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: 1274323
Sex: F
Age: 31
State: NY

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

Lab Data:

Allergies: Allergic to bactrim and ceclor

Symptom List: Dysphagia, Epiglottitis

Symptoms: 100.1 fever after 2 ibuprofen, chills for several hours, body aches (felt more like bone aches - even my teeth hurt), didn't sleep at all due to body aches

Other Meds: Levoxyl 112mcg Venlafaxine 75mg Take daily probiotic

Current Illness: N/A

ID: 1274324
Sex: F
Age: 56
State: OH

Vax Date: 03/15/2021
Onset Date: 03/15/2021
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: --NONE--

Symptom List: Anxiety, Dyspnoea

Symptoms: Onset of sx started several hours after first Covid vaccine. Started with severe injection site pain, diffuse pruritis, body aches, fever 101.7 axillary, chills/sweats, and severe HA. Took acetaminophe, alternated w ibubrofen every 4 hours overnight. Next AM woke w T 99.7 axillary, HA, weakness, severe body aches, fatigue, sore throat and dry throat. Injection site swollen to ~7 mm diam with bruised appearance, extremely tender, unable to lie on L side. Able to sip sports drink; warm, clear liquids (soup) without appetite. Continued w Ibuprofen HA formula. Sleep difficult due to chills/sweating. Also frequent cough, SOB with ADLs. Recd Dose #2 Pfiz 4/5/21 - s/sx worsened significantly and CONTINUE.

Other Meds: --NONE--

Current Illness: --NONE--

ID: 1274325
Sex: M
Age: 54
State: NJ

Vax Date: 04/05/2021
Onset Date: 04/22/2021
Rec V Date: 04/30/2021
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

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

Symptoms: Ischemic CVA

Other Meds: Amlodipine 10mg PO daily Lipitor 80mg PO bedtime Chlorthalidone 25mg PO daily Losartan 50mg PO daily

Current Illness: HTN

ID: 1274326
Sex: F
Age: 17
State: LA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was not 18. She had no symptoms and feels fine.

Other Meds:

Current Illness:

ID: 1274327
Sex: M
Age: 53
State: TX

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Penicillin

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

Symptoms: Patient received J&J vaccine dose #1. Over the next two weeks, developed fatigue, anorexia, and malaise (had been fatigued prior to dose). Presented to local hospital and ultimately was diagnosed with acute megakaryocytic leukemia. Now in hospital for initial treatment of leukemia. Unlikely to be related to vaccine, reporting due to hospitalization and severity of illness.

Other Meds: None

Current Illness: None diagnosed (see report)

ID: 1274328
Sex: F
Age: 54
State: CA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: unknown

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

Symptoms: patient inadvertently vaccinated on day 16 post Dose 1. patient informed, no s/s immediately reported.

Other Meds: unknown

Current Illness: unknown

ID: 1274329
Sex: F
Age: 64
State: PA

Vax Date: 03/28/2021
Onset Date: 03/01/2021
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: no

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I GOT RINGING EARS WITH THE FRIST DOES. A FEW DAYS AFTER GETTING IT. IT HAD BEEN 24/7 . IAM HAVING TROUBLE SLEEPING. THE NOISE IS CONTANT. IT HAS GOTTON VERY LOUD AT TIMES IT WENT AWAY IN A FEW DAYS>

Other Meds: IDERAL 60mg SIMVASTATIN 20mg FOSMAX 70mg SYTHROID 112mg

Current Illness: none

ID: 1274330
Sex: F
Age: 28
State:

Vax Date: 04/22/2021
Onset Date: 04/23/2021
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: My period was two weeks early after getting my second dose of Pfizer vaccine.

Other Meds: Birth control

Current Illness:

ID: 1274331
Sex: F
Age: 36
State: OR

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: No adverse effects detected at this time. Despite being specifically asked, Pt did not disclose that they had received Pfizer for their first dose. Pt received Pfizer vaccine for Covid-19 at another location but received Moderna for the 2nd dose before this was discovered.

Other Meds:

Current Illness:

ID: 1274332
Sex: M
Age: 72
State:

Vax Date: 03/01/2021
Onset Date: 04/30/2021
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: asymptomatic covid infection after 1 month of vaccine administration

Other Meds:

Current Illness:

ID: 1274333
Sex: F
Age: 71
State: CA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: 2nd dose of Moderna COVID Vaccine administered 21 days after 1st dose to prevent wastage of expiring doses. No adverse reaction noted.

Other Meds:

Current Illness:

ID: 1274334
Sex: F
Age: 45
State: CA

Vax Date: 03/30/2021
Onset Date: 04/30/2021
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: No Known Allergies

Symptom List: Rash, Urticaria

Symptoms: Patient first experienced drooping right eyelid the evening following vaccination. She has hx of Bell's Palsy in 2012 and reports same symptoms continued to develop, right eyelid and right mouth drooping. She also reports tingling and numbness throughout most of right side of face. These symptoms have not improved or worsened since 03/30/21 and continue today 04/30/21. She also reports sensation of heart fluttering intermittently for 3 days following vaccination; this symptom has resolved.

Other Meds: Amlodipine 2.5 mg p.o. daily Seasonique 0.15-0.03-0.01 mg one tab daily

Current Illness: none

ID: 1274335
Sex: M
Age: 35
State: MN

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

Lab Data:

Allergies: NA

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

Symptoms: Covid arm. 4? rash at point of injection

Other Meds: NA

Current Illness: NA

ID: 1274336
Sex: F
Age: 25
State: NM

Vax Date: 04/08/2021
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: NKDA

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

Symptoms: Healthy young women of 25 years of age with spontaneous pregnancy. Regular period prior to becoming pregnant. Patient had miscarriage on 04/29/21 with anembryonic pregnancy. Anembryonic pregnancy confirmed by ultrasound on 4/23/21. Covid vaccine received on 4/8/21. Patient roughly 4 wks pregnancy at time of vaccine dose.

Other Meds: Prenatal vitamin.

Current Illness: None.

ID: 1274337
Sex: M
Age: 44
State: CO

Vax Date: 04/10/2021
Onset Date: 04/24/2021
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: Severe to moderate epistaxis for 6 days. Rhino rocket at onset of bleed and removed 36 hours later. Various other packings attempted for approximately 60 hours all of which failed to stop recurring bleeding. Rhino rocket inserted and will remain inserted for four days. Scheduled to be removed by an Ear, Nose and Throat specialist at the end of four day period. Continuing treatment unknown at this time.

Other Meds: None

Current Illness: None

ID: 1274338
Sex: M
Age: 64
State: OH

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: NKDA

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

Symptoms: The patient received their first dose of Moderna COVID-19 vaccine on 04/01/2021; The patient returned Public Health's drive through vaccination clinic on 04/29/2021 to receive their second dose of the COVID-19 vaccine. The nurse administering the vaccine to the patient asked the patient what vaccine they had received first and the patient informed the nurse they had Pfizer COVID-19 vaccine, the nurse then administered Pfizer COVID-19 vaccine to the patient as that was the vaccine Public Health was providing that day for second doses. The patient was inadvertently given the Pfizer COVID-19 vaccine instead of the Moderna COVID-19 vaccine for their second dose. Therefore there was no adverse reaction to the COVID-19 vaccine, the patient was inadvertently given Pfizer COVID-19 vaccine instead of second dose being Moderna COVID-19 vaccine.

Other Meds: N/A

Current Illness: N/A

ID: 1274339
Sex: F
Age: 46
State: UT

Vax Date: 03/19/2021
Onset Date: 04/18/2021
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: NKDA

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

Symptoms: Woke up in the morning (a.m.) of 04/18/2021 with two breakout lesions/welts on left backside of lower abdominal region, along with one rash on the front of the lower abdominal region of what appeared to be a Shingles (herpes zoster) outbreak/reactivation. I have never had Shingles before in my lifetime. I did experience the chickenpox at age 5. I have not received the Shingrix vaccination because I am under the age of 50 years old. I instantly went to the nearest Urgent Care and, shortly after 9:00 a.m. I was diagnosed with having a Shingles (herpes zoster) outbreak/reactivation. The doctor prescribed valacyclovir 1 gram to be taken 3 times a day for 7 days. I took all doses on time and never missed or skipped a dose. I completed this course of valacyclovir on 04/24/2021. The reason for my reporting this adverse event is because I read an article.

Other Meds: Morning: Alive Women's Ultra Potency Complete Multivitamin (1) Iodoral (1) Vitamin D3 + K2 10,000/200 mcg IU (1) and 5,000 IU/100 mcg (alternate dosages q.o.d.) Country Life Co-Enzyme B-Complex (1) Zinc Picolinate 50 mg (1) N-acetyl-cyst

Current Illness: NONE

ID: 1274340
Sex: F
Age: 70
State: NJ

Vax Date: 03/24/2021
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: Penicillin, some sulfites, mild egg allergy, dust, mold, mild seasonal.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I felt nothing at all adversely at the time of administration. I returned on 04/21/2021 for the second dose, but elected to wait the two weeks longer, as offered. On the 34th day after the first dose I broke out in hives in several areas, including upper thighs, upper and lower arms, hands and neck. I have not had an outbreak of hives for nine years and have not changed anything in my personal care routine or food selections. Some of the hives are very small, some are larger and inflamed. The lesions are very pruritic. I have no way of knowing if the hives are related to the injection, but since there is nothing else new that I know of to account for them I felt it best to report it, which was suggested by my local pharmacy as well. I am now very concerned about getting the second dose this coming week. Since I have a long-standing autoimmune condition, could this be a delayed reaction?

Other Meds: Multivitamin/mineral, D3 1000 mcg, C 500 mg, Omega 3-6-9, Liquid Kelp 800 mcg. No prescription or OTC medications.

Current Illness: No acute illnesses.

ID: 1274341
Sex: F
Age: 39
State: IL

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: anaphylaxis to penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt started coughing 10 minutes after receiving 1st dose of Pfizer Covid vaccine. Pt was sitting down and started coughing. She informed us she has an anaphylaxis reaction to penicillin. We gave her 50mg of Diphenhydramine and gave her some water. She was alert and communication with us. After 30 minutes her coughing subsided and she said she felt better. She contacted her husband to dive her home.

Other Meds: hydroxychloroquine, Eliquis 2.5mg

Current Illness: unknown

ID: 1274342
Sex: F
Age: 54
State: OR

Vax Date: 02/26/2021
Onset Date: 03/05/2021
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: None

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

Symptoms: Red circle; raised welt at injection site bigger than original mark. Painful bruise feeling, like the original shot, for 3 days, then just itchy and tender for 17 days.

Other Meds: Vitamin C 1,000 mg Vitamin D-3 5,00 mg

Current Illness: None

ID: 1274343
Sex: F
Age: 47
State: CA

Vax Date: 04/20/2021
Onset Date: 04/22/2021
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: None

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

Symptoms: Numbness, tingling, burning bilateral feet and hands

Other Meds: Flonase

Current Illness: None

ID: 1274344
Sex: F
Age: 51
State: CA

Vax Date: 04/11/2021
Onset Date: 04/13/2021
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: Codine and mushrooms

Symptom List: Unevaluable event

Symptoms: Urinary/stomach pain, muscle/back pain, joint pain, chest pain

Other Meds: Atorvastatin calcium 40mg, Provera 5mg, toprol xi 50mg, hydrochlorothiazide 25mg, metformin hydrochloride 1,000mg, Farmiga 10mg, lotrel 10/40mg, doxazosin message 1mg, iron 65mg, coq 10 100mg, d3 50mcg, Kirkland triple action joint health

Current Illness: N/A

ID: 1274345
Sex: F
Age: 29
State: SC

Vax Date: 03/15/2021
Onset Date: 03/18/2021
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: My menstrual cycle was late by 7 days. This was then followed by 20+ days of continual bleeding

Other Meds: Zyrtec, Sprintec, Wellbutrin, Prozac

Current Illness:

ID: 1274346
Sex: F
Age: 71
State: CO

Vax Date: 02/21/2021
Onset Date: 02/26/2021
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: no

Symptom List: Injection site pain, Pain

Symptoms: 5 days after her 2nd moderna covid vaccine shot, my mother was walking to her camper, and her knee "gave out." She has never had any pain or other problems with her knee prior to this moment. She did not sustain any falls or injuries before or after the immediate onset of knee pain. Since her knee gave out, she has had severe knee pain, swelling, and has been unable to ambulate well. She went to see an orthopedist, who did an MRI and diagnosed her with "arthritis." She has had to have fluid removed from the knee twice. She also developed shingles on her forehead 4/1/2021, 8 days after her 2nd dose of vaccine.

Other Meds: Protonix prn, Ambien prn, +50 multivitamin gummy

Current Illness: no

ID: 1274347
Sex: F
Age: 31
State: OR

Vax Date: 04/10/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: latex

Symptom List: Injection site pain, Menorrhagia

Symptoms: On the 28th of April, 18 days from the shot, I went for a walk and came home around 6:30 p.m. to the outside of my right calf bright red and hot. I went to the ER where an ultrasound was performed and they found a DVT blood clot. I am now on an anticoagulant, Xarelto and have an appointment with my doctor on the 5th to schedule more imaging and blood work.

Other Meds: Sulcrafate, pantraprazoale, ativan, armour thyroid, digestize enzyme, neem plus, berberine complex, doterra LLV vitamins & supplements

Current Illness:

ID: 1274349
Sex: F
Age: 24
State: CA

Vax Date: 03/25/2021
Onset Date: 04/01/2021
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:

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

Symptoms: 2 weeks or so after the second dose I had a very light 5 or so days of menstrual bleeding in the middle of my cycle. My cycles are between 35 and 40 days, so this was strange. I had the copper IUD put in in December so my body is still adjusting and I have very heavy periods. I have recently started my normal period afterward. The only change otherwise was receiving the 2nd dose of Pfizer.

Other Meds: Multivitamins, daily allergy relief. Uqora urinary health supplements.

Current Illness:

ID: 1274350
Sex: F
Age: 72
State: FL

Vax Date: 02/11/2021
Onset Date: 04/02/2021
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: Hypopaque

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever, chills, fatigue, nausea, severe joint inflammation from the neck to all joints, down to the feet, elbows and wrists

Other Meds: Pravastatin 40 mg daily, multivitamins, vit E, vit C, Airborne, D3, Lysine , Flaxseed, Lecithen, Zinc, Tumeric

Current Illness: None

ID: 1274351
Sex: F
Age: 60
State: GA

Vax Date: 04/27/2021
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: RA

Lab Data:

Allergies: penicillins,latex

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: my face started getting numb and my arms,legs and face feel heavy and tingly. The heaviness went away yesterday. My whole face feels numb. The patient is a 60 year old female who presents for preventive health care. Preventive health care scheduled includes other. Note: denies slurred speech/facial weakness. denies cp/sob/edema/rashes/anaphaltic reaction headache resolved.

Other Meds: NIFEdipine ER (60MG Tablet ER 24HR, 1 Oral daily, Taken starting 12/04/2020) Active. Cymbalta (60MG Capsule DR Part, 1 Oral daily, Taken starting 10/16/2020) Active.

Current Illness:

ID: 1274352
Sex: F
Age: 17
State: CA

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:

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

Symptoms: Headache (4/10). Fear of needles, with history of fainting. O2 sat 100%. BP 91/74 (pulse 63).

Other Meds:

Current Illness:

ID: 1274353
Sex: F
Age: 36
State: TX

Vax Date: 04/01/2021
Onset Date: 04/23/2021
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: Nickel

Symptom List: Nausea

Symptoms: Severe itching/burning over entire body that is still ongoing and taking medication for

Other Meds: Wellbutrin Zoloft Claritin d ibuprofen Tylenol magnesium

Current Illness: None

ID: 1274354
Sex: F
Age: 71
State: CA

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: 2nd dose of Moderna COVID Vaccine administered 21 days after 1st dose to prevent wastage of expiring doses. No adverse reactions noted.

Other Meds:

Current Illness:

ID: 1274355
Sex: M
Age: 27
State: MD

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: Lightheaded Seen by onsite EMTs Pt.CAOX3; pale;diaphoretic, initial v/s WNL. Pt. stated relief after lying supine. Once seated patient c/o lightheaded again. Pt. hypotensive at v/s recheck. Recheck 88/54 Pt. remained in supine position for extended observation time. Post orthostatic blood pressure , patient remained WNL, CAOX3 Recorded by Pt. discharged home at 15:15 p.m.

Other Meds:

Current Illness:

ID: 1274356
Sex: F
Age: 52
State: AZ

Vax Date: 01/26/2021
Onset Date: 04/12/2021
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: Cephalexin (not a true allergy, just makes me very ill)

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

Symptoms: Shingles, while currently on the medication that they use to treat Shingles with

Other Meds: Valacyclovir HCL 1 gm, Centrum Women's 50+ multi-vit, Melatonin 10 mg

Current Illness: none

ID: 1274357
Sex: F
Age: 31
State: WA

Vax Date: 04/27/2021
Onset Date: 04/28/2021
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: n/a

Symptom List: Tremor

Symptoms: Soreness of Body, Mild headache, Stomach cramps, Light headedness, Fatigue Tinnitus on left ear Took Tylenol once on 4/26nd once 4/27

Other Meds: Tylenol

Current Illness: none

ID: 1274358
Sex: M
Age: 21
State: NJ

Vax Date: 02/24/2021
Onset Date: 02/26/2021
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: Erythema, Pruritus

Symptoms: Myalgia for ~2 months since getting first dose. Am a college tennis player, but am unable to perform essentially any exercise more intense than a few miles of walking and biking for 10 minutes.

Other Meds:

Current Illness:

ID: 1274359
Sex: F
Age: 20
State: FL

Vax Date: 04/14/2021
Onset Date: 04/22/2021
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: Dyshidrotic Eczema 8 days after vaccination. I have never had a previous eczema reaction in my life before. It began with small red bumps on the palms, then on elbows, then on feet. It would progress slowly day by day. The small red bumps started to look like blisters.

Other Meds:

Current Illness:

ID: 1274360
Sex: F
Age: 20
State: NC

Vax Date: 04/29/2021
Onset Date: 04/30/2021
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:

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

Symptoms: Fever (100.1), nausea, vomiting, fainting (21 hours after vaccine), chills, headache, body ache, sore arm, light headed/dizzy. All symptoms discovered upon waking in morning 21 hours after vaccine. Fainted 15 minutes after waking, Treated with DayQuil and sleep, Symptom length of time unknown since ongoing and treated quickly.

Other Meds: Propranolol, Amitriptyline, Junel fe

Current Illness:

ID: 1274361
Sex: F
Age: 48
State: CA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: Prevacid, Prilosec

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Felt dizzy, nauseous, almost fainted

Other Meds: Trinetellix, fish oil

Current Illness:

ID: 1274362
Sex: F
Age: 35
State: PA

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

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

Lab Data:

Allergies: None

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

Symptoms: I am pregnant and due at the end of July. Immediately following the shot my arm turned red, painful and swollen at the site of the injection. At about 4am I woke up with very rapid heartbeat which I still have possibly to a lesser degree. When I got up around 9 I experienced nausea and violently vomited twice. I have aches and pains and a throbbing migraine for the last 2 hours. My arm is still swollen and painful.

Other Meds: Levothyroxine 125mcg, Escatilopram 10mg and Pink Stork Total Prenatal plus DHA 2 capsuls daily.

Current Illness: No

ID: 1274363
Sex: F
Age: 66
State: OH

Vax Date: 02/16/2021
Onset Date: 02/25/2021
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: None

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

Symptoms: Dose 2 was given before minimum interval. It was given 9 days after the first dose.

Other Meds: None

Current Illness: None

ID: 1274364
Sex: M
Age: 27
State: ID

Vax Date: 04/08/2021
Onset Date: 04/11/2021
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: sulfa

Symptom List: Pain in extremity

Symptoms: Pt experienced malaise, sibjective fever, chills, headaches, and myalgias following vaccination then on 4/11 (3 days post vaccine) experienced sharp chest pains radiating up left side of neck and down bilateral arms. Pt presented to urgent care clinic where EMS was activated for transport to the Emergency Department. Pt was evaluated for STEMI by cardiologist in the ED, cath lab was not recommended and pt was admitted for ealuation of possible myocarditis.

Other Meds: none

Current Illness: none

ID: 1274365
Sex: F
Age: 57
State: PA

Vax Date: 12/21/2020
Onset Date: 12/31/2020
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: NKA

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

Symptoms: Cough Headache New loss of taste or smell Congestion or running nose

Other Meds: LORazepam (ATIVAN) 1 mg tablet olmesartan-hydroCHLOROthiazide (BENICAR HCT) 20-12.5 mg per tablet

Current Illness: NONE

ID: 1274366
Sex: M
Age: 53
State:

Vax Date: 04/26/2021
Onset Date: 04/27/2021
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:

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

Symptoms: Chills followed by fever then aches.

Other Meds:

Current Illness:

Date Died: 04/27/2021

ID: 1274367
Sex: F
Age: 100
State: CT

Vax Date: 04/06/2021
Onset Date: 04/27/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Approximately 1 week after vaccine, patient began shaking /trembling per caregiver and son. Less shaking 2 days before she died. Following vaccination, appetite decreased and then appetite disappeared 2 days before she passed. History of infection in her foot per caregiver. noted to have a blister on her right toe that became purple/ dark color. MD was notified and was started on an antibiotic. Patient was on palliative care due to advanced age and bedridden status. MD - No autopsy was done.

Other Meds: eye drops, "water pill","1/2 a sleeping pill", vitamin - per caregiver who was not at the house during the call.

Current Illness: none

ID: 1274369
Sex: M
Age: 48
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No allergies. Potential allergy to crayfish and scallops. Not sure if true allergy since it is mostly diarrhea and vomiting

Symptom List: Vomiting

Symptoms: Ringing in ears starting 7 hour post dose and still continuing 26 hours later

Other Meds: None

Current Illness: None

ID: 1274370
Sex: F
Age: 50
State: OR

Vax Date: 04/22/2021
Onset Date: 04/26/2021
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: Tightness in chest seems to be subsiding after three days although I can't really take any caffeine/stimulant (which was what I initially blamed) or it comes back again, though it was worse before where I would have to catch my breath.

Other Meds: ritalin (low dose, not daily, and stopped at onset because I initially thought it was the cause)

Current Illness: none

ID: 1274371
Sex: M
Age: 60
State: GA

Vax Date: 04/23/2021
Onset Date: 04/26/2021
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: Cipro and levaquin

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

Symptoms: Recurring hiccups for almost 48 hours straight

Other Meds: Everyday Cialis 5mg; vitamin b12 1000 mcg daily; saw palmetto 160 mg twice daily; hemp extract 25 mg daily; melatonin 10 mg daily; prostagenix 3 times daily

Current Illness: None

ID: 1274372
Sex: F
Age: 49
State: MI

Vax Date: 04/23/2021
Onset Date: 04/23/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Allergies DoxycyclineHives Bactrim [Sulfa Drugs]Rash CiprofloxacinRash CodeineNausea and Vomiting Dilaudid [Hydromorphone]Rash Flagyl [Metronidazole Hcl]Hives Flu Virus Vaccine FluoxetineOther Influenza Vaccines Iv Contrast Opioid AnalgesicsNausea/Vomiting/Diarrhea Tetanus Toxoid AdsorbedOther Tetanus Toxoids

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Went to ED after vaccination reaction - diagnosis: Anaphylaxis CHIEF COMPLAINT: POSSIBLE ALLERGIC REACTION (ptjust had 2nd COVID vaccine. c/o voice changes and changes in swallowing. pt is able to maintain secretions at triage. ) DIAGNOSIS at time of disposition: 1. Anaphylaxis, initial encounter This is a 49-year-old female that presents emergency department 1 hour after receiving her 2nd COVID vaccine (pfizer), and states that she waited her 15 minutes after receiving the shot and felt fine. She then reports that when she got to the car she started feeling some chest tightness a bit of more difficulty with her breathing and felt like her throat was scratchy and a bit tight as well. She has had complications with taking the flu vaccine as well as a tetanus shot. Where she has had rashes then enlarged lymph nodes. But never this reaction. She has never been hospitalized or brought to the ER due to anaphylaxis. She does not use an epinephrine pen at home. Patient states before the shot she was feeling well. She does not have any systemic symptoms like fever, nasal congestion or sore throat. Patient also denies any recent episodes of vomiting or diarrhea. This patient came in the emergency department was concerning signs and symptoms for anaphylaxis. The patient was immediately given a dose of IV Solu-Medrol 125 mg, IV Benadryl 50 mg, and 20 mg of IV Pepcid. Patient was placed on cardiac monitor. I went back to re-evaluate the patient she was feeling significantly improved within a short period of time. Patient was monitored in our emergency department for most 2 hours. Patient's symptoms had resolved. Patient was comfortable being discharged home. Patient has several allergies in her history. Patient was sent home with a prescription for prednisone as well as Pepcid. Patient also given a prescription for an epinephrine pen and told and instructed on how and when to use this. The patient is going to have someone pick her up as she was instructed that the Benadryl can make her very drowsy and a would be rather unsafe to drive. She was going to contact a family member to pick her up. Patient will return if she has any more symptoms

Other Meds: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler azelastine (ASTELIN) 0.1 % nasal spray betamethasone valerate (VALISONE) 0.1 % cream Calcium-Vitamin D-Vitamin K (CALCIUM + D + K PO) CYMBALTA 60 MG delay

Current Illness: NA

ID: 1274373
Sex: F
Age: 50
State: AZ

Vax Date: 01/08/2021
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: unknown

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

Symptoms: COVID-19 illness after receiving dose one and dose 2 of COVID vaccine (Pfizer). On 4/27 developed the following symptoms: cough, headache, sore/scratchy throat, congestion, runny nose, eye pressure, and myalgia. COVID test confirmed COVID-19 infection. Vaccinated with Pfizer COVID vaccine as follows: dose 1 on 12/18/2020, dose 2 on 1/8/2021.

Other Meds: Levothyroxine, estradiol, progesterone, bupropion, loratadine, VD3

Current Illness: n/a

ID: 1274374
Sex: M
Age: 27
State: IN

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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:

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

Symptoms: Patient has history of passing out after vaccines and blood draws. 10 min after vaccine administration patient passed out twice and almost passed out a third time, HR and BP were being monitored and were low. EMS was called when patient was about to pass out for a third time. EMS arrived and recommended patient be transported to hospital via ambulance. Patient refused to go and signed AMA waiver before leaving.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm