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: 1273013
Sex: F
Age: 43
State: IN

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Body aches

Other Meds: Klonopin Pristiq

Current Illness: Diverticulitis

ID: 1273014
Sex: F
Age: 35
State: MD

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Lamictal

Symptom List: Anxiety, Dyspnoea

Symptoms: Onset of facial numbness localized to both sides of the face approximately 15 min after receiving the second dose of the Pfizer vaccine. Nubness was localized to both sides of the face, nose and neck. Symptoms resolved after 30 min of observation without any medical intervention.

Other Meds: Loratidine

Current Illness: None

ID: 1273015
Sex: F
Age: 41
State: MI

Vax Date: 03/27/2021
Onset Date: 04/03/2021
Rec V Date: 04/30/2021
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: Get hives from pomegranate and mouth burns from kiwi. Hives from Cardezem LA

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

Symptoms: Dose 1: arm was itchy at injection site and a little spotty red. Felt a little off for a week. 7 days after shot I got 'covid arm, or moderna arm' that grew to 12 cm x 12 cm on left arm. Was completely gone 7 days after it started. Dose 2: Covid-arm 2 days after the shot and grew to 12 cm x 12 cm on right arm. Other side effects were uncontrollable body shakes and fever (started about 11 hours after injection), sore arm, body aches, headache, brain fog, and fatigue. Most symptoms subsided after one day of onset. Covid arm went away after 4 days (maybe slightly still visible).

Other Meds: Ibuprofen and prenatal vitamin (with DHA)

Current Illness: n/a

ID: 1273016
Sex: F
Age: 45
State: NH

Vax Date: 04/01/2021
Onset Date: 04/08/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 8th day skin reaction at injection site 1 inch in diameter - red, warm to touch, itchy 9th day redness increased to 3 inches in diameter, bulls eye appearance, applied steroid cream 10th day faded away

Other Meds:

Current Illness:

ID: 1273017
Sex: M
Age: 33
State: GA

Vax Date: 04/10/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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: NKA

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

Symptoms: PT REPORTED TO ED WITH C/O SOB/DYSPNEA, CHEST PAIN, PROBLEMS WITH INSPIRATION AND FATIQUE-TACHYCARDIA HR 119- BILATERAL LEG PAIN SINCE 4/26/21

Other Meds: PHENTERMINE 37.5 MG PO DAILY TRAMADOL 50MG PO PRN

Current Illness: NOT NOTED IN CHART

ID: 1273018
Sex: M
Age: 24
State: CA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Systemic: Nausea-Mild, Systemic: Tinnitus-Medium

Other Meds:

Current Illness:

ID: 1273019
Sex: F
Age: 59
State: IN

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/30/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Tuesday evening I was tired and sore. Chills and my entire body started aching late Tuesday night about 11pm and continued throughout all day Wednesday. I was also light headed. On Thursday I was better but not 100% same as today Friday 4/30/2021

Other Meds: Lisinopril

Current Illness: None

ID: 1273020
Sex: F
Age: 52
State: CT

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Body aches, chills ,fever of 101 at 8:30pm Extreme fatigue, loss of appetite, chills until around 2 am on the 30th diareah and cramping but chills and fever gone. Body aches gone. Appetite back.

Other Meds: Levothyroxine 25 MCG Quetiapine fumarat 50 mg

Current Illness:

ID: 1273022
Sex: F
Age: 21
State: MI

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient vaccinated at 12:37pm. While in observation, patient became warm at 12:40pm and fell off chair and onto the floor. Patient reported feeling cloudy and not remembering falling to floor. No injuries were sustained. Cool compresses applied to neck and forehead. Patient able to stand and was assisted to table to lie down if needed. Patient vitals within normal limits. Patient reported not eating prior to vaccination and also having a great fear of needles. Patient given lunch and reported improvement at 1:13pm. Patient released at 1:37pm. Vitals remained normal throughout observation.

Other Meds: Unknown

Current Illness: Unknown

ID: 1273023
Sex: M
Age: 50
State: IN

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: When I woke It felt like a inner tube was inflated around my waist really tight and locked up where my back is fractured and the upper earlier surgery hurt and itched from nerve I am assuming. It settled in to all my weak spots. Today I have no pain like that in my back but right leg function and reflexes are nonfunctioning with spasms.

Other Meds:

Current Illness:

ID: 1273024
Sex: F
Age: 53
State:

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: nausea / lightheaded / resolved

Other Meds:

Current Illness:

ID: 1273025
Sex: F
Age: 38
State: IN

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Stiff neck and pain no treatment

Other Meds: Citalopram and daily allergy

Current Illness:

ID: 1273026
Sex: F
Age: 43
State: IN

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: Gluten, epinephrine

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

Symptoms: 4/28/21 10:20 am received vaccine 5:00 pm soreness in arm 9:00 pm extreme nausea, chills, fever, of 100.3 - my normal is 96.3 - fully clothed in pants and sweatshirt under several blankets and couldn?t get warm- this lasted all night and the entire next day 4/29/21 - slept on and off the entire day bouncing between freezing and sweating. 5:30 pm got up for dinner, ate about 4 bites and became nauseous and had to go lay back down. Slept the rest of the night, bouncing between freezing and sweating. 4/30/21 6:00 am - woke up with a migraine and dizzy. Fever has finally broken but still bouncing between freezing and sweating.

Other Meds: Na

Current Illness: None

ID: 1273027
Sex: M
Age: 39
State: IL

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)

Other Meds:

Current Illness:

ID: 1273028
Sex: F
Age: 36
State: IN

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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: 14 hours after injection I started experiencing chills and body aches...eventually around 16 hours after injection became really warm, fever reached 101.3. Fatigue. Could barely stand and experienced some shortness of breath/headache. Slept for 2.5 over night. Attempted to work the next morning, but left after a couple of hours. Experienced more chills and a fever of 100.3 approximately 30 hours after injection. Fatigue/aches continued. One more round of chills/warm body with high temp of 99.8 degrees @ 36 hours after injection. Took ibuprofen throughout. Melatonin 5 mg and went to sleep for the night. Woke up feeling great!

Other Meds: Azelastine Fluticasone

Current Illness: None

ID: 1273029
Sex: F
Age: 38
State: FL

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: I received my vaccine around 10:00 a.m. Over night, I was sore on my arm, shoulder, neck, and chest on the side that I received my vaccine. When I woke up in the morning, my lymph node under my arm pet on the vaccine side was swollen and sore. 2 days later, it seems to be getting smaller.

Other Meds: Viorele

Current Illness: None

ID: 1273030
Sex: F
Age: 55
State: MD

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: PATIENT FELT TINGLING IN HER LEG,THEN NUMBNESS IN HER ARM-911 WAS CALL AND PATIENT LEFT WITH PARAMEDIC

Other Meds:

Current Illness:

ID: 1273031
Sex: F
Age: 42
State: DE

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Immediate elevated heart rate and tingling arm. Repeated episodes of elevated heart rate for 24 hours post injection. Shortness of breath 48 hours post injection

Other Meds: None

Current Illness: None

ID: 1273032
Sex: M
Age: 66
State: NJ

Vax Date: 03/25/2021
Onset Date: 03/26/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: He got his vaccine, within 24 hours later he had hives, his lips and face swelled up, he had a low grade temp of 99.8 having chills and wanting to stay warm and lay in bed with multiple blankets. After his daughter noticed it about 2 hours later they went to the ER, and they gave him a steroid, Benadryl and a steroid and gave him IV Pepcid until the swelling went down and he felt better. They gave him 6 days worth of Benadryl, and steroids which he did take for that. After 6 days and after 24 hours he broke again in the same manner and they told him that it was okay as long as he was breathing well. He then went to the UC and he bought OTC Benadryl which he continued. Then exactly 30 days after he went to the ER on 4/24/21 he broke again with the lips swelling, hives, temperature was normal but feeling achy and the same symptoms he had from the beginning. He went to his PCP and he has him now on steroids, Benadryl and the Pepcid when needed as well. He takes the Benadryl as needed and then the symptoms subside and the reaction comes back. If he does not do the Benadryl until later this evening then his lips will start tightening and then swell.

Other Meds: Aspirin 81 mg, hydrochlorothiazide, Rosuvastatin, Celebrex.

Current Illness: None.

ID: 1273033
Sex: F
Age: 68
State: IN

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Penicillin,Compozine, IV Dye Contrast, Morphine, NSAIDS, Flagyl

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

Symptoms: EXTREME SWELLING IN LEFT ARM & DEBITATING PAIN Requiring continuous.ice packs for 24 hours

Other Meds: Amplodipine,Valsartan,Clonidine,Protonix,Spirolactone, Bystolic, Tylenol, ProAir

Current Illness: Costochondritis, HBP, Reflux, Asthma, Diverticulosis, Arthritis

ID: 1273034
Sex: F
Age: 46
State: MN

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 04/30/2021
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: Penicillin and Pen family. Amox, ceftin, cefzil, erythromycin, morphine, topical sulfates like neosporin. Egg yokes, sweet potatoes, horse radish, cucumbers, and lactose intolerant.

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

Symptoms: Metallic type taste and smell occurred within 5 minutes of the shot. Slight swelling of the tongue and throat. Caused the need to repeatedly clear my throat and some coughing. Reported to staff who pulled me aside to keep me there longer. After an hour of being there, they felt I was ok to leave and recommended I take an antihistamine when I get home, which I did. The also advised to report adverse reactions stating I had a mile allergic reaction to the shot. I also noticed the roof of my mouth was very swollen within two hours of the shot too. The ridges on the roof of the mouth were very pronounced and painful. Strong metallic taste with it. Went to bed because I was so tired. Woke up to my arm being extremely sore and the area of the shot was raised, warm and painful to the touch. Felt very achy, headache, and exhausted the next day like I had the flu for about 24-36 hours. Slept the majority of the next day. Smell and taste resolved within a few hours but the roof of the mouth took 3 days before resolving. Took advil and Zyrtec (Antihistamine) as recommended by the staff.

Other Meds: None. Flonase used that morning for season allergies.

Current Illness: No.

ID: 1273035
Sex: F
Age: 61
State: NM

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 04/30/2021
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: Unevaluable event

Symptoms: At 11:15 p.m. (10 hrs. after shot), I woke up nauseous, sat up in bed and felt weird, got up and made it to the foot of bed and passed out. When I came to, had my husband get me a cold rag, but then I felt diarrhea hit, I crawled to the hall to the bathroom, stood up and had the uncontrollable shakes so bad the whole toliet shook with me. After I finished in bathroom I went back to bed and literally shook for 1 1/2 hours and was up most of the night. This was my 2nd shot. On the 1st shot it made me feel like I was in a fog, like when you pass out and come to and your not all there. Took 3 hours to shake that one. I don't know what is in the freakin thing, but my body cant take this kind of stuff and I WILL NOT be doing any more of this quickly made, quickly approved vaccines. Count me out for any further ones. I'M DONE !!! I have never taken the flu shot ever so I WON'T be doing any more of these no matter how much the CDC pleads with me

Other Meds: none

Current Illness: none

ID: 1273036
Sex: M
Age: 37
State: PA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Systemic: Chills-Mild, Systemic: Confusion-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Severe, Additional Details: Pt experienced syncope and had a blood pressure reading of 70/40 and a pulse of 44. EMT was called and pt resolved to blood pressure of 105/65 and a pulse of 55. Pt was chose not to go to hospital after filing consent with EMT, he was then pickd up by a coworker and will return for his car later. Pt noted to have a history of low BP in the past but has not see a MD recently and was advised to follow up with new pcp.

Other Meds:

Current Illness:

ID: 1273037
Sex: F
Age: 55
State: IN

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Massive joint pain. Every joint

Other Meds: Omoprazile

Current Illness:

ID: 1273038
Sex: M
Age: 16
State: MD

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient was 16 years old at time of vaccination. No immediate adverse effect noted after injection.

Other Meds:

Current Illness:

ID: 1273039
Sex: F
Age: 50
State: NH

Vax Date: 04/17/2021
Onset Date: 04/30/2021
Rec V Date: 04/30/2021
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: eggs

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

Symptoms: Immediately after vaccination the site bruised. Site was painful, and swollen for 5 days. Considerable fatigue and aches for 5 days. Two weeks after vaccination a raised, red rash 3" wide by 1.5" high appeared about 2" below the injection site (Moderna Arm).

Other Meds: none

Current Illness: none

ID: 1273040
Sex: F
Age: 36
State: IA

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Arm sorenesss within hour of shot, arm redness with raised bump about 2 inch circumference 14 hrs after , Flushed face with hot flashes 14 hrs after shot, then slight fever of 99.8 (normal temp for me is 97.8) 24 hours later body aches and chills. I?ve been taking ibuprofen every 4 hours while awake, first 24 hours, then switched to Tylenol.

Other Meds: None

Current Illness: None that aware of

ID: 1273041
Sex: M
Age: 44
State: WI

Vax Date: 04/21/2021
Onset Date: 04/27/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Severe body ache, chills, light nausea

Other Meds: Bayer Cranberry Vitamin D Miralax

Current Illness: None

ID: 1273042
Sex: F
Age: 60
State: CT

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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: ZPAC

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

Symptoms: 2nd vaccine adverser events: fever, chills, shakes, muscle cramps, headache, nausea, dizziness, tiredness

Other Meds: none

Current Illness: none

ID: 1273043
Sex: M
Age: 62
State: AR

Vax Date: 04/23/2021
Onset Date: 04/25/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Nausea

Symptoms: pt says he woke up next day and he had a sore arm and other common flu like symptoms that subsided the same day. On 4/25/2021 he woke up w/ Bells Palsy on the left side of his face. He called his PCP . He had a tele-visit and was prescribed Valacyclovir 1gm every 8 hrs and prednisone 3 20mg tabs once daily. On 4/29/21 he had a tele-health visit w/ NP . He was prescribed some sleep meds. Today 4/30/20 he has a headache behind his left ear. He will FU w/ his PCP Magen Mallet on 5/3/21.

Other Meds: gabapentin

Current Illness:

ID: 1273044
Sex: F
Age: 44
State: FL

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Systemic: Fainting / Unresponsive-Severe

Other Meds:

Current Illness:

ID: 1273045
Sex: F
Age: 20
State: AL

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Nausea-Medium, Systemic: Tachycardia-Medium, Additional Details: Loss of hearing for a few minutes. EMTs came to store monitored pt and BP for additional 15-20 mins. BP increased to over 100. PT had water, crackers and chocolate. Pt felt fine and refused to be taken by ambulance but had a friend pick her up. I explained situation to friend and pt was told to take it easy for the rest of the day.

Other Meds:

Current Illness:

ID: 1273046
Sex: M
Age: 46
State: NY

Vax Date: 04/02/2021
Onset Date: 04/09/2021
Rec V Date: 04/30/2021
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:

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

Symptoms: There was itching and swelling in arm couple of days after shot. After nearly 1 week there was a increased itching and swelling in the same arm. Also a little fatigue. This lasted for 3-4 days.

Other Meds:

Current Illness:

ID: 1273047
Sex: M
Age: 25
State: NY

Vax Date: 04/26/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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: none

Symptom List: Tremor

Symptoms: 4/26 received 2nd Pfizer dose. 4/28 did nonstrenuous exercise. 4/28-4/29 acute abdominal pain/soreness out of proportion to activitiy

Other Meds: none

Current Illness: none

ID: 1273048
Sex: F
Age: 38
State: OH

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 04/30/2021
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: Erythema, Pruritus

Symptoms: Developed a red, itchy rash on my left forearm.

Other Meds: None

Current Illness: No

ID: 1273049
Sex: M
Age: 55
State: OR

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: Approximately 10-12mins after the J&J shot was administered, the patient got our attention to let us know he wasn't feeling well and might faint. I quickly tended to him as he slowly passed out. I craddled his head to make sure he did not hit it on the countertop. Pateint was seated. After approximately 30 second the patient started to come to. We gave him some water, took his bp, had him wait 30mins and took his bp again before he left with his wife.

Other Meds:

Current Illness:

ID: 1273050
Sex: F
Age: 44
State: FL

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 04/30/2021
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: PCN

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

Symptoms: Pt with sudden fatigue, tiredness, scratchy throat and shortness of breath with in 2 hr of taking vaccine and lasting 3 weeks with only slow improvement

Other Meds: citalopram, buspar

Current Illness:

ID: 1273051
Sex: F
Age: 22
State: IA

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Swollen lymph node in armpit on left side, headache, sore arm

Other Meds: none

Current Illness: none

ID: 1273052
Sex: F
Age: 63
State:

Vax Date: 03/16/2021
Onset Date: 03/28/2021
Rec V Date: 04/30/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient ended up with a 16 day hospital stay within 6 weeks of receiving the covid vaccine.

Other Meds:

Current Illness:

ID: 1273054
Sex: F
Age: 38
State:

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/30/2021
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: At the 20 hr mark after shot Severe nausea Severe intense Vomiting Severe Diarrhea Very severe debilitating stomach pain (All this lasted about 5 hrs) Also, Spotting from period that lasted 3 days started at the 20hr post shot time. As well as since shot. Period came a week early and was very very heavy and intense). This never ever happens.

Other Meds:

Current Illness:

ID: 1273055
Sex: F
Age: 68
State: IN

Vax Date: 02/12/2021
Onset Date: 02/21/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: THERE WAS NO SECOND SHOT THAT DAY, DIDN'T KNOW HOW TO DELETE. SORRY MY MISTAKE NO ISSUES OTHER THAN SORE ARM AND ITCHY AT SHOT SITE NEXT DAY- BUT DAY 9,10, AND 11 MY ARM BECAME HOT, ITCHY AND I NOTICED I COULDN'T TASTE FOOD. I CAN MAYBE TASTE 10% OF WHAT I EAT NOW. IT'S NOT IMPROVING MUCH AT ALL AND IT'S BEEN 2 AND A HALF MONTHS. I CAN SMELL BUT NOT TASTE FOOD.

Other Meds: Metfoemin 1500 per day, Women's Daily Multivitamin, PreserVision 1 per day, D3 100 mcg per day, Levothyroxine 88mcg, Zinc 50 mg, Stool Softner 2 per day, Losatan 50MG, Duloxetine 60MG, Rosuvastain

Current Illness: no, perfect health

ID: 1273056
Sex: F
Age: 25
State: MT

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/30/2021
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: Fever & Fatigue

Other Meds:

Current Illness:

ID: 1273057
Sex: F
Age: 48
State: FL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/30/2021
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: penicillin

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

Symptoms: Extremely sore arm for 36 hours

Other Meds: Lexapro, Verapamil, Enalapril, multivitamin, Vitamin D

Current Illness:

ID: 1273058
Sex: M
Age: 24
State: ME

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 04/30/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Systemic: Fainting / Unresponsive-Medium, Additional Details: Pateint fainted within 5 minutes of receiving the vaccine. 911 was called and responded but he had quickly come to. He felt better within 10 minutes but the paramedics examined him anyway. He left of his own accord.

Other Meds:

Current Illness:

ID: 1273059
Sex: F
Age: 30
State: NJ

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/30/2021
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: Amoxicillin

Symptom List: Vomiting

Symptoms: Adverse event was body aches and intense headaches for two days after the adverse symptoms started. This is only after the second vaccine. There was no reaction other than arm soreness after the first vaccine. At the time of the second vaccine, I was 13 weeks pregnant due to deliver on October 31, 2021.

Other Meds: Prenatal vitamin with DHA

Current Illness: Morning sickness

ID: 1273060
Sex: F
Age: 46
State: NY

Vax Date: 04/13/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I started feeling vertigo a few times on 4/28. Since then (today is the 3rd day) I've been feeling dizzy at times even when sitting. I only had the first shot 2 weeks ago and haven't had the 2nd shot yet.

Other Meds: None

Current Illness: None

ID: 1273061
Sex: F
Age: 40
State: MA

Vax Date: 04/21/2021
Onset Date: 04/28/2021
Rec V Date: 04/30/2021
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: Gluten and dairy sensitivity

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

Symptoms: Seven days after I received the vaccine my arm was swollen, red and itchy at the injection site.

Other Meds: None

Current Illness: None

ID: 1273062
Sex: F
Age: 69
State: MI

Vax Date: 03/31/2021
Onset Date: 04/18/2021
Rec V Date: 04/30/2021
Hospital: Y

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: No known allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received 1st dose of moderna vaccine on 3/31/21. Patient went to the ED on 4/18/21 complaining of 2 weeks of worsening shortness of breath, fatigue, weakness, and new onset chest heaviness which ultimately was a pulmonary embolism (PE). Patient did not have any prior health/risk factors to PE. Patient did test positive for COVID-19 on 4/18

Other Meds: Albuterol (Proventil) Inhaler as needed Amlodipine 10mg daily Clondine 0.1 mg three times daily Potassium chloride 40mEq daily

Current Illness: Patient presented to the emergency room on 4/18/21 complaining of 2 weeks of worsening shortness of breath, fatigue, weakness, and new onset chest heaviness that began on the morning of 4/18. Patient described that pain as intermittent episodes of chest heaviness/tightness in the substernal region with the pain coming and going within 30 seconds and unrelated to increased physical activity or remedied by rest. Prior to this event, she had seen a cardiologist 10-15 years ago. Upon evaluation the patient presented with an elevated heart rate (120 bbpm), afebrile, normal white blood cell count, and elevated inflammatory markers (LDH 366, d-dimer >10 mcg/mL, ferritin 1030, CRP 42.05). CT with contrast on 4/18 showed extensive pulmonary emboli. Patient received 1st dose of moderna vaccine on 3/31/21 (LOT #: 047A21A). Patient tested positive for COVID-19 on 4/18. No other clear hypercoagulable risk factors.

ID: 1273063
Sex: F
Age: 36
State: MO

Vax Date: 03/30/2021
Onset Date: 04/27/2021
Rec V Date: 04/30/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Onions

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

Symptoms: Second shot I had fever, chills, hot flashes, and rapid heart beat. Everything has gone away except for the rapid heart beat. It goes high every time I stand up/move around then will go back down once I am sitting/resting. I am calling my doctor this morning for an evaluation.

Other Meds: None

Current Illness: Tick bite

ID: 1273064
Sex: F
Age: 40
State: GA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/30/2021
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: Citrus, Doxycycline, Aspirin

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

Symptoms: Around 3pm I began feeling so weak and sleepy I was struggling to keep my eyes open while typing emails for work. By 8pm I had a mild fever and was freezing. The next day the fever persisted and I have aches and chills. I slept most the day. The fever did not break till the next morning. I was only taking acetaminophen for the fever and pain.

Other Meds: 1. Iron 65mg 2. Vitamin D3 5000iu 3. Propranolol 40mg 4. Bupropion HCL XL 150mg 5. Acyclovir 800mg 6. Zyrtec D 7. MigRelief 8. Spironolactone 100mg 9. Biotin 10000mcg 10. Pantoprazole 40mg 11. Levothyroxin 100mcg 12. Eliquis 2.5mg 13. Ajovy

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm