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: 1284245
Sex: F
Age: 34
State: PA

Vax Date: 03/20/2021
Onset Date: 04/26/2021
Rec V Date: 05/03/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Menstrual cycle began 2 weeks early (first cycle after 2nd dose). Unknown at this time if it's a permanent cycle change

Other Meds:

Current Illness:

ID: 1284247
Sex: F
Age: 41
State: IL

Vax Date: 03/15/2021
Onset Date: 03/20/2021
Rec V Date: 05/03/2021
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: Delayed menstruation by more than a week, bleeding significantly less than normal.

Other Meds: Zrytec, Benadryl, Ibuprofen, Prenatal Multi-Vitamin, Iron, D3, Magnesium,

Current Illness: None

ID: 1284248
Sex: M
Age: 33
State: VA

Vax Date: 04/30/2021
Onset Date: 05/02/2021
Rec V Date: 05/03/2021
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: A very pointed headache just above my left eyebrow. Has lasted about 2 days. No treatment this far. No further treatment has been followed, waiting for the headache to diminish. Which had begun slightly.

Other Meds: None

Current Illness: None

ID: 1284249
Sex: F
Age: 19
State: NC

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: none reported

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: pt received shot at 14:35. at 14:40, pt reported feeling tingly and was given bottle of water. at 14:44, pt was given benadryl 25mg tablet. 2nd tablet was attempted at approx 15:02pm but unsuccessful (pt couldn't swallow) pt complained of feeling cold, was given blanket and taken outside to sit in warm sunshine. bp strong, as reported by RN. 136/40, pulse 80. pt's lethargy increased and 911 was called at 15:09. epi-pen was adminsitered at 15:11 upon pt unable to open eyes and beginning to drool. caller remained on phone with 911 until medics arrived at 3:16pm. emts assessed pt, loaded onto stretcher & departed approximately 15:30 to hospital.

Other Meds: none reported

Current Illness: none reported

ID: 1284250
Sex: M
Age: 29
State: MI

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Passing out, vomiting, forgot best friend, fever of 102, diarrhea, and loss control of bowels.

Other Meds: None

Current Illness: None

ID: 1284251
Sex: F
Age: 22
State: FL

Vax Date: 04/26/2021
Onset Date: 04/29/2021
Rec V Date: 05/03/2021
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: n/a

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

Symptoms: After the 2nd dose (April 26), on April 29th at 3:00 AM I woke up because I was violently itching my right forearm and my left hand. I had a lot of bumps on my forearm that were itchy and turning red as a result of my itching. My left hand had no bumps but it was completely swollen. My face began to swell at my upper cheeks and around my jaw. The right side of my upper lip swelled up prior to the rest of my face and remained that way. It became difficult to keep my eyes open. This facial swelling lasted for three days and on the third day, my neck began to swell right along with my submandibular lymph nodes. This neck and facial swelling went down on May 2nd after I was advised by a sports medicine staff member to take ibuprofen.

Other Meds: n/a

Current Illness: n/a

Date Died: 04/29/2021

ID: 1284252
Sex: F
Age: 68
State:

Vax Date: 04/20/2021
Onset Date: 04/22/2021
Rec V Date: 05/03/2021
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:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: patient suffered from a massive right ICA stroke on 4/22 (2 days after vaccine). stroke progressed to cerebral edema with evidence of herniation. she was intubated and unfortunately expired. not a neurosurgery candidate due to her age and signs of herniation.

Other Meds:

Current Illness:

ID: 1284255
Sex: F
Age: 37
State: OR

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Pharyngeal swelling

Symptoms: Patient states started having pain and swelling at injection site. The size of a tangerine, hard and raised with a small rash which has continued to grow to about 4 to 5 inches. Rash is itchy and hot. No fever .

Other Meds: unknown

Current Illness: Unknown

ID: 1284256
Sex: M
Age: 64
State: NC

Vax Date: 04/27/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
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: Lump under left arm pit. Lump is about the size of a quarter. Lump is not sore when touch. Lump appears to be shrinking. Noticed the lump 30 Apr 2021. Contacted my Primary Care Physician on 3 May 2021.. Physician stated if the lump gets larger or is sore to touch to go to an Urgent Care or Hospital Emergency

Other Meds:

Current Illness:

ID: 1284257
Sex: M
Age: 40
State: CA

Vax Date: 04/27/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
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: has had a previous vaccine issue which caused him to end up in the icu in the past

Symptom List: Diarrhoea, Nasal congestion

Symptoms: pt reports ringing in his ears that has been occurring intermittently. This started two days after his vaccination (1st dose Moderna). He says that at times it goes away and then comes back. He said that last night the ringing was so bad he was not able to sleep.

Other Meds: N/a

Current Illness: n/a

ID: 1284258
Sex: F
Age: 64
State: CA

Vax Date: 03/11/2021
Onset Date: 03/31/2021
Rec V Date: 05/03/2021
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: Very Large (size of an egg swollen lymph node) came on suddenly 2 1/2 weeks after receiving the vaccine in the same arm. It was located 16 cm from the nipple. Took 10 day antibiotic - relieved the throbbing and decreased somewhat in size but still there. After initial ultrasound a biopsy was insisted upon by all Dr.'s involved. They were very concerned by the looks of the ultra sound images. I insisted on waiting 2 additional weeks. On 4-27 returned for a mammogram and follow up ultra sound. Mammogram was normal and lymph node had decrease 1/2 in size making the Dr.'s agree a biopsy was not needed and most likely the result of the J & J vaccine.

Other Meds: Ginger/Turmeric -- raw juiced

Current Illness:

ID: 1284259
Sex: F
Age: 34
State: MA

Vax Date: 04/23/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
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: penicillin, bactrum

Symptom List: Rash, Urticaria

Symptoms: "covid arm" - A rash developed at the injection site one week after the shot. Redness, inflammation, itchiness, mild discomfort

Other Meds:

Current Illness:

ID: 1284260
Sex: F
Age: 28
State:

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: A few hours after I received the vaccine I started to get a headache that lasted until I went to bed. When I woke up the next morning my head still hurt and my whole body ached. This lasted until I went to bed that night. When I woke up in the morning all symptoms were gone and I felt completely fine.

Other Meds: generic daily allergy pill (for seasonal allergies)

Current Illness:

ID: 1284261
Sex: F
Age: 41
State: PA

Vax Date: 05/02/2021
Onset Date: 05/03/2021
Rec V Date: 05/03/2021
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: Sulfur

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

Symptoms: headache, body pains, fever, chills, nausea - all of them are severe in nature. Started having periods on the same day and before vaccination 5/2/2021. Took 2 Motrin (200mg each) once in the morning and once in the night which provided some relief.

Other Meds: Multivitamins

Current Illness: None

ID: 1284262
Sex: F
Age: 50
State: CA

Vax Date: 04/21/2021
Onset Date: 04/25/2021
Rec V Date: 05/03/2021
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: sulfa

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

Symptoms: late onset dizziness and vertigo. After both shots the dizziness occured 4-5 days later. Its ongoing and inconsistent.

Other Meds: multivitamin, calcium, cbd oil

Current Illness: none

ID: 1284263
Sex: F
Age: 59
State: GA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 05/03/2021
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: Cephlexin, adhesives

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

Symptoms: Lesions over body. Started as small bumps then grew into large patches ones hands, arms and legs. All areas infected have swollen. Can not make fist with right hand

Other Meds: Losartan, diltazem, advair and MegaRed vitamins

Current Illness: None

ID: 1284265
Sex: F
Age: 45
State: IN

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 05/03/2021
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: Upper arm and shoulder has been consistently aching and in pain.

Other Meds: Metformin,

Current Illness: None

ID: 1284266
Sex: F
Age: 39
State: IN

Vax Date: 05/01/2021
Onset Date: 05/03/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Shellfish, ibuprofen, Neutrogena salicylic acid facewash

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Red rash and hard nodule about 3-4 inches long starting a few inches below injection site. Very tender to touch.

Other Meds: Vitamin D supplements, Ipratropium Bromide Nasal Solution

Current Illness: None

ID: 1284267
Sex: F
Age: 52
State: IL

Vax Date: 12/18/2020
Onset Date: 12/19/2020
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, keflex, Ilisone, Bacitra, Reglan, Sulfa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After a couple of weeks of pain at the injection site, the pain began to grow steadily until today it reaches down the top of my right arm, the underside of my right arm, and down my side from my arm pit to below my ribcage. It used to hurt only when I would utilize certain ranges of motion. Now, it hurts on and off regardless of my movements. Sometimes it hurts all the way to my hand. I cannot sleep on my right side anymore and if I accidentally move it in too large of a motion the pain is at a 10.

Other Meds: None

Current Illness: none

ID: 1284268
Sex: F
Age: 18
State: ND

Vax Date: 04/06/2021
Onset Date: 04/12/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Kiwi

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

Symptoms: Was was pain in calf area and having a hard time breathing and very tired.. went to doctor on 4/20/2021 Doctors Diagnosed with Pulmonary Embolism

Other Meds: Escitalopram DEPO-PROVERA IM

Current Illness: None

ID: 1284269
Sex: F
Age: 31
State: WA

Vax Date: 04/22/2021
Onset Date: 04/29/2021
Rec V Date: 05/03/2021
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:

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

Symptoms: Headeache, lost of taste, eye pain, numbness in face, ear pain

Other Meds:

Current Illness:

ID: 1284270
Sex: M
Age: 24
State: TX

Vax Date: 05/02/2021
Onset Date: 05/03/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Unevaluable event

Symptoms: Woke up in the middle of the night, 12 hours after the shot, with uncontrollable chills, nausea, headache, and fever. Had to stay awake from 3am-5am because on the verge of vomiting, but never did. Kept sipping water and took 2 ibuprofen. The symptoms dulled slightly after 5am but had a 100 degree fever all day, along with full body muscle soreness and couldn't leave the couch more than a few times because of moderate nausea, headache, and soreness.

Other Meds: None

Current Illness: None

ID: 1284271
Sex: F
Age: 57
State: AZ

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Patient experienced light fainting, lower blood pressure after getting her vaccine. Patient's vitals were normal, patient was observed for 30 min by EMS. Patient felt fine after 30 min. Patient didn't need any treatment.

Other Meds: None

Current Illness: NONE

ID: 1284272
Sex: F
Age: 64
State: PA

Vax Date: 04/20/2021
Onset Date: 05/01/2021
Rec V Date: 05/03/2021
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: Have Celiac disease. Allergic to Sulfa drug and contrast dye in CT scans; both cause severe hives, itching, agitation. Can eat shrimp, but cannot clean it-break out in hives. Allergic to garlic. Lactose intolerant. Allergies-grass, trees, dust mites, pollen, smoke, dander.

Symptom List: Injection site pain, Pain

Symptoms: Red rash appeared on Saturday, May 1, after receiving shot on April 20. Rash-red area 2-3 inches long, itchy at times. Shot location is sore

Other Meds: Citalopram HBR 5m daily; Pantoprazole sodium delayed release tablets, USP 40mg daily; Systane Balance twice daily each eye; Vitamin D & B complex; Tums as needed; Sudafed PE as needed; Fexofenadine hydrochloride tab 180mg daily

Current Illness: Celiac disease

ID: 1284273
Sex: M
Age: 68
State: PA

Vax Date: 04/16/2021
Onset Date: 04/26/2021
Rec V Date: 05/03/2021
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: Injection site pain, Menorrhagia

Symptoms: significant hair loss in patches Started shortly after the first shot, got much worse after the second dose.

Other Meds: none

Current Illness: none

ID: 1284275
Sex: M
Age: 45
State: CO

Vax Date: 05/02/2021
Onset Date: 05/02/2021
Rec V Date: 05/03/2021
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: None

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

Symptoms: Dizziness within 20 minutes of vaccine that lasted the remainder of the day. Woke up with a fever (101.2), chills, severe muscle aches, headache. Now over 24 hours later the symptoms are worse. He?s been sleeping all day. He has had Advil.

Other Meds: Multivitamin Citalopram Prilosec

Current Illness: No

ID: 1284276
Sex: F
Age: 39
State: AZ

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 05/03/2021
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: VICODINE

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: FEVER, CHILLS, BODY ACHE, NAUSEA, VOMITING,

Other Meds: N/A

Current Illness: N/A

ID: 1284278
Sex: F
Age: 61
State: CT

Vax Date: 03/02/2021
Onset Date: 03/30/2021
Rec V Date: 05/03/2021
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 known.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Ears ringing, both ears, noticed after 2nd dose when had fever for 36 h following dose.

Other Meds: Sentra multivitamin (silver, for women)

Current Illness: None.

ID: 1284279
Sex: M
Age: 60
State: NV

Vax Date: 02/23/2021
Onset Date: 02/25/2021
Rec V Date: 05/03/2021
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: I have been experiencing Tinnitus starting approx. 2 days after receiving the second dose.

Other Meds: Lisinopril Omeprazole Claritin

Current Illness: none

ID: 1284280
Sex: M
Age: 55
State: NM

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Augmentin Wellbutrin Latex Peanut Banana Tomato

Symptom List: Nausea

Symptoms: Shortness of breath Itchy all over Diarrhea the next afternoon Definitely an allergic reaction

Other Meds: Amlodipine Aripiprazole Atorvastatin Azelastine B Complex Buspirone HCL Co Q-10 Cyclobenzaprene Duloxetine HCL Fluticasone Propionate Ibuprofen Ipratropium Bromide Levocetirizine Levothyroxine Losartan Melatonin Meloxicam Metformin Metoprol

Current Illness:

ID: 1284281
Sex: M
Age: 45
State: OR

Vax Date: 04/07/2021
Onset Date: 04/22/2021
Rec V Date: 05/03/2021
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: Injection site pain

Symptoms: Janssen COVID-19 Vaccine EUA Pain started in right shoulder joint, by next morning was in right hip joint. Went to ER, given oxy and toradol, next day, pain was diminished in right but migrated to left shoulder joint, and wrist joints and finger joints of both hands. Minimal swelling in hands. Went to PCP on day 5, prescribed prednisone that helped greatly, pain still present but markedly less. Joint pain now in knee joints also.

Other Meds: Fluticasone, allegra

Current Illness: none

ID: 1284282
Sex: F
Age: 45
State: HI

Vax Date: 04/06/2021
Onset Date: 04/14/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Amoxycillin and drinking alcohol

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

Symptoms: Rashes on the underside of left and right arm, arm pits and below armpits on left and right side of body and slowly spreading to breasts.

Other Meds: Nature's Bounty Extra Strength Hair, Skin & Nails Ginko Biloba 120mg w/ Vinpocetine Wild Alaskan Salmon Oil Omega-3 (1000mg) Calcium Nitrate Magnesium and Zinc w/Vitamin D3

Current Illness: Mild dry patch on hands due to frequent handwashing.

ID: 1284283
Sex: F
Age: 81
State: NC

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Resident did not experience any adverse side effects. No treatment needed

Other Meds:

Current Illness: none

ID: 1284284
Sex: F
Age: 56
State: OH

Vax Date: 03/30/2021
Onset Date: 04/27/2021
Rec V Date: 05/03/2021
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: Tremor

Symptoms: My second shot I had fever for 2 days and swollen lymph node and very hard time swallowing and extremely fatigued

Other Meds: Yes

Current Illness: None

ID: 1284285
Sex: F
Age: 44
State: MA

Vax Date: 04/23/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs, thimersol, fresh tree fruit. (sensitive skin overall)

Symptom List: Erythema, Pruritus

Symptoms: Immediately after vaccine I felt only arm pain through entire arm and neck and hand for a few days, accompanied by a low fever 4 hours after shot that only lasted overnight. 4 days after vaccine my arm felt bet, but still swollen. 7 days after the vaccine I woke up with arm pain through entire arm/hand and into neck. It was as if I just got the shot again, later in the day the injection site turned red and worsened over the next few days. The significant arm pain, site swelling and redness continued for 4 days so far, accompanied by some intermittent flu like feelings too. Tonight the arm is much less red, but still swollen at injection site and whole arm and neck are painful. The symptom that has concerned me most is the pain running from my fingers through my should and neck, it's as if my neck is very stiff and sore. The pain gets worse intermittently, Right now it's noticeable but not at as bad as it can be.

Other Meds: Zyrtec, Nasacort, Multivitamins, fish oil.

Current Illness: Eczema, otherwise none.

ID: 1284286
Sex: F
Age: 17
State: CA

Vax Date: 05/02/2021
Onset Date: 05/02/2021
Rec V Date: 05/03/2021
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: n/a

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

Symptoms: Patient who is 4 months short of 18 years old received Moderna Covid Vaccine indicated for 18 years and older. After administration of vaccine, realised while data entry of the age. Rph immediately contacted the Clinical Team and Pharmacy District Manager and notified them. Right after that, Rph also called the Patient's mom and left a message to call back. Mother called in approximately 30 minutes. I sincerely apologised and told her upfront what had happened and enquired how patient was doing and reasured her that i will contact their Dr first thing monday morning when they opened and keep her updated. She said patient was doing well and asked if she needs to keep their second appointment. I told her i will check with their Dr and our Clinical team and get back to her promptly.Followed up with their Dr and RN on behalf of the Dr and our Clinical team said as per CDC guidelines to give her the second moderna covid shot as scheduled for 5/30/21. Left 2 messages for mom to call us. Will follow up tomorrow.

Other Meds: n/a

Current Illness: n/a

ID: 1284287
Sex: M
Age: 50
State: NY

Vax Date: 04/13/2021
Onset Date: 04/20/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: worsening tinnitus

Other Meds: Gabapentin

Current Illness:

ID: 1284288
Sex: M
Age: 23
State:

Vax Date: 04/29/2021
Onset Date: 05/02/2021
Rec V Date: 05/03/2021
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: Blue dye #1

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I started having Diarrhea and have to pee a lot more. It started yesterday evening and I noticed all day today that I had to pee more often than normal. I had diarrhea 3 times. (My wife got the same vaccine at the same time and has similar symptoms)

Other Meds:

Current Illness:

ID: 1284289
Sex: F
Age: 23
State: KS

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 05/03/2021
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: Seizure.

Other Meds: None

Current Illness: None

ID: 1284290
Sex: M
Age: 50
State: MI

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 05/03/2021
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: mild gluten intolerance

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

Symptoms: High fever for two days. First day could not get out of bed to get water to drink. Followed by half day of moderate fever. One week later very itchy rash appeared on left armpit, left groin and left hand. This was accompanied with slight fever and general weakness. Rah eventually resolved a week after four days of Valacyclovir therapy. The Valacyclovir helped with to reduce the itching. Viral cause of the rash suspected.

Other Meds: Regular Multi-vitamins

Current Illness:

ID: 1284291
Sex: F
Age: 55
State: NY

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/03/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pain in extremity

Symptoms: 4/30-A few hours after injection: left arm soreness and discomfort 5/1-Approximately 12 hours after injection (6:30am): arm soreness plus chills, headache and fast heartbeat/palpitations; did not take any medication as there was no fever (94 degree temp) but side effects improved with rest and sleep and were minor by evening (7pm). 5/2-AM: Arm soreness and occasional sharp pain mid chest (on sternum); side effects improved during the day but worsened in the evening @11pm with arm soreness, headache, fast heartbeat and sharp chest pain through the night. Took Tums and drank magnesium carbonate with L-thiamine but symptoms remained. Slept upright as this seemed to lessen pain. 5/3 - Intermittent chest pain and fast heartbeat throughout day.

Other Meds: Calcium carbonate, magnesium oxide, magnesium carbonate and L-thiamine, D3, multivitamin, iron bisglycinate, hawthorn extract, black cohosh, dong quai extract

Current Illness: N/A

ID: 1284292
Sex: F
Age: 45
State: IN

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
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. Extreme all over muscle pain and soreness. Debilitating. Could not move or get out of bed for 24 hours. Headache still lingering.

Other Meds:

Current Illness:

ID: 1284293
Sex: F
Age: 41
State: MA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/03/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Asked to evaluate patient c/o palpitations after moderna #1 dose. Pt awake and alert, HR 96/min, BP 160/100. ECG - NSR 96/min no acute ST-T changes. Pt rested and observed for 30 min. Palpitations slowly resolved. HR 89, BP 144/100 before leaving clinic. No cp, no sob or dizziness was experienced

Other Meds: Fluticasone nasal, loratadine, Ketotifen ophthalmic

Current Illness: Allergic rhinitis

ID: 1284294
Sex: M
Age: 59
State: CA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 05/03/2021
Hospital: Y

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: Bell?s Palsy/ Valtrex / Prednisone

Other Meds: Carvedilol 12.5 mg

Current Illness: None

ID: 1284295
Sex: M
Age: 16
State: MD

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 05/03/2021
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: NKA

Symptom List: Vomiting

Symptoms: During a 2nd dose mobile clinic for the Moderna vaccine, it was determined that this patient had been vaccinated with his 1st dose of Moderna under the approved age as outlined by the EUA. Patient was 16 at time of first dose administration, turning 17 three days later. Patient had no known adverse reactions to receiving a dose of Moderna, but was not administered a 2nd dose when it was determined that he did not meet the approved age. Patient's pediatrician was notified at time of finding, and had no further guidance.

Other Meds: Unknown

Current Illness: N/A

ID: 1284296
Sex: F
Age: 34
State: OK

Vax Date: 01/06/2021
Onset Date: 02/01/2021
Rec V Date: 05/03/2021
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: Arithromyicyn (emicen)

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Joint pain in my right hip. No treatment at this time. Hoping it would go away.

Other Meds: Thyroid medication Birth control

Current Illness: Day after 2nd vaccine (2nd vaccine occurred on 2/2/21) Sick to stomach Headache Tired Joint pain Continued on Joint pain in my right hip (never had an issue before)

ID: 1284297
Sex: F
Age: 38
State: CA

Vax Date: 01/12/2021
Onset Date: 02/05/2021
Rec V Date: 05/03/2021
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: No

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

Symptoms: Vertigo, extreme fatigue, decreased energy and endurance, weakness in extremities and with walking, bodily shakiness.

Other Meds: CBD OIL intermittently

Current Illness: No

ID: 1284298
Sex: F
Age: 37
State: VA

Vax Date: 05/03/2021
Onset Date: 05/03/2021
Rec V Date: 05/03/2021
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: Amoxicillin Acetaminophen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Muscle aches, headache, earache, Sever chills, loss of appetite, diarrhea

Other Meds: Hibiscus tea

Current Illness:

ID: 1284300
Sex: F
Age: 34
State: MI

Vax Date: 03/15/2021
Onset Date: 03/18/2021
Rec V Date: 05/03/2021
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 drugs

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

Symptoms: I had a rash that started (no pain of any kind) 2/20 faded in and out over a 2 week period- had blood work (all normal) and a biopsy (3/8) with the rash starting to be painful on 3/11. I had my first covid shot (3/15) and the pain only got worse. Boost results were: Henoch-Schonlein Purpura/Acute Leukocytoclastic vasculitis; It?s been bed-ridden pain (and under steroid, tylenol3, gabapentin, & colchicine medicated). Had first full week of minimal to no pain between the weeks of 3/18-3/26. Had 2nd dose on 3/30, and symptoms re-enflamed that night. *note had also had a baby 1/6, a hemorrhage due to retained placenta - had a D&C on 2/12. No way to know what is tied to what but I felt this was important to share

Other Meds: Humira, generic for Pepcid, multivitamin

Current Illness: Humira; Had the start of what was found to be HSP- however it did not get ultra flared up until after the vaccine. Started to heal and then re-enflamed after my second dose.

ID: 1284301
Sex: F
Age: 53
State: FL

Vax Date: 03/09/2021
Onset Date: 03/19/2021
Rec V Date: 05/03/2021
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: Septra

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

Symptoms: Burning rash all over face and ears developed 10 days after second shot, on March 19, 2021. Skin burned, got extremely dry, got very itchy. Symptoms continue to this date.

Other Meds: Certrizine Metformin Phentermine

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm