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: 1275004
Sex: F
Age: 20
State: CA

Vax Date: 04/22/2021
Onset Date: 04/27/2021
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: N/A

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received the vaccine on Thursday, 4/22/21. Patient started having warmth and redness at injection site on Tuesday, 4/27/21. Patient hasn't take any over-the-counter medications. Patient stated the the swelling has increased. Patient stated the pain has stayed the same. Patient reported side effect to pharmacy on Friday, 4/30/21

Other Meds: Kelnor

Current Illness: N/A

ID: 1275005
Sex: F
Age: 31
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: CDC recommended use of this form to report potential vaccination administration error regarding uncertainty whether vaccine was administered subcutaneously or intramuscularly. Patient was supposed to receive second dose Moderna vaccine via intramuscular injection. Vaccine provider was a nursing student under supervision. Provider stated "This is my first time" and "I didn't feel it go in" multiple times and voiced uncertainty about whether vaccine was administered and called over supervisor for assistance. Supervisor examined syringe and stated "The syringe is empty". Puncture mark at injection site is present. Patient is concerned whether possible subcutaneous rather than intramuscular delivery of vaccine will reduce vaccine effectiveness. Patient spoke with CDC on 4/30/21 and CDC recommended reporting here.

Other Meds:

Current Illness:

ID: 1275006
Sex: F
Age: 33
State: CT

Vax Date: 04/27/2021
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: 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: Purple bruises to right thigh x2, 24 hours after first shot and 72 hours after first shot.

Other Meds: None

Current Illness: Common cold

ID: 1275007
Sex: M
Age: 57
State: NY

Vax Date: 03/20/2021
Onset Date: 03/27/2021
Rec V Date: 04/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: patient was fine until a week later when started getting dizzy and throwing up. taken to ER, but didn't tell them had been vaccinated. Couldn't find anything wrong and was sent home after a few days. Went to ER again and this time wife told them he had been vaccinated week before symptoms started. Did brain MRI and found a blood clot. Pt currently in rehab.

Other Meds:

Current Illness:

ID: 1275008
Sex: F
Age: 26
State: PA

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: Tree nuts, peanuts, shellfish, bananas, kiwi, ragweed

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

Symptoms: Headache, pain and soreness at injection site that makes it difficult to move left arm, joint pain in hips and knees, fatigue, overall abdominal pain

Other Meds: Claritin, bupropion, buspar

Current Illness: Gastritis

ID: 1275009
Sex: F
Age: 50
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: NKDA

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

Symptoms: Dizziness and lightheaded. VS wnl except BP- 179/109 Pt was given Clonidine 0.1 mg and BP was checked 20 min later- BP 157/84. Pt stated sxs had resolved after 10 min. Pt was observed for 45 min and was allowed to go home with ER precautions. Husband accompanied pt.

Other Meds: Metformin 1000 mg Levemir 31 un Lisinopril 15mg Steglatro 5 mg Atorvastatin 40 mg Aspirin 81 mg

Current Illness: Uncontrolled DM- Hgb A1C > 14

ID: 1275011
Sex: M
Age: 23
State: CA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: on 4/30/21 at 3:37 Patient received his First dose of Moderna vaccine lot #047B21A 0.5 ml to his left deltoid. Patient stated that he pass out with Any shots. He denies any known alergey with any vaccination . However, after patient received the vaccine, at 3:40 pm he became very pale, diaphoretic, Vs: BP 90/60, Pulse 66, resp 18, o2 sat 97% on room air, patient placed on the floor with his leg Elevated.Immediately patient voiced that he is feeling much better on the floor. At 3:50 Vittal signs rechecked which showed improvement BP 100/70, Pulse 72, resp 18, o2 sat 98% on room air, patient color returned to baseline, no further diaphoresis noted. At 4:00p Patient voiced no further complain. Vs: Bp 120/80, Pulse 72, O2 sat 98% , resp 20. Patient released home accompanied by family member post 30 minutes observation also writer recommended patient to follow with his PCP or if symptom persisted to seek emergency help. He verbalized understanding.

Other Meds: none

Current Illness: none

ID: 1275012
Sex: F
Age: 38
State: CA

Vax Date: 01/04/2021
Onset Date: 01/09/2021
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: none

Symptom List: Pharyngeal swelling

Symptoms: should immobility and pain

Other Meds: levothyroxine

Current Illness: hoshimoto's disease

ID: 1275013
Sex: F
Age: 30
State: CA

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: Mushrooms, Lavender, monocyline, Doxycyline, Contrast Dye

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Within hours of receiving the Covid vaccines, I began experiencing multiple seizures. I also lost the ability to open my right eye for 5-10 minutes. The seizures were also experiences with my first dose on 3-30-21, but as I had had multiple seizures that week, we did not think it caused by the shot. We now know it to be caused by the vaccine, as I had been seizure-free for almost 2 weeks prior to the second shot.

Other Meds: Amitriptyline, Escitalopram, Levetiracetam, Baclofen, Ativan, Magnesium Citrate, b12, Women's Vitamins

Current Illness: None

ID: 1275014
Sex: F
Age: 78
State: CA

Vax Date: 02/20/2021
Onset Date: 02/24/2021
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: Statins, - mycins

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Severe exacerbation of autoimmune symptoms. Ten weeks after shot, still mostly bedridden with very low energy and flu-like symptoms. Increased MCAS symptoms. CCI worse.

Other Meds:

Current Illness: Several auto/neuroimmune illnesses: ME/CFS, MCAS, IBS, fibromyalgia, SIBO CCI (Craniocervical instability) Multiple osteoarthritis

ID: 1275015
Sex: F
Age: 39
State: NC

Vax Date: 04/17/2021
Onset Date: 04/18/2021
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: None

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

Symptoms: The day after the vaccine I experienced the normal flu symptoms that they spoke about but in addition I started having heart palpitations (skipped beats) that have progressively gotten worse over these two weeks. In addition my previously diagnosed Fibromyalgia has flared back with nerve pain, digestive issues, fatigue, joint and muscle pain, palpitations, etc.

Other Meds: BuPROPion XL (150 MG)

Current Illness: None

ID: 1275016
Sex: F
Age: 57
State: OH

Vax Date: 03/31/2021
Onset Date: 04/01/2021
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: My left arm hurt very bad. Within three days , my shoulder was in too much pain to use. It worsened and ached and throbbed with Extreme pain even when not moving it. I could not sleep or use the arm at all. The whole shoulder and arm. It was constant agony red.

Other Meds: Women s multi vitamin; cymbalta.

Current Illness: None

ID: 1275017
Sex: M
Age: 35
State: CA

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: nka

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

Symptoms: 35 y.o. male who received the Janssen Covid-19 Vaccine, Ad26.COV2.S (PF) 0.5 mL IM Susp, Lot 042A21A on 4/30/2021. 4:00-The patient experienced the following reaction(s) during the immediate of observation: After receiving vaccine pt experienced anxiety attack, and was cyanotic in appearance as well as visibly perspiring. Pt c/o feeling hot. 4:05-Patient was treated/managed as follows: Pt brought to treatment area and given water and ice packs. Vs performed: BP-142/70, HR-84, R-17, 02-94-96%. Pt reports feeling better at this time. Pt difficulty swallowing, in no distress. Paramedics arrive on the scene and take second set of VS, transfer of care. Patient given educational material regarding vaccine and advised to continue to self-monitor per the CDC guidance.

Other Meds: none

Current Illness: none

ID: 1275018
Sex: F
Age: 17
State: OR

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: NA

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

Symptoms: on the same day as first dose of covid vaccine, several hours later, patient had first episode of supraventricular tachycardia. Required vagal maneuvers in ambulance to resolve. No longterm sequelae.

Other Meds: NA

Current Illness: NA

ID: 1275019
Sex: M
Age: 62
State: IA

Vax Date: 04/12/2021
Onset Date: 04/23/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Bloody nose x 2, blood blisters inside mouth including tongue, cheek, and lip. These symptoms showed up on 04/23/21. Went to the dentist on 04/24/21 due to having tooth extraction on 03/18/21. Dentist confirmed that had healed completely and recommended getting blood work done. Went to Urgent Care had blood drawn, report showed ZERO platelets. I was sent to ER where they ran a blood test again, platelets were ONE. 2 bags of platelets were infused, that brought platelets to 5. I was then admitted to the hospital and four hours later platelets were down to 2. They infused another 2 bags of platelets. Blood test showed platelets at 10. Four hours later the platelets were down to 4. On 04/25/21 I was diagnosed with ITP and was given an infusion of IVIG, on 04/26/21 my platelets were up to 16. They infused another IVIG on 04/26/21 and on 04/27/21 platelets were at 41. I was discharged on 04/27/21. Went to clinic on 04/29/21 and platelets were at 130.

Other Meds: Fiber Gummies Baby Aspirin

Current Illness: None

ID: 1275020
Sex: M
Age: 49
State: CA

Vax Date: 04/07/2021
Onset Date: 04/08/2021
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 known allergies

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

Symptoms: Dyspnea and mild chest wall pain since 2nd vaccine.

Other Meds: Nystatin/Triamcinolone ointment atorvastatin sertraline

Current Illness:

ID: 1275021
Sex: F
Age: 17
State: MD

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: Patient presented to the vaccine to receive COVID 19 vaccine. The patient was given the Moderna brand of the COVID 19 vaccine which is only approved for patients 18 years of age and older. No adverse event occurred during the 15 minutes post vaccination waiting perioid.

Other Meds:

Current Illness:

ID: 1275022
Sex: F
Age: 59
State: IL

Vax Date: 03/26/2021
Onset Date: 03/26/2021
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: Latex, adhesives, Penicillin, Amoxicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: The site of my joint replacement on my left hand/arm became quite weak, painful, and went backwards in strength and healing. Was coming back to where it had been when I received my 2nd vaccine on 4/23/21. Same weakness and pain occurred and am working to strengthen and aleve pain to where it was in March.

Other Meds: Claritin D, Lisinopril, Naproxin, Multi-vitamin, Orange Burps, Garlique, Osteo-Bi Flex, D3, Airborne, Tylenol

Current Illness: 9/17/20 Right thumb joint and 12/17/20 left thumb joints were replaced with my own tendon to form new joint.

ID: 1275024
Sex: M
Age: 42
State:

Vax Date: 04/29/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Woke up that night with excessive tinnitus that is continuing 18 hours later (now 27 hours after injection). It is constant and loud enough that I am having great difficulty hearing people speak, listening to radio at normal volumes (it must be very loud to be heard over the tinnitus)

Other Meds: sertraline buproprion testosterone gel generic multivitamin

Current Illness: none

ID: 1275025
Sex: F
Age: 58
State: CA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
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: Chills, sweats, headache, fatigue, loss of appetite, body aches.

Other Meds: Levoxyl Valsaartan Vit D Probiotic Estradiol Ashwagandha

Current Illness: None

ID: 1275026
Sex: F
Age: 27
State: GA

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

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

Symptoms: Patient presented to the pharmacy with a fine red rash on her lower back on the right side and on the right side of her face. She was vaccinated in her left arm. Patient was not sure if this was related to the vaccine. She noticed it the morning after vaccination and suspected it could have been poison ivy as her husband had given her a back rub the night before. She was advised to apply hydrocortisone cream for itching, she could apply ice for swelling. She was advised that if it got worse or she developed any other symptoms to please seek medical attention.

Other Meds: Lyrica, tizanidine

Current Illness: none

ID: 1275027
Sex: F
Age: 32
State: CA

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: novocaine

Symptom List: Unevaluable event

Symptoms: 32 year old female with 2nd Moderna dose 4/27/21. Left arm is hurting and skin is peeling with some bruises. Very difficult to move arm. Nothing tried for treatment so far. No similar reaction from first dose, just mild injection site pain. Unsure if feverish, doesn't feel great, but not all the way sick.

Other Meds: cabergoline 0.5 mg tabs, 0.5 tabs PO, once a week sumatriptan succinate 25 mg tabs, 1 tab PO QD, can repeat a dose in 2 hours if needed as needed for migraine headache Zoloft 25 mg PO qday trazodone 100 mg PO qhs as needed for insomnia

Current Illness: none

ID: 1275028
Sex: F
Age: 25
State: CT

Vax Date: 04/29/2021
Onset Date: 04/30/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Stiff neck, neck pain

Other Meds: None

Current Illness: None

ID: 1275029
Sex: F
Age: 50
State: CA

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: tingling in back of tongue approximately 30 minutes after injection, resolved on its own at approximately 90 minutes after injection

Other Meds: none

Current Illness: none

ID: 1275030
Sex: F
Age: 71
State: CA

Vax Date: 03/06/2021
Onset Date: 04/11/2021
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: Soy sensitive

Symptom List: Injection site pain, Menorrhagia

Symptoms: Red, itchy, bumpy rash on inner right elbow; subsided after a week

Other Meds: Losartan Potassium 100 mg; Atorvastatin 20 mg; Omeprazole DR 40 mg; Amlodipine Besylate 5 mg; Monetelkast Sod 10 mg; Escitalopram 10 mg; Pregabalin CV 25 mg

Current Illness: Asthma

ID: 1275031
Sex: F
Age: 56
State: FL

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: For 48 hours: fatigue, headache, muscle pain, chills, nausea, diarrhea, pain in injection arm, pain and swelling of lymph nodes under both arms and in neck, fever of 101-102.4 for the first 24 hours then fever of 100-101 for second 24 hours.

Other Meds: Lisinopril/HCTZ 20mg/12.5mg, Atorvastatin 20 mg, Aspirin 81 mg, Multi Vitamin

Current Illness: None

ID: 1275032
Sex: M
Age: 32
State: NY

Vax Date: 04/30/2021
Onset Date: 04/30/2021
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: Hives, angioedema. Pt sent to ED for monitoring. Vaccine 1st dose at 12:30 pm. Hives began 7 pm.

Other Meds: None

Current Illness: None

ID: 1275033
Sex: M
Age: 63
State: OH

Vax Date: 04/03/2021
Onset Date: 04/10/2021
Rec V Date: 04/30/2021
Hospital: Y

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

Lab Data:

Allergies: None at that time

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 4-3-21- received my first covid 19 shot 4-10-21 went to have foot blister examined- they admitted me and started an IV of Vancomycin which sent me into anaphylaxis and this stopped my heart. I required cpr, defibrillator to get things going again. I was on life support for the better part of 4 days and then finally come back

Other Meds: Metformin, Januvia, Lipitor, Lisinipril, Glipizide, Aspirin

Current Illness: None

ID: 1275034
Sex: F
Age: 61
State: AL

Vax Date: 04/22/2021
Onset Date: 04/30/2021
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: None

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

Symptoms: Today I had a rash on my leg. My doctor, told me to use Impoyz cream, twice a day for 10 days then call if not better.

Other Meds: Carvedilol 3.125 mg one pill once a day, Vitamin D3 5000 iu one pill once a day, Centrum Silver for women over 50, Citracal Calcium 630 mg 2 tablets twice daily.

Current Illness: None

ID: 1275035
Sex: F
Age: 27
State: NY

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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Breastfeeding 8 week old baby had a fever one day after maternal vaccination

Other Meds:

Current Illness:

ID: 1275036
Sex: F
Age: 54
State: CA

Vax Date: 04/02/2021
Onset Date: 04/03/2021
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: Penicillin

Symptom List: Injection site pain

Symptoms: >24 hours after 1st dose onset of a bulletin ous rash over legs and trunk as well as lip swelling and tingling; no SOB, nausea, altered mental status or dizziness

Other Meds: None

Current Illness: None

ID: 1275038
Sex: F
Age: 51
State: GA

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

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

Symptoms: After receiving the shot, I was directed to the 30-minute wait section because I disclosed that I am highly allergic to sulfa. About 2 minutes after sitting down, I started having difficulty breathing and became very dizzy. It was if I could literally feel the vaccine rush through my body and even down into my legs. It felt like heat in my legs. I wanted to remove my mask to try to breathe, but I knew I should not. I am a single parent and my child was at home attending remote school so I was thinking I did not want to go to the hospital. I instantly prayed and paced my breathing as I struggled and began to sweat. I began slowly moving my legs because I started thinking about the J&J blood clot issues and prayed more. The ladies monitoring the section were at the front of my section and I was in the very back, so I could not alert anyone. I struggled and prayed about 10 minutes until my breathing improved (through prayer), but I was still dizzy. I sat there over 30 minutes because I was fearful to stand. I finally got up, but was still dizzy and lethargic. I called my mother and sat in my truck in the parking lot for another 30 minutes because I was not capable of driving. For approximately one week, I had tempered breathing, was very nauseous, fatigued, and lethargic. Interesting enough, I had only minor pain in my arm.

Other Meds: Synthroid

Current Illness: Allergies (dust mites, grass, trees)

ID: 1275039
Sex: F
Age: 22
State: NC

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Appearance of hives on my left thigh

Other Meds:

Current Illness:

ID: 1275040
Sex: F
Age: 79
State: MI

Vax Date: 02/05/2021
Onset Date: 02/07/2021
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: dairy

Symptom List: Tremor

Symptoms: Less than 48hrs after the shot I had a big red blotch on my cheek. By Sunday morning I look like I had a bad case of the measles. It is only on my face and down my chin. I check into what I had eaten or touched but I did nothing out of the ordinary. My doctor did not what to do. So on this day of April 30 I still see nothing changed. Please help me.

Other Meds: pravastatin,amiodaroneklor-kon, gabapentin,vitamin for women over50

Current Illness: none

ID: 1275041
Sex: F
Age: 54
State: OR

Vax Date: 04/26/2021
Onset Date: 04/26/2021
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: Very mild reaction (throat itchiness) after eating walnuts

Symptom List: Erythema, Pruritus

Symptoms: 4/26; 6pm - 4/27; 12am: mild aches, fatigue, and mild chills 4/27; 12am - 6pm: extreme chills, extreme all-over body aches, nerve pain, myalgia, severe headache, weakness and fatigue, confusion and disorientation, high fever 103 - 104 4/27; 6pm: fever got as high as 106.2 - Treated with ice packs and ice water and went to ER 4/27; 6pm - 9 pm: fever and other symptoms lessened, and continue to lessen now, 4/30

Other Meds: Acyclovir, ceterizine, escitalopram, carbonyl iron, fluticasone, hydrochlorothiazide, omeprazole, Pulmicort flexhaler

Current Illness: None.

ID: 1275042
Sex: F
Age: 45
State: MD

Vax Date: 04/01/2021
Onset Date: 04/01/2021
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: Fever for 15 hours. Chills, aches, nausea, and fatigue. Injection sight red warm and itchy.

Other Meds: Rosuvastatin 5mg

Current Illness: Covid

ID: 1275043
Sex: F
Age: 19
State:

Vax Date: 04/26/2021
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: no

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

Symptoms: 48 hours after vaccine, patient began feeling very ill. She went to bed and did not feel like doing anything. She developed a rash on both arms, breasts, and left leg. On the same arm as the vaccine, she had a huge bruse with a welp around it, but the bruise and welp were on the under side of her arm. Patient went to walk in clinic then to ER. They gave her a steroid shot, and prescribed oral and topical benadryl and a steroid pack. As of 4/29, the patient was improving.

Other Meds:

Current Illness:

ID: 1275044
Sex: M
Age: 32
State: CA

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient received second dose Moderna at day 21 vs 28 day

Other Meds:

Current Illness:

ID: 1275045
Sex: M
Age: 24
State: NC

Vax Date: 04/11/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: blood in stool

Other Meds: vitamin d, sertraline

Current Illness:

ID: 1275047
Sex: M
Age: 69
State: NY

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 04/30/2021
Hospital: Y

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: About 6 ? 7 days w/ side effects ? Significant Malaise, tiredness. Unable to function or concentrate. Likely a "self inflicted" situation by unknowingly sitting in chair in a daze ultimately developing blood clots (pulmonary edema), blood clots in legs, leading to mild heart attack, hospitalization. I believe there may be a direct connection to a medical procedure (vedolizumab (Entyvio) 300 mg intravenously infusion) that preceded the vaccination on the previous Friday (2/19/21).

Other Meds: ascorbic acid (vitamin C) (Vitamin C) 500 mg orally daily calcium carbonate 260 mg calcium orally daily (648 mg) dutasteride (Avodart) 0.5 mg orally daily ferrous sulfate 140 mg orally daily (45 mg iron) multivitamin 1 tab orally daily pred

Current Illness: Tooth Abscess

Date Died: 04/15/2021

ID: 1275048
Sex: M
Age: 75
State: TX

Vax Date: 03/08/2021
Onset Date: 03/17/2021
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: He was allergic to an antibiotic called biaxin

Symptom List: Pain in extremity

Symptoms: Patient was a healthy 75 year old male when he got the shot. Within 5 hours, he began to feel TIRED, which was an expected side effect. He felt tired for several days. Nine days later he went to Memorial Hermann ER in Kingwood, and they said he had pneumonia. They also said he had a "small mass" at the bottom of his lung and might want to get it checked out. On March 20, he developed a cough. On March 21 we went to a different ER and a CT scan showed he had plureal effusion. On the next day he was short winded. He went back to the ER and they admitted him and transferred him to hospital by ambulance. On March 23, 1.7 liters of fluid was drained from his lung and sent to be tested. On March 26 he was diagnosed with malignant plureal effusion. He passed out at the doctor office and tranferred to to another facility by ambulance. He remained there for 4 days for tests, and a port was put in to drain the fluid. On March 29 he was transferred . They repeated many tests and did a bronchoscopy. On April 1 they told him he had squamous cell carcinoma. He came home on April 2. The doctor called and said they made a mistake he had small cell carcinoma. He remained home until April 11, when he was taken back to by ambulance. He had gone from a healthy appearing individual on March 17 to a critically ill individual and he died on April 15. Doctors had never seen cancer overtake a man in 28 days. 28 days!!!! On March 22, he had a small mass at the bottom of his lung, and one week later, it was a mass so large, his lung could not be seen and his lung had collapsed. Doctors assumed that the cancer was dormant and that the vaccine did something to wake it. It attacked my husband with a vengeance. He never smoked.

Other Meds: Patient had successfully managed heart disease and diabetes for 3 decades and he took medications for those conditions. His A1C was 6.2. He had just had blood work done on Feb 22, which showed nothing wrong. Patient took amlodipine, metro

Current Illness: Patient had NO illness at the time of the vaccination. He was active with our family and we had just had a family birthday party.

ID: 1275049
Sex: M
Age: 42
State: CA

Vax Date: 03/31/2021
Onset Date: 04/11/2021
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: None

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

Symptoms: Noticed a small spherical lump near collarbone possibly lymph node, no pain, no treatment. Will monitor over time.

Other Meds: None

Current Illness: None

ID: 1275050
Sex: F
Age: 46
State: TX

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: Melon

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

Symptoms: Day 1 99.8 fever at 6:30. , Day 2 101.4 fever with meds, chilly, body ache fatigue, headache, rash on arm and leg. Day3: same as day 2. Day 4: blisters in my mouth and throat, the skin on the roof of my mouth peeled off, headache, nausea,, diarrhea , joint painDay 5, 6, 7 same. Day 8 Blisters in ears and throat blisters start to pop. Severe diarrhea, severe abdominal cramping, severe nausea, -Day 9, 10, 11 Diarrhea ends, severe abdominal cramping, joint pain still bad, short of breath, random severe sharp headache, random severe sharp arm pain. Blood oxygen dips to 94 occasionally. Occasional nausea.day 12: mild nausea, occasional severe cramping, joint pain, occasional sharp pain in head, occasional heaviness in lungs, slight congestion.

Other Meds: Adderall, and benadryl

Current Illness: None

ID: 1275051
Sex: F
Age: 44
State: CT

Vax Date: 04/01/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Within minutes of receiving injection lips tingled. Face became numb (lips, cheeks, nose). Some difficulty swallowing (discomfort in throat and Eustachian tube). Numbness dissipated after 2 hours. Throat/ear discomfort completely dissipated within 8 hours.

Other Meds: None

Current Illness: None

ID: 1275052
Sex: F
Age: 38
State: VA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: None

Symptom List: Vomiting

Symptoms: Period was due April 1st but it was 11 days late. (Period usually comes every 30 days give or take a day).

Other Meds: Vitamin d, multivitamin, biotin, d-mannose, viviscal

Current Illness: None

ID: 1275053
Sex: M
Age: 36
State: VT

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: light headed, dizziness, sweating, anxious, vision blur saw yellow, had him sit extra 15 minutes until felt better took temperature - low registered 95, drank juice had a granola bar , stayed seated until felt better was with friend who was able to help when left temperature was at 96

Other Meds:

Current Illness:

ID: 1275055
Sex: F
Age: 33
State: PA

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: RA

Lab Data:

Allergies:

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

Symptoms: Chest tightness started 14 hours after injection. Continued to hurt 24 hours later, low grade fever, severe nausea, headache, sore arm, fatigue

Other Meds:

Current Illness:

ID: 1275056
Sex: F
Age: 44
State: MI

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none to knowledge

Symptom List: Injection site swelling, Limb discomfort

Symptoms: covid arm, swelling, soreness hot to touch at injection site, tingling in left hand

Other Meds: zyrtec, vitafusion calcium + D3 gummy (2 per day)

Current Illness: none

ID: 1275057
Sex: F
Age: 23
State: OH

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: RA

Lab Data:

Allergies: none reported

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

Symptoms: About 5 minutes after vaccine, pt stated she was not feeling well, felt lightheaded and sweaty. Pt appeared pale. Applied cool wet paper towels to pt's neck and forehead, had her take deep breaths. Started to also feel nauseated. Then had her lay on exam table for a few minutes. Pt started feeling better and sat up for a few minutes. Further monitored pt for a total of 30 minutes from the time she said she did not feel well. Pt recovered, color back in face, was able to walk out of clinic area without assistance.

Other Meds: unknown

Current Illness: unknown

ID: 1275058
Sex: F
Age: 31
State:

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 left facility and returned after having left with complaints of tingling of mouth/throat. Patient developed cough and stridor. Epinephrine was administered and patient was transferred via EMS to ER

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm