: FL

Vax Date: 04/13/2021
Onset Date: 04/15/2021
Rec V Date: 04/26/2021
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: weakness in BLE, shallow breathing, elevated B/P (systolic ranging from 213 to 163), this morning B/P 179/89 Went to ER, script from hospital were just painkillers per husband. Recommended to continue taking b/p medications, and to obtain a pulse oximeter, and oxygen tank depending on blood oxygen reading. If symptoms worsen, contact primary provider. 4/19-Completed follow up call on 4/19/2021 at 10:27am: Pt reports that she feels a little weak (she contribute this to her laying down too much), and feeling lightheaded when she stands up to quickly. Otherwise, pt reports she is feeling much better today (BP 149/71, pulse: 79, blood sugar: 78). Pt states she went to the ER as a percauation, tests were done and she was released the same day she went in. Pt reports she is to follow up with her MD, and no prescriptions was written from ER. Pt also reported that with both of her shots she had some tenderness in her right arm ~1 hour afterwards, the tenderness went away the next day. Recommend pt to regularly monitor her BP and blood sugar at home, keep a log and bring to her follow up visits with MD. Also recommend pt to make sure to get up slowly from sitting or laying down position, and to hold onto something while standing for approx. 30 sec to a minute to make sure stance is steady enough walk to prevent fall risks since she states she gets lightheaded.

Other Meds: Synthroid, furosemide, amariadone, pantoprazole, metoprolol, metformin, pravastatin, Plavix, gabapentin, Eliquis

Current Illness:

ID: 1258855
Sex: F
Age: 71
State:

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 04/26/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Diaphoretic, tachycardia - observed by fire rescue for 30 minutes, returned to normal, cleared to go.

Other Meds:

Current Illness:

ID: 1258856
Sex: F
Age: 66
State: NY

Vax Date: 01/22/2021
Onset Date: 02/18/2021
Rec V Date: 04/26/2021
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: Following day-sore arm and headache. On day 18 and 19 petechiae noted on the dorsum of both feet, with numbness over the medial malleolus on the right. The petechiae resolved in 2 days. Numbness persists. Primary care notified.. ASA discontinued immediately on observation.

Other Meds: 81 mg ASA, Vit D, Vit C, Fish oil, Multivit. Calcium citrate, Zyrtec

Current Illness:

ID: 1258857
Sex: F
Age: 61
State: WA

Vax Date: 02/01/2021
Onset Date: 03/05/2021
Rec V Date: 04/26/2021
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: Clicking in left ear my Dr told me it was Tinnitus on 3/9/2021

Other Meds: Imitrex; Wellbutrin

Current Illness: none

Date Died: 04/22/2021

ID: 1258858
Sex: M
Age: 71
State: MI

Vax Date: 03/31/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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 died on 4/22/21. Vaccinated with 2nd dose of Moderna on 3/31/21. Vaccinated with Shingrix on 4/15/21.

Other Meds:

Current Illness:

ID: 1258859
Sex: F
Age: 26
State: IL

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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: Patient received moderna as her second shot at Meijer pharmacy, however, after we gave the shot we realized she had already gotten one dose on Pfizer on 4-1-21 from a Walgreens pharmacy.

Other Meds:

Current Illness:

ID: 1258860
Sex: M
Age: 74
State: MA

Vax Date: 03/09/2021
Onset Date: 03/15/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: antihistamines, erythromycin, lisinopril (cough)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient has square rash on upper left chest, which started 5 days after first vaccine and has persisted for six weeks

Other Meds: losartan, amlodipine, hydrochlorothiazide, atorvastatin, aspirin, omeprazole

Current Illness: None

ID: 1258861
Sex: M
Age: 17
State: VA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Administration Error: Moderna given to 17 year old.

Other Meds:

Current Illness:

ID: 1258862
Sex: F
Age: 49
State: CA

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: The lady that gave me the immunization rubbed my arm with disinfectant then looked away at something or someone, then went on to give me the shot about two inches above from were she had rubbed my arm with the disinfectant. In that moment I was just concerned with not having that area disinfected, but since I felt no pain I was happy and I thought she was the greatest. In that same evening I began experiencing pain in my arm. My arm has been in so much pain and my range of motion with that arm is about two inches. When I first stared to feel that my arm was hurting I attributed that to the vaccine. I then stared noticing that I was loosing the range of motion with that arm and yet I had no other symptoms from the vaccine. Every night the pain is intolerable as my arm hurts so much, even when doing nothing. Even the pull from gravity makes my arm hurt. I went to the Health Department on April 19, 2021 to let them know what was going on with my arm and that I have no other symptoms and they totally dismissed my concern, they said, that since it is not bruised or swollen there is no reason to be concerned. They did say that the shot was given to me in a unusual high spot, but that it was nothing to be concerned about. They also said that it was totally normal to have arm pain after the vaccine and didn?t even acknowledge that I can?t move my arm and that I am in so much pain. I ended up going to urgent care and the doctor there gave me a splint and said that this was normal pain due to the vaccine. He put me off of work for two days, but my arm is not getting any better. On 4/21 I went to follow up with my primary physician as the pain on my should was expanding and now I have shooting pains toward my neck. She gave me tramadol and ibuprofen for the pain, she also told me to ice my arm and do range of motion stretches. I went back to the doctor on 4/26 as the pain has not gotten better. I have some improvement in my range of motion as I have been doing the stretches that the doctor advised me to do but the pain in my shoulder is still very intense, especially at night. I was told to continue taking tramadol and to now apply heat to my shoulder. She told me to give the healing process more time as my bursa keeps healing.

Other Meds: isoniazid

Current Illness: n/a

ID: 1258863
Sex: M
Age: 43
State: PA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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: NKA

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

Symptoms: Pt. had a Syncopal episode post 10 from vaccination. Was lowered to floor without injury .Did not recover immediately . Became nauseous and shaky then began vomitting. Pt remained lightheaded and near syncopal whenever brought to a sitting position or standing position. Pt. refused Benadryl . Pt. admitted having nausea and diarrhea for past 1-2 days intractable vomitting 5 yrs ago Agreed to EMS transport to ED

Other Meds: Duvox, Statin drug , Buspar

Current Illness: OCD

ID: 1258865
Sex: F
Age: 71
State: FL

Vax Date: 03/03/2021
Onset Date: 03/08/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Paxil Otezla Remecade Allopurinol

Symptom List: Unevaluable event

Symptoms: Woke up on fifth day post inj with red, raised area on left temple that was painful to the touch. Extended onto scalp. Applied various topical medications with no relief. Scalp improved in about a week. Rah still visible on temple.

Other Meds: Cosentyx Methotrexate Losartin Hydrchlorothiazide Atenolol Estradiol Vit B6 Fish Oil

Current Illness: None

ID: 1258866
Sex: F
Age: 25
State: AL

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: PATIENT HAS HISTORY OF SEIZURES. SEIZURE ACTIVITY X 4 MINUTES. PATIENT IS ALERT AND ORIENTED X 4. BP 141/64, HR 46, O2S 98%. 911 WAS CALLED AND EMS ARRIVED AT 10:52. PATIENT WAS TRANSPORTED TO HOSPITAL AT 10:53.

Other Meds: ?

Current Illness: ?

Date Died: 04/24/2021

ID: 1258867
Sex: F
Age: 72
State:

Vax Date: 03/15/2021
Onset Date: 04/03/2021
Rec V Date: 04/26/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: This 72 year old female received the Covid shot on 03/15/2021 and went to the ED on 4/3/2021 and was admitted on 4/3/2021 with abdominal pain, nausea, chest pain, NSTEMI and died on 04/24/2021 . Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.

Other Meds:

Current Illness:

ID: 1258868
Sex: M
Age: 73
State: VA

Vax Date: 04/02/2021
Onset Date: 04/09/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Talwin codiene sulfur

Symptom List: Injection site pain, Menorrhagia

Symptoms: Iching at the injection site and 24 hours of exhaustion/tireness. It acts as though the vaccine is time released. I have had two episodes of this so far.

Other Meds: Alfuzosin/finesteride fish oil/D3/C1000/calcium

Current Illness: none

ID: 1258869
Sex: U
Age: 67
State:

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 04/26/2021
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:

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

Symptoms: Diaphoretic, flushed, tachycardia. monitored for 30 minutes, cleared with no symptoms.

Other Meds:

Current Illness:

ID: 1258870
Sex: M
Age: 41
State: KY

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient is currently in jail and that is where patient received the vaccine. He woke up the following morning with a full body rash and arm pain. He couldn't raise arm up and here a month later he still can't raise his arm.

Other Meds: Not Sure, patient was in jail at time of complaint

Current Illness: none

ID: 1258872
Sex: M
Age: 34
State: CO

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
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: Pt was seen in the Covid vaccine clinic for his second dose of moderna vaccine. Pt stated to this nurse that he typically passes out after receiving a vaccine or blood draw. This RN advised pt to sit in the same chair for his 15 min observation period. At approximately 1642 Pt started slumping over in his chair and was unresponsive to voice. His eyes were open, his skin become very pale and was diaphoretic. This Rn along with several RNs that were near by came to his aid. VS were obtained. At 1644 pt lost consciousness for approximately 15 to 30 seconds, EMS was called at this time (1644). Right before pt woke up he had witnessed convulsions. Upon waking, pt was lip smacking, no emesis at this time. His eyes were open and he was supporting his own weight but was not responding to voice commands. At approximately 1646 pt was alert and responding appropriately, stated that he knew where he was now and he was no longer confused. Pt was given an apple juice which he was able to drink without complications. At 1708 pt was A&O x4, had a steady gait, stated that he felt back to baseline and safe to drive home. Pt declined EMS evaluation and left the clinic.

Other Meds:

Current Illness:

ID: 1258873
Sex: F
Age:
State: FL

Vax Date: 02/13/2021
Onset Date: 02/14/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: She did not seek medical attention. Used inhalers, says her body produces a lot of epinephrine and it got rid of the allergic reaction. Antihistamines and steroids for 2 days. Advised to FU with Allergist. Agree with her pcp on not getting second dose of Covid 19 vaccine unless they r/o serious allergic reaction.

Other Meds: Diltiazem Atenolol

Current Illness:

ID: 1258874
Sex: F
Age: 53
State: WI

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: dust, ragweed, pollen

Symptom List: Nausea

Symptoms: The day after receiving the vaccine, had a sore left arm where the first shot had been given. (The second shot was given higher up on the same arm.) Arm started turning red and was tender and warm to the touch. Started feeling achy everywhere. Took ibuprofen and Tylenol, and felt better, but arm continued to have red mark. Had slight fever that night, and felt much better two days after the vaccine, but red spot on arm continued to grow in size and was tneder. By the third day after the vaccine, I felt fine except for the sore arm. It is not as sore, but is now itchy....The red mark has grown to be a welt about 7 by 4 inches in size. It feels like it should be all better in the next couple of days.

Other Meds: multi-vitamin and Vitamin D supplement

Current Illness: none

ID: 1258875
Sex: F
Age: 29
State: CA

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Non

Symptom List: Injection site pain

Symptoms: Day of injection 4/15/2021 4:30pm I got the shot waited in the lobby to see if I had sensitive symptoms and if not I was free to leave. After getting home I started getting chills and fever. 4/16 Chills, fever, muscle aches the whole day and dizzy when standing. But it was all manageable. 4/17 Chills, fever, muscle aches the whole day and dizzy when standing, nauseas, head ache. Not manageable I did no physical activities that day as well, my fitness watched showed my heart rate was up +10 beats. This lasted for about a week as well as my stress levels and body energy depleting faster then usual. My period cycle happened earlier then what is what I consider normal. That was worrying to me. I am a very active person I bike a lot and hike a lot. After taking an Tylenol to try and get my self together. Biking was very difficult for the same amount of miles I usually have no problem biking.

Other Meds: Non

Current Illness: Fever, tiredness, headache, migraine, chills, muscle pain, palpitations, my period cycle moved one week earlier then scheduled, burning chest/ thyroid area, Nausea.

ID: 1258876
Sex: F
Age: 33
State: NJ

Vax Date: 04/15/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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 Known

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

Symptoms: A red, slightly tender, itchy welt, about 5 inches in diameter that developed 7 days after my first vaccine that strongly resembles "Covid-Arm" reported in the initial trials. It's been another 4 days and it doesn't seem to be going away (which seems normal based on the study reports). I plan to take some Benadryl tonight and unless it doesn't go away on its own in a few more days I don't expect to see a doctor. Only reporting to help with tracking. The "Covid-Arm" report didn't suggest any other treatment besides antihistamines, and I can do that on my own.

Other Meds: Birth control, probiotics (Hum Flatter Me), Loratadine, collagen peptides, ZitSticka clear skin vitamins

Current Illness: None

ID: 1258877
Sex: F
Age: 64
State:

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/26/2021
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: no know allergies

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

Symptoms: Patient experienced itching and hives during observation. Redness was also noted to bilateral upper extremities and trunk. Vitals were within normal limits. Patient was given Benadryl 12.5 mg oral solution and dexamethasone 4 mg PO x 1 dose with water.

Other Meds:

Current Illness:

ID: 1258878
Sex: M
Age: 61
State: WI

Vax Date: 04/08/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
Hospital: Y

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-itching

Symptom List: Tremor

Symptoms: Received Moderna Covid Vaccine on 3/3/21 and 4/8/2021. Nted onset 4/24 of right calf discomfort, swelling and firmess and at same time began to have exertional dyspnea with chest heaviness. U/S RLE - extensive DVT. CTA - multiple segmental vessels with clot, dilated right ventricle

Other Meds: green tea leaf extract, mvi, tamsulosin

Current Illness: BPH, eczema

ID: 1258879
Sex: F
Age: 67
State: FL

Vax Date: 04/12/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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: TETRACYCLINE,DOXYCYCLE,TIZANIDINE,CLINDAMYCIN,THEOPHELENE

Symptom List: Erythema, Pruritus

Symptoms: PATIENT CALLED TODAY AND SPOKE WITH PHARMACIST AND TOLD THAT SHE HAVE RIGHT SIDE OF HEAD IS NUMB. PAIN IN CHEEKBONE. EYES ARE SWALLON. PHARMACIST TOLD HER TO SEE HER PRIMAMARY DOCTOR AND CHECK OUT THESE SYMPTOMS.

Other Meds:

Current Illness:

ID: 1258880
Sex: F
Age: 43
State: MI

Vax Date: 01/18/2021
Onset Date: 01/27/2021
Rec V Date: 04/26/2021
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: None

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

Symptoms: Started with right ear pain, which became within several days severe Bell?s palsy. I had complete right sided facial paralysis, including the right side of my mouth, throat and eye not closing. I had extreme fatigue, facial pain, ear pain, throat pain, difficulty swallowing. This took 1 month to have improvement. Also had some elevated heart rate.

Other Meds: Zyrtec, symbicort, melatonin, gabopentin, singulair

Current Illness: None

ID: 1258881
Sex: M
Age: 32
State: MA

Vax Date: 04/25/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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: chills, slight fever, overall drowsiness, lack of appetite These symptoms woke me up many times overnight the night of the shot. It's been about 24 hours now, and a long nap has lessened them, but my head still hurts.

Other Meds: VitaFusion D3 gummies; Flintstones chewable multivitamin with iron

Current Illness: none

ID: 1258882
Sex: M
Age: 25
State: GA

Vax Date: 04/02/2021
Onset Date: 04/17/2021
Rec V Date: 04/26/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vaccine (Moderna) given on 4/2 On 4/17, patient noted back pain radiating toward abdomen. Developed rash in same area of pain on 4/19- Seen on 4/20 and diagnosed with Herpes Zoster. Followed on 4/23 with same diagnosis.

Other Meds: none

Current Illness: none

ID: 1258883
Sex: M
Age: 17
State: WI

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: No known allergies

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

Symptoms: Patient was seen in COVID vaccine clinic for first dose of Pfizer vaccine. Patient has a history of vasovagel episodes related to anxiety and past healthcare appointments. Per mother patient has "White Coat Syndrome", and has been 2 years since previous episode. Given history patient laid supine on examination table for vaccine. Immediately following vaccine patient complained of lightheadedness and lost consciousness for approx 30 seconds. Patient woke up to stimulation but continued to complain of "fuzziness". Initial vitals HR 45, BP 100/51, MAP 73, RR 14, and sats 99% with bounding pulses.

Other Meds: Unknown

Current Illness:

ID: 1258884
Sex: F
Age: 44
State: IN

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: HEADACHE, FEVER, BODY ACHES, LETHARGY, CONFUSION

Other Meds:

Current Illness:

ID: 1258885
Sex: M
Age: 15
State: IA

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 04/26/2021
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: Pain in extremity

Symptoms: Vaccine given to patient 2 weeks before he was 16 years of age. Pt had no issues with dose.

Other Meds:

Current Illness:

ID: 1258886
Sex: F
Age: 36
State: PA

Vax Date: 04/23/2021
Onset Date: 04/25/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 1) N/A 2) 2nd does administered around 11:15 A.M 4/23. Onset of chills at 10:00 P.M. that day. Woke up at 7 A.M with no symptoms on 4/24. Around 10 A.M. on 4/24, chills began to set in, followed by fatigue, and a minor cough. I started to develop a fever around 1 P.M., at 99.0, then to 99.9 by 1:30, 100 by 1:45. I reached 100.4 by 2 PM. After taking Ibuprofen and Tylenol, the fever and exhaustion began to fade. I took a 40 minute nap around 4 P.M. and was fever free afterwards. I woke at 7 A.M on 4/25 and felt great. Went through my daily activities, and by 4 P.M. that afternoon, I began to feel very warm and exhausted. I also developed a cough that was more forceful than the previous day. I never had a fever. I began to feel better after taking DayQuil around 6 P.M. On 4/26 I felt like I was experiencing a typical case of hives, my face felt itchy as well as my arms and legs.

Other Meds: norgestimate-ethinyl estradioL 0.25-35 mg-mcg per tablet Ibuprofen

Current Illness: None

ID: 1258887
Sex: M
Age: 17
State: CO

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 04/26/2021
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: MEDICATION ADMINISTERED AS AN "OFF-LABEL" USE DUE TO PATIENT AGE. PATIENT ONLY EXPERIENCED MUSCLE SORENESS IN INJECTION ARM.

Other Meds:

Current Illness:

ID: 1258888
Sex: F
Age: 38
State: PA

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: Sick to my stomach all day next day and finally threw up at 3:30 AM on April 24th and felt better after that. However April 25th/26th I stated to break out with blisters on my body. I found two. One on the inside of my right thigh and one on my lower back. They look like shingles. NOT HAPPY.

Other Meds: Birth control

Current Illness: None

ID: 1258889
Sex: F
Age: 33
State: ME

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: No

Symptom List: Vomiting

Symptoms: Consistent headaches, nausea, dizziness, hot flashes, chills, coughing, shooting pain down right arm into right hand.

Other Meds: Sertraline Ibuprofen Vitamin D Vitamin C Vitamin B Acetaminophen

Current Illness: Cough, headaches, runny nose.

ID: 1258890
Sex: F
Age: 38
State: WI

Vax Date: 01/13/2021
Onset Date: 02/05/2021
Rec V Date: 04/26/2021
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: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I developed scleritis/episcleritis of my eye. I needed topical steroid drops and oral ibuprofen.

Other Meds: Prenatal Vitamins, Vitamin D, Calcium

Current Illness: No

ID: 1258891
Sex: U
Age:
State: CO

Vax Date:
Onset Date:
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Flu-like symptoms; fever; chills; aches; tiredness. Treatment: OTC ibuprofen Outcome: Effective at relieving symptoms

Other Meds:

Current Illness:

ID: 1258892
Sex: F
Age: 64
State: OR

Vax Date: 03/31/2021
Onset Date: 04/02/2021
Rec V Date: 04/26/2021
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: I have no sense of smell whatsoever since receiving my first vaccine. That's the only side-effect I have. It's not bothersome (thank goodness I can still taste food) but I have been encouraged to report it to someone.

Other Meds: I wasn't taking my prescription medications at that time due to a head injury Feb. 22nd (hadn't taken medications since head injury).

Current Illness: I sustained Traumatic Brain Injury on Feb. 22nd. For almost a month I had taken anti-nausea medication and pain medications. I was taking neither medication on March 31.

ID: 1258893
Sex: F
Age:
State: FL

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/26/2021
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: Vomited once, Dysphagia comes and goes. Explained to seek medical attention if dysphagia continues. Caller voiced understanding.

Other Meds:

Current Illness:

ID: 1258894
Sex: F
Age: 62
State: MN

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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: sulfa

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

Symptoms: Mild headache in morning after vaccine, progressed to moderate headache with body aches, fever (100 F) and lightheadedness in midafternoon. Symptoms remained into the night and fever rose to 101 F. Symptoms resolved overnight but headache and fever (100) returned for 3-4 hours in the afternoon of April 23.

Other Meds: escataloprim 5 mg; vit D, vit B12, biotin, multivitamin, fish oil, turmeric, glucosamine/chondritin

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm