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: 1270543
Sex: F
Age: 53
State: MI

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/29/2021
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: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Lost feeling and use of legs for 5 mins Lung congestion Back Pelvic pain Exhaustion Headache Heavy menstruation after 1 1/2 yrs of no periods

Other Meds: Aller-tec

Current Illness: None

ID: 1270544
Sex: F
Age: 43
State: NC

Vax Date: 04/12/2021
Onset Date: 04/15/2021
Rec V Date: 04/29/2021
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: Percocet ...hydrocodone

Symptom List: Anxiety, Dyspnoea

Symptoms: Neuropathy flared up very painful in feet hands and breast ..Right arm has numbness on skin but painful under skin from hand to elbow ..what seems to react like tendonitis .

Other Meds: Treseba injection Humalog injection gabapantin Hydroxychloroquine lisionopril Tylenol simvastatin

Current Illness: Diabetes lupus sle

ID: 1270545
Sex: F
Age: 73
State: ME

Vax Date: 03/17/2021
Onset Date: 04/02/2021
Rec V Date: 04/29/2021
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: None known

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

Symptoms: Spontaneous total loss of vision in right eye. Blood clot formed and had stroke. CRAO--Central Retina Arterial Occlusion; will not recover use of eye. All tests have turned out normal

Other Meds: Hydrochoricyasid 24 mg; Losartin 50 mg; Gemfibrisil; aspirin

Current Illness: No

ID: 1270546
Sex: M
Age: 50
State: MD

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/29/2021
Hospital: Y

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

Lab Data:

Allergies: No Known Allergies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On April 1, 2021, I received my 1st dose of the Pfizer vaccine at the Center and the only side effect from the vaccine at that time was localized soreness at the injection site of my left shoulder. On April 2, 2021, earlier that day the soreness at the injection site began to dissipate after doing push-ups and massaging my left arm. After going to bed last night and that night is when the additional side effects started. I was awakened by itching on both arms which had formed whelps from my shoulder to my forearm. For the next 13 days, the whelps and itching were sparsely during the day (which had consumed my legs, upper torso as well as arms) as they presented the illusion to be getting better but would flare up at night while sleeping. I attempted to do home remedies from Calamine lotion, Benadryl and cold showers but nothing seemed to effectively work against the itching and the whelps that resembled Hives. On April 13, 2021, while at work a new side affect began which was the swelling of my bottom lip (particularly the right half) along with itching in my throat. The swelling reduced itself as I continued to work through the night but the discomfort in my throat continued. The whelps and itching were still sparsely present as well. On April 14, 2021, later that morning, post work, the reduced swelling of my lower lip and throat discomfort I decided to go to the ER. While enroute to the ER, my top lip began to tingle and swell. These events made me more concerned about the severity I was experiencing since receiving the vaccine. After checking into the ER and being triaged, the doctor informed me that I would be hospitalized overnight due to the swelling of my upper lip, elongated tonsils, elevated blood pressure and the diagnosis of whelps as Hives. For the next three nights I was intravenous administered Epinephrine, Benadryl and Prednisone. On April 16, 2021, the third night I was discharged from the hospital with the same medications and informed to follow up with an allergist.

Other Meds: Atorvastatin Calcium daily, Drisdol 1.25 MG Q7days, Flomax 0.4mg daily, Norvasc 5mg daily, aspirin 325mg daily, zyrtec 10mg prn, hydrochlorothiazide 25 mg daily, sertraline 200mg daily.

Current Illness:

ID: 1270547
Sex: F
Age: 78
State: MD

Vax Date: 02/26/2021
Onset Date: 03/01/2021
Rec V Date: 04/29/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Existing low level tinnitus became much more intense, louder and unrelenting

Other Meds: Flonase, Breo100, Losartan, Zyrtec, Acetaminophen

Current Illness: None

ID: 1270548
Sex: F
Age: 36
State: ME

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/29/2021
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: Upon administration in the left arm of Moderna vaccine using the DropSafe 3m 25 g 1 inch need, the needle disengaged with the syringe upon administration. The vaccine leaked out of the syringe, down the patients arm and on the floor. Needle was retracted from pt's arm. Pt tolerated well and had no complaints at the time. Pharmacist aware and assessed. It was determined that patient did not receive dose of vaccine given the amount that was leaked out. Pt was provided a full dose of the vaccine administered in the right arm. Pt tolerated well.

Other Meds:

Current Illness:

ID: 1270549
Sex: F
Age: 44
State: IN

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/29/2021
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: Keflex

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Itchy skin, low grade fever, muscle pain, joint pain, extream thirst, fatigue

Other Meds: None

Current Illness: None

ID: 1270550
Sex: M
Age: 21
State: DE

Vax Date: 03/24/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Pharyngeal swelling

Symptoms: COVID breakthrough vaccine. Fully vaccinated, tested positive for COVID > 14 days after completing vaccine series. Known COVID exposure, mild symptoms.

Other Meds: Loratadine

Current Illness: none

ID: 1270551
Sex: F
Age: 75
State: MD

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 04/29/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Weakness on left side arm and leg. Stroke happened on 4/8/21.

Other Meds: Tramadol Meclizine Ondansetron

Current Illness:

ID: 1270552
Sex: F
Age: 30
State: IN

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
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: Mango allergy Hayfever allergy

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Swelling in armpit of injection arm, chills, sharp pains, joint aches, foggy head, headache, muscle pain.

Other Meds: Cbd gummies B-12 Zyertec

Current Illness: None

ID: 1270553
Sex: F
Age: 78
State:

Vax Date: 03/18/2021
Onset Date: 04/27/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: Hayfever

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

Symptoms: I had an unsettling waking event happen to me yesterday morning, so I didn?t feel like I could gather myself to be at an appointment after the event. I was very disoriented upon waking. I could not gather my thoughts and memories. Things like: I knew I was in a city , but didn?t know where the city was in the world; and other things like that. It was as though I had stepped out of my life and didn?t remember enough to step back in. It only lasted maybe 5 min, but was completly disconcerting & disarming. I?ve never had a similar event. And it came after another disarming 10 min bout of dizziness / sense of off-balancedness and a very slight nausea the night before. It too, was arresting because I had had no alcohol to drink for months. I felt continually better during the early morning and didn?t think about it much during the rest of the day.

Other Meds: Blood Pressure medications Pradaxa

Current Illness: No

ID: 1270554
Sex: M
Age: 35
State: MI

Vax Date: 04/10/2021
Onset Date: 04/12/2021
Rec V Date: 04/29/2021
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: PCN

Symptom List: Rash, Urticaria

Symptoms: Pt presented to office with erythematous papilar rash approximately 48 hours after receiving his second dose of Covid vaccine. Pt's first dose was 3/20/21 and pt denied any adverse events with that dose. Rash began on trunk and was spreading to neck and down arms. Pt denied any other symtoms and was afebrile. A punch biopsy was taken and pt was advised to take benedryl and call with any other symptoms. Pt was seen 1 wk and 2 wks for f/u. At 1 wk f/u pt stated that rash had resolved approximately 48 hours after being seen in office. Biposy showed urticarial dermatitis.

Other Meds: Lexapro Vitamin D OTC Lithium Synthroid Rexulti Olanzapine Ketoconazole Shampoo

Current Illness: None

ID: 1270556
Sex: F
Age: 38
State: TN

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: Nickel, Latex.

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

Symptoms: Patient experienced an upper chest and bilateral shoulder rash, facial edema, and a tingling sensation past receiving the vaccine. A discussion was held between Provider, PHARM-D MAJ, and OIC MAJ that resulted in the patient not being a candidate for a second dose.

Other Meds:

Current Illness:

ID: 1270557
Sex: F
Age: 46
State: TX

Vax Date: 03/11/2021
Onset Date: 04/17/2021
Rec V Date: 04/29/2021
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: This is a continuation from report on 4/8 Pt has worsened symptoms. I went to Gynecologist on 4/19 still exp night sweats.The Gynecologist stated I have high disblasha on my cells I'm scheduled for cervical procedure on 5/17. I went to my physician EKG I'm scheduled on 5/6 Physical Stress test.I also went to dermatologist on 4/22 removed (burned) 9 places on my skin (face,chest stomach) that had abnormal cells.The dermatologist recommend have a upcoming scan for my lymph nodes. As of now my lymph nodes (both sides) are swollen still exp day and night sweats, joint pain and tired. I'm now on high blood pressure medication.Both doctors have stated the vaccine has sent me into "haywire with my immune system".

Other Meds:

Current Illness:

ID: 1270558
Sex: F
Age: 57
State: FL

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 04/29/2021
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: N/A

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

Symptoms: Employee was administered the Moderna vaccine on 12/29/2020. Employee stated more than half of the vaccine ran out of her arm. Employee received the 2nd dose as scheduled without incident, Employee stated she had titres completes which showed no immunity. CDC contacted and recommended a booster vaccine to be given and mark the 1st dose erroneous.

Other Meds: N/A

Current Illness: N/A

ID: 1270559
Sex: F
Age: 52
State: AZ

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Extreme fatigue, headache, muscle aches, lymph node pain and swelling under left arm

Other Meds: Vit D Zinc Selenium Cetirizine Losartan Omeprazole

Current Illness: None

ID: 1270560
Sex: F
Age: 59
State: CT

Vax Date: 03/28/2021
Onset Date: 03/29/2021
Rec V Date: 04/29/2021
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: Aspirin and penicillin

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

Symptoms: Triggered 3-1/2 + week long migraine. Pain intensity at times 9/10. Neurologist put me on extended prednisone taper to help break cycle.

Other Meds: Clonopin, buspirone, Duloxitine, Crestor, topamax, nortriptyline, Ginger, B2, magnesium glycinate, vitamin D, krill oil, melatonin Sumatriptan, Benadryl, compazine Alleve, Tylenol extra strength , Advil

Current Illness: None

ID: 1270561
Sex: F
Age: 23
State: IL

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: History of passing out on vaccines, lab work, "any needles" phobia c/o lightheadedness

Other Meds: None

Current Illness: None

ID: 1270562
Sex: M
Age: 53
State: NC

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/29/2021
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: facial swelling, facial drooping, complaints of left ear pain Emergency department visit diagnosed with Bell's palsy treated with valtrex prednisone

Other Meds:

Current Illness:

ID: 1270563
Sex: F
Age: 57
State: PA

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: skin rash to penicillin during childhood

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

Symptoms: torso rash that looked like scratches, apparently a form of hives, slight to moderate itching/burning sensation on torso and face, developed about 13 hours after injection and appears about 75% resolved within 36 hours after appearance, no treatment administered

Other Meds: fish oil capsules, Flovent inhaled corticosteroid, Nasocort allergy nasal spray

Current Illness:

ID: 1270565
Sex: F
Age: 41
State: NE

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 04/29/2021
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: Generic darvocet

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

Symptoms: Slight fever, moderate achiness everywhere, stuffy nose, slight cough

Other Meds: N/A

Current Illness: N/A

ID: 1270566
Sex: F
Age: 54
State: MO

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: Shellfish

Symptom List: Unevaluable event

Symptoms: Dizziness, Headache, Heart Palpitations five minutes after injection

Other Meds: none

Current Illness: None

ID: 1270567
Sex: F
Age: 36
State: WI

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/29/2021
Hospital: Y

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: NKDA

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

Symptoms: 15 minutes after dose, complained of itching. Sent to Emergency Department. Found to have lacy erythematous rash on thighs and back. No breathing difficulty and no swelling. Received diphenhydramine IV, famotidine IV, and methylprednisolone IV. Discharged with prescriptions for oral diphenhydramine, famotidine, and prednisone. Returned to ED 15 hours after dose complaining of fatigue and extremity weakness. No rash, no breathing difficulty, and no swelling noted. Admitted for observation and to rule out neurologic syndrome. Workup negative. However patient reported transient neurologic symptoms at various times in the past. Discharged with instructions to follow up with neurologist in the future.

Other Meds: Fluticasone nasal spray

Current Illness: None

ID: 1270568
Sex: M
Age: 60
State: CA

Vax Date: 02/24/2021
Onset Date: 02/26/2021
Rec V Date: 04/29/2021
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: none

Symptom List: Injection site pain, Pain

Symptoms: After first dose-Numbness and tingling that started in the left jaw area, moved into era and throat, then moved up to the scalp on the left side only. (I thought I was getting shingles) Pricking sensation in left arm. After second dose tingling and numbing in different parts of the body with pricking at different time ALL over my body randomly. Sometime feeling of cold and other times the feeling of heat. It takes 1-3 day to subside and as it subside I get an itchy feeling. Comes back what seems to be every 2 weeks. It is like my nerves are "firing off", again, all over and randomly.

Other Meds: Famotidine, Hydrochlorothiazide, KLOR-Con, Fish oil, Magnesium, Vitamin D3 and C, Simvastatin, baby aspirin

Current Illness: none

ID: 1270569
Sex: F
Age: 41
State: LA

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient presented on 4/27 for second vaccination. When asked about reactions to the first she stated she had lip swelling and blisters form the day after her first vaccination. She presented with photos in her phone of her reaction to the vaccination. On the photos her top lip was swollen and she had blisters formed. Patient did not report this reaction prior to 4/27/2021.

Other Meds: No medications on file

Current Illness: None reported

ID: 1270570
Sex: F
Age: 59
State: NJ

Vax Date: 04/26/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
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: Penicillin, sulfa drugs, nitrofurantoin, and meperidine

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

Symptoms: Red rash. Hot to the touch, 3 distinct areas of upper left arm. Each area is 2 to 2 1/2 inches in diameter. Self treated with o oral OTC diphenhydramine at 9:00pm on 4/28/2021. Rash has not yet resolved.

Other Meds: Levothyroxine, ranitidine, calcium, baby aspirin

Current Illness: none

ID: 1270571
Sex: F
Age: 49
State: PA

Vax Date: 12/18/2020
Onset Date: 12/31/2020
Rec V Date: 04/29/2021
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: dry cough, fatigue, runny nose, congestion. Reports chills but no fever.

Other Meds: None

Current Illness: None

ID: 1270572
Sex: M
Age: 16
State: PA

Vax Date: 03/27/2021
Onset Date: 04/24/2021
Rec V Date: 04/29/2021
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: No adverse reaction, individual is under 18 and was given the Moderna vaccine on March 27th. It was identified at the second dose day April 24th. At that time 2nd dose was not given. After reviewing CDC guidelines individual is scheduled for 2nd dose on 5/8/2021 as off label.

Other Meds: unknown

Current Illness: unknown

ID: 1270573
Sex: F
Age: 57
State: FL

Vax Date: 03/19/2021
Onset Date: 03/21/2021
Rec V Date: 04/29/2021
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: Allergic to all nuts, many pollens, latex.

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

Symptoms: Dizziness and nausea on changing position from sitting to standing, standing to sitting, standing to lying down (veritigo)

Other Meds: Advair HFA 45/21 am, Singular, multi-vitamin, Flaxseed oil, vitamin D, magnesium

Current Illness: None

ID: 1270574
Sex: F
Age: 49
State: IN

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
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: Fever, chills, body aches

Other Meds:

Current Illness:

ID: 1270575
Sex: F
Age: 23
State: MD

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: Anesthesia

Symptom List: Injection site pain

Symptoms: Fever, Vomiting, Headache, Chills and body aches

Other Meds: Birth Control

Current Illness:

ID: 1270576
Sex: M
Age: 38
State: OH

Vax Date: 04/19/2021
Onset Date: 04/24/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Ankle and heel swelling and pain Red patch on right foot that is warm to the touch Node on right arm - swollen, red, and tender Node behind right knee Dizziness

Other Meds:

Current Illness:

ID: 1270577
Sex: F
Age: 89
State: MN

Vax Date: 02/26/2021
Onset Date: 03/26/2021
Rec V Date: 04/29/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Patient hospitalized within 60 days of receiving a COVID vaccine

Other Meds:

Current Illness:

ID: 1270578
Sex: M
Age: 44
State: TX

Vax Date: 04/14/2021
Onset Date: 04/21/2021
Rec V Date: 04/29/2021
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: Tremor

Symptoms: Fever 5+ days Joint pain and stiffness - patient could not bend wrists, ankles or walk without assistance Could not straighten knees Rash started in legs and covered entire body including palms of hands, soles of feet

Other Meds: None

Current Illness: None

ID: 1270579
Sex: M
Age: 52
State: VA

Vax Date: 03/10/2021
Onset Date: 03/19/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: About a week after my first Pfizer shot, I was diagnosed with shingles.

Other Meds:

Current Illness:

ID: 1270580
Sex: M
Age: 78
State: PA

Vax Date: 01/18/2021
Onset Date: 01/25/2021
Rec V Date: 04/29/2021
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: Enlarged lymph node on lower right side of face which continues to get larger by the day, after 3months it is passing the size of a golf ball. A needle biopsy pulled off 20 cc of turbid blood tinged fluid. Local physicians are suggesting the lymph node should be removed. I would never recommend anyone taking a covid vaccine shot. I do have an overactive immune system.

Other Meds: Lisinopril 10mg 1 tab daily Aspriin 81mg 1 tab daily Fluticasone Propionate 50mcg Montelukast NA 10mg tab Altorvastatin Calcium 20mg Famotididine 40mg Centrum Silver 1 tab daily loop Caltrate 600+D (800IU) 1 tab daily Glucosamine Condroit

Current Illness:

ID: 1270581
Sex: F
Age: 76
State: PA

Vax Date: 03/27/2021
Onset Date: 04/01/2021
Rec V Date: 04/29/2021
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: Morphine, Advil

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

Symptoms: On April 1, 2021 I woke up with pain in my left hip. As the day went on it got much worse and the nausea started to the point where my husband had to take me to the ER . They gave me some pain medicine, nausea medicine and did a cat scan of my abdomen. Nothing was found and I was sent home. April 4th the pain got so severe and the dry heaving to the point where blood came out. Again I went into the ER this time by ambulance because I was so weak at that point where I couldn?t walk. Again they gave me pain medicine and nausea medicine along with prednisone. It took about a week to recuperate and now I have severe tinnitus.

Other Meds: As air Diskus, Citalopram, clorazepate, gabapentin, hydrocodone, levothyroxine, lisinopril, magnesium, medical marijuana, Proair HFA, multi vitamin.

Current Illness:

ID: 1270582
Sex: F
Age: 46
State: NC

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: severe headache, fever, chills, sweating, arm pain, swollen lymph notes, nausea, weakness, dizziness. I have never been so sick in my entire life.

Other Meds:

Current Illness:

ID: 1270583
Sex: F
Age: 22
State: IN

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
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: N/A

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

Symptoms: Slight fever, muscle aches for 24 hours after vaccine received

Other Meds: Nexplanon arm bar birth control

Current Illness: N/A

ID: 1270584
Sex: F
Age: 54
State: GA

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 04/29/2021
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: Sulfur and Penicillins

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

Symptoms: Patient was post-menopausal. She reports starting vaginal bleeding the 2nd CoVid vaccine. Additional lab work is being done to rule out other cause of bleeding such as cervical cancer.

Other Meds: Levothyroxine 112 MCG

Current Illness:

ID: 1270585
Sex: F
Age: 60
State: IA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: Birth Control Pill

Symptom List: Pain in extremity

Symptoms: Pt mentioned to the vaccinator that she had developed hives after her first shot that she received on 3/2/2021. She complained of itchiness and hives and had to take benadryl for 2 days until they were gone. PT stayed at recovery area for 30 minutes to monitor for any anaphylactic response. She left without further issues. Contact information given to Pt in case anything develops later today.

Other Meds: None

Current Illness: No

ID: 1270586
Sex: F
Age: 28
State: AZ

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: fatigue, headache, muscle pain, joint pain, chills, nausea. And weakness and dizziness. All started 15-20 hours after injection. Weakness and dizziness comes and gos. Still have other symptoms.

Other Meds:

Current Illness: Stomach flu

ID: 1270587
Sex: F
Age: 31
State: GA

Vax Date: 03/12/2021
Onset Date: 03/24/2021
Rec V Date: 04/29/2021
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: Cefatin

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

Symptoms: Started experiencing chest pain on March 26th in the evening. I went to my primary care physician that Friday and she performed an EKG that came back normal. She told me if the pain persisted to go to the ER to where they could further evaluate me. A week later I went to the emergency room. They performed a CT scan and EKG and ran blood work everything came back normal. They did state that I had a pulmonary nodule that was benign and to get it rechecked in one year. For aftercare I was Referred to a cardiologist. Upcoming appointment is May 14th 2021.

Other Meds: No

Current Illness: Low iron

ID: 1270589
Sex: F
Age: 41
State: MI

Vax Date: 01/28/2021
Onset Date: 04/24/2021
Rec V Date: 04/29/2021
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: sulfa antibiotics - hives

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

Symptoms: On 4/24/2021 developed COVID-19 symptoms. Cough, diarrhea, headache, nasal congestion. Tested positive by PCR.

Other Meds: albuterol inhaler

Current Illness: none

ID: 1270590
Sex: F
Age: 62
State: GA

Vax Date: 04/23/2021
Onset Date: 04/26/2021
Rec V Date: 04/29/2021
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:

Symptom List: Vomiting

Symptoms: Patient stated she did not feel bad for the first three days after she got her vaccination(4/23) but that on the third day(Monday 4/26) she started to feel nauseated, had diarrhea, and felt weak. She said this proceeded to get worse on Tuesday and was worst on Wednesday April 28th, when she felt almost too weak to stand per her reporting. When we spoke on 4/29/2021- she said she was feeling much better and felt she would continue to improve.

Other Meds:

Current Illness:

ID: 1270591
Sex: M
Age: 68
State: OH

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 04/29/2021
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: sudden right sensorineural hearing loss--pt has complete hearing loss in right ear and did not respond to treatment.

Other Meds: Synthroid, Plavix, accupril, zocor, Cardizem cd,

Current Illness: none

ID: 1270592
Sex: F
Age: 70
State: NY

Vax Date: 03/12/2021
Onset Date: 04/19/2021
Rec V Date: 04/29/2021
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: Erythromycin Shellfish Shellfish Derived

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

Symptoms: On 4/23/21 she presented to the ED with 4 day history of left sided weakness and slurred speech. She was hypertensive on arrival 249/121. In the emergency room labs remarkable for platelet count 92, INR 1.0, glucose 170, GFR 70.7, AST 48, alkaline phosphatase 167, troponin I 0.039. COVID-19 and other viral serologies not detected. CT of the brain showed a small subacute infarct in the right body of the corpus callosum. MRI advised by radiology. Patient received aspirin, amlodipine 10 mg, enalapril 1.25 mg IV then 0.625 mg IV for uncontrolled hypertension. MRI of brain reveals small subacute infarct involving the body of the corpus callosum, and punctuate acute infarct to the posterior left frontal lobe. Angiogram of brain was performed revealing focal severe stenosis of the mid basilar artery, moderate to severe stenosis of the short segments of both intracranial internal carotid arteries and moderate to severe short-segment stenosis of the intracranial left vertebral artery, felt to be chronic and unrelated to current symptoms. She was started on dual antiplatelet therapy: clopidogrel 75 mg PO DAILY and aspirin 81 mg Tablet, Delayed Release (Dr/Ec) 81 mg PO DAILY. It should be noted that lab work reveals Thrombocytopenia chronically from 2011 forward.

Other Meds: Diltiazem 300 Mg ER24 hour PO daily Advil PM 200/28 2 cap PO HS Metformin 1000mg PO BID Omega3 fatty Acid Capsule 1 cap PO BID Ramipril 5 Mg PO Daily

Current Illness: None

ID: 1270593
Sex: M
Age: 30
State: NC

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 04/29/2021
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: Sulfa drugs

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Waves of exhaustion for 5-6 days and discomfort at injection site for 6 days following injection. When the exhaustion would hit, starting the day after injection, I was too weak to go up and down stairs. It seemed significant and was more than normal tiredness, and I ended up needing to take a half day at work four days after vaccination. On the sixth day after vaccination, I was feeling well again and discomfort at the injection site had subsided as well. It was the worst the day after getting vaccinated, which was to be expected. I did not expect it to last so long.

Other Meds: Allegra

Current Illness: N/A

ID: 1270594
Sex: F
Age: 73
State: MI

Vax Date: 04/26/2021
Onset Date: 04/29/2021
Rec V Date: 04/29/2021
Hospital:

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

Lab Data:

Allergies: bactrim

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

Symptoms: swelling of tongue and left side of lip, benadryl. lasted 10hr, swelling has decreased

Other Meds: lisinopril, magnesium oxide, hydralazine, metformin, carvedilol, mirtazapine, divalproex sodium, atorvastatin

Current Illness: none

ID: 1270595
Sex: F
Age: 20
State: IN

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/29/2021
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: Headache, chills, fever; took Ibeuprofen throughout day and night of vaccine; slept most of the day

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm