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: 1286138
Sex: F
Age: 0
State: IL

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: After first dose of moderna was administered patient got up to sit in waiting area. She began to complain of not being able to see and said that she could only see black. She then said that she could not hear anything. She became sweaty and felt faint. We had her lie down and called 911. She got better by the time EMS arrived and was not transported to the hospital.

Other Meds: n/a

Current Illness: n/a

ID: 1286139
Sex: F
Age: 44
State: ME

Vax Date: 04/09/2021
Onset Date: 04/18/2021
Rec V Date: 05/04/2021
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: pennicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: serious hives from neck to groin area, including both arms and itchy hands.

Other Meds: Levothyroxin, vit B12

Current Illness: no

ID: 1286140
Sex: F
Age: 35
State: IL

Vax Date: 04/26/2021
Onset Date: 04/29/2021
Rec V Date: 05/04/2021
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: Swelling in the left eye lid. This happened after my first shot as well. About 3-4 days after.

Other Meds: birth control, probiotics

Current Illness: None

ID: 1286142
Sex: F
Age: 61
State: GA

Vax Date: 04/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/04/2021
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 began having symptoms the day she went to hospital and was diagnosed (per patient), of Bells Palsy of the right side of face.

Other Meds:

Current Illness:

ID: 1286143
Sex: M
Age: 58
State: PA

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/04/2021
Hospital:

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

Lab Data:

Allergies: Allergies No Known Allergies

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

Symptoms: respiratory illness Cough - benzonatate (TESSALON PERLES) 100 mg capsule; Take 2 capsules (200 mg total) by mouth 3 (three) times a day as needed for cough for up to 7 days Increase fluids. Can honey and honey tea as needed. Can use OTC allergy medications like Claritin, Zyrtec and Allegra as needed. OTC Tylenol or ibuprofen for fever, discomfort. Recommended saltwater gargles, nasal saline sprays, humidifier and vapor rub at night. If symptoms persist without improvement over the next 2-3 days despite above treatment, follow-up with PCP for further evaluation.

Other Meds: predniSONE (DELTASONE) 10 mg tablet triamcinolone (KENALOG) 0.5 % ointment

Current Illness: None

Date Died: 04/23/2021

ID: 1286144
Sex: M
Age: 49
State: NY

Vax Date: 04/21/2021
Onset Date: 04/23/2021
Rec V Date: 05/04/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Shortness of breath followed by sudden collapse followed by death.

Other Meds: Doxepin, Gabapentin, Lamotragine, Methocardimal, Resperidone

Current Illness:

ID: 1286145
Sex: F
Age: 37
State: OH

Vax Date: 04/14/2021
Onset Date: 04/17/2021
Rec V Date: 05/04/2021
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: Macrobid Benadryl

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient reports usual reactions six hours after vaccine (body aches, chills, fever of 103). These resolved after 48 hours with the aid of ibuprofen and Tylenol. On Saturday, April 17,2021; she was awakened with a piercing headache on the top of the right side of her head and radiating to her right eye. She was seen in the ED at Hospital on 04/28/2021 for the headache that would not subside. She was seen again on 05/04/2021 for fainting with the headache. The ED physician has asked for a VAERS report since the headache has not resolved and is worsening.

Other Meds: None

Current Illness: None

ID: 1286146
Sex: F
Age: 45
State: OR

Vax Date: 04/04/2021
Onset Date: 04/19/2021
Rec V Date: 05/04/2021
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: My mentral cycle is 8 days late as of today. My cycle is regular and this is a new occurance.

Other Meds: melatonin 1mg as needed, sertraline 100 mg nightly

Current Illness: none

ID: 1286147
Sex: M
Age: 31
State: NJ

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Shortly after the administering the vaccine the person tensed up and became unresponsive. He appeared to be having a seizure. I was able to get the patient to the floor and he became responsive. He said he "was ok". We had contacted EMS. We had the patient lie flat until the EMT's arrived. He was very sweaty and tired but he insisted he was fine. He refused to go to the ER and he was able to get a ride home.

Other Meds: unknown

Current Illness: None

ID: 1286148
Sex: M
Age: 20
State: MI

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: nkda

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine administered too early. 1st dose = 4.24.21; 2nd dose = 5.4.21. Patient received 2nd dose of Pfizer vaccine too early on 5/4/21. Per MCIR, he received his first dose at Kroger on 4/24/21. This was not recognized until patient had received his vaccine already.

Other Meds: sertraline

Current Illness: na

ID: 1286149
Sex: F
Age: 17
State: SC

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

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

Lab Data:

Allergies: NA

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

Symptoms: Patient is 17 years and 8 months (not 18 years of age as required for Moderna vaccine). No adverse reaction.

Other Meds: NA

Current Illness: NA

ID: 1286150
Sex: F
Age: 66
State: CA

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

Symptom List: Rash, Urticaria

Symptoms: Patient to the ED with c/o numbness of his face, buttocks with breakout of Shingles shortly after Vaccine. Patient received Vaccine on 4/22/2021 and broke out and just recovering from Shingles.

Other Meds: Albuterol Inhaler

Current Illness: Hx COPD

ID: 1286151
Sex: F
Age: 80
State: NE

Vax Date: 04/12/2021
Onset Date: 04/17/2021
Rec V Date: 05/04/2021
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: NSAIDS, lisinopril, losartan, phenylephrine, celecoxib, naproxen, nickel

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

Symptoms: Severe thrombocytopenia developing 1 week after 1st Moderna vaccine. Pt got first vaccine April 12 or 14 (she can't remember which) and is due for her next May 10 or 12 (though she is not getting this dose per Hem/onc note). Plt down to 3K (from 258K on 3/29/21). This has required 2 hospitalizations with multiple transfusions, bone marrow bx, high levels O2. She is currently in the hospital and her oncologist noted on 5/4/21: "this is covid vaccine related until proven otherwise (she got her 1st Moderna shot one week before plts plummeted); would not get 2nd dose; should be reported to VAERS."

Other Meds: Prlia, tylenol, albuterol inhaler, ASA, lipitor, Vit D, CoQ10, B12, decadron, glucosamine, synthroid, lutein, prilosec, GInseng complex, vesicare, tagrisso

Current Illness: None

ID: 1286152
Sex: F
Age: 52
State:

Vax Date: 01/21/2021
Onset Date: 04/26/2021
Rec V Date: 05/04/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: I63.511 - Acute ischemic right MCA stroke R53.1 - Left-sided weakness G51.0 - Facial paralysis on left side I63.9 - Stroke determined by clinical assessment I63.411 - Cerebral infarction due to embolism of right middle cerebral artery

Other Meds:

Current Illness:

ID: 1286153
Sex: F
Age: 67
State: AZ

Vax Date: 02/17/2021
Onset Date: 02/27/2021
Rec V Date: 05/04/2021
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: PENICILLIN propylene glycol

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

Symptoms: Random hives appearing on most parts of my body. A few pop up each day and then resolve in a day or two and then more pop up every day since now for the past 7 weeks or so.

Other Meds: MULTI VITAMINS

Current Illness: N/A

ID: 1286154
Sex: F
Age: 54
State:

Vax Date: 04/14/2021
Onset Date: 04/20/2021
Rec V Date: 05/04/2021
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: Ibuprofen, naproxen, advil, iodine, penicillin, sulfa antibiotics

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

Symptoms: Chronic epistaxis approximately 6 days after receiving vaccine. She is currently on Coumadin therapy and her INR is normal.

Other Meds: Coumadin, gabapentin

Current Illness:

ID: 1286155
Sex: F
Age: 57
State: CA

Vax Date: 04/23/2021
Onset Date: 05/03/2021
Rec V Date: 05/04/2021
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: patient called in pharmacy 11:35 am on 5/4/21 and told that she had gotten seizures 2 times yesterday night on 5/3/21 at 9pm and 10:30pm. she went to ER and got injection. she will see neurologist to check overall. she states she missed seizure meds few times recently.

Other Meds: LAMICTAL 200MG, 1 BID TOPAMAX 200MG ,1 BID KEPPRA 750 MG, 1 BID VENLAFAXINE 37.5ML, 1 QD

Current Illness:

ID: 1286156
Sex: F
Age: 59
State: OR

Vax Date: 01/12/2021
Onset Date: 02/01/2021
Rec V Date: 05/04/2021
Hospital:

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

Lab Data:

Allergies: SHRIMP

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Face feeling cold and nostril pain have become more sensitive to certain food consumption, such as, lime/lemon, honey and certain vegetables (Bok chow, green mustard and etc). Watchful of food type consumption and result is the same.

Other Meds: PRESCRIPTION: GABAPENTIN

Current Illness: TRIGEMINAL NEURALGIA AND HIGH BLOOD PRESSURE

ID: 1286157
Sex: M
Age: 62
State: MI

Vax Date: 04/08/2021
Onset Date: 05/03/2021
Rec V Date: 05/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Possible breakthrough COVID infection. The patient tested positive, asymptomatically, on 5/3/2021. He received two doses of the COVID vaccine on 3/11/21 and 4/8/21. He states that members of his household tested positive for COVID 6 weeks prior to 5/3/21 and he experienced anosmia and sore throat at that time but never got tested to confirm if he had COVID.

Other Meds:

Current Illness:

Date Died: 04/17/2021

ID: 1286158
Sex: F
Age: 75
State: NC

Vax Date: 03/06/2021
Onset Date: 04/16/2021
Rec V Date: 05/04/2021
Hospital:

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

Lab Data:

Allergies: NKMA

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

Symptoms: Pt had an appointment with her cardiologist 4/15/2021 and no changes in patient's health noted states daughter. Patient performed yard work at noon 4/16/2021 and developed chest tightness that was relieved by rest. After patient's nap at noon no more chest discomfort occurred. Patient went to bed that night and husband noted she was sleeping comfortbly with no breathing difficulties at midnight. At 3 am husband found patient cold and she had expired.

Other Meds: Losartin 50mg;Flecainide 100mg;Xarelto 20mg;Atenolol 25mg; Acetaminiophen; Multi-vitamin;Vitamin D3;Vitamin C 500mg; Magnesium Glucinate 400mg; Glucosamine 1500mg; Black Cumin seed oil 1000mg; Garlic extract 1200mg; Fish,Flax and Borage Oil

Current Illness: No acute illness

ID: 1286159
Sex: M
Age: 33
State: TX

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/04/2021
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: Fever, post-nasal drip, cough, burning throat, stuffy head, achiness, fatigued. From Friday morning through Monday afternoon. Starting Monday night the fatigue and fever seemed to go away and it was just the post-nasal drip, cough, and stuffy head through Tuesday.

Other Meds: None

Current Illness: Slight sore throat prior

ID: 1286160
Sex: F
Age: 35
State: TX

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: Unevaluable event

Symptoms: Patient reports feeling slight chest tightness, no other symptoms reported. Patient states she feels fine and will follow up with ER if need be. Cleared by EMS. BP:115/82, pulse :76, Spo2: 98%.

Other Meds:

Current Illness:

ID: 1286161
Sex: F
Age: 16
State: CA

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

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

Symptoms: 03May21-daughter C/O obstruction in throat. upon view, left tonsil is enlarged, red, 'puffy', striated with white patches. Uncomfortable to swallow. slight runny nose, congested voice, puffy eyelids (slight). Went to urgent care, was tested for Mononucleosis and results positive.

Other Meds: birth control pill

Current Illness: Covid19- diagnosed 07april, waited 2 weeks post end of symptoms to vaccinate

ID: 1286162
Sex: F
Age: 35
State: CA

Vax Date: 04/15/2021
Onset Date: 04/17/2021
Rec V Date: 05/04/2021
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: Mango(fruit)

Symptom List: Injection site pain, Pain

Symptoms: I have a lump in my left armpit. The size is about a half-inch. There was nothing before vaccination. I had a little pain for 3 days, but now there is no pain.

Other Meds: N/A

Current Illness: N/A

ID: 1286163
Sex: M
Age: 53
State: CA

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

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

Lab Data:

Allergies: UNKNOWN

Symptom List: Injection site pain, Menorrhagia

Symptoms: Was ?sick? for 9 days after receiving the Covid shot: Doesn't feel right, Covid Brain, felt like back of brain was swelling and shaking and would get a head rush when bending over. Felt like he had radiation in his blood like there was amphetamines in it, ?edgy?, fatigue, sleepy. Denies fever or muscle aches. Went to the ER on 4/4 or 4/11 not for sure on date. They didn't do a COVID test and diagnosed him with depression due to his dog dying and divorce.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1286164
Sex: F
Age: 19
State: MI

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 05/04/2021
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: Extreme pain in left arm : spans from elbow to armpit

Other Meds: Propranolol, Prozac, Fludrocortisone

Current Illness: None

ID: 1286165
Sex: F
Age: 66
State: OK

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/04/2021
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: Lipitor, Zantac, Zocor, Titanium dioxide

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vaccine Friday 4/30/21 at 1 pm?.By 8pm entire left side was red, itchy and turned into whelps. Used allergy medication and tylenol with relief. Is using benadryl which works well but makes her very drowsy.

Other Meds: Systane OTC Eye drops as needed ASA 81 mg daily Vitmain D-3 2000 Unit 2 Tablets daily Calcium 500mg 2 tablets daily Synthroid 75mcg Daily Lisinopril 5 mg daily amitriptyline 10 mg daily HS PRN

Current Illness: None known

ID: 1286166
Sex: F
Age: 72
State: MI

Vax Date: 03/28/2021
Onset Date: 04/29/2021
Rec V Date: 05/04/2021
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: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient is a 73 y.o. female who presents today with multiple complaints worsening shortness of breath, cough, weakness, headache, nausea, and diarrhea. Symptoms began with a cough 3 days prior. She went to dialysis on her usual time. Sent to ER to be evaluated due to cough. Positive COVID-19 4/27. Other family members positive. Patient became progressively more weak, short of breath that she was unable to go to dialysis today. She has had poor intake with intractable nausea and diarrhea. Audible gurgling. In ER, potassium elevated and chest x-ray with congestion consistent with overload. Nephrology intending on dialysis today while inpatient. Due to poor respiratory status now requiring oxygen typically only at night. Decadron added. Not a candidate for remdesivir.

Other Meds: Pacerone Norvasc Eliquis Apresoline

Current Illness: No acute illness

ID: 1286167
Sex: M
Age: 44
State: CA

Vax Date: 04/25/2021
Onset Date: 05/03/2021
Rec V Date: 05/04/2021
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: Covid arm, large red spot at injection site.

Other Meds: Lisinopril, Rapid Keto Burn and vitamins

Current Illness: None

ID: 1286168
Sex: M
Age: 26
State: CA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 05/04/2021
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

Symptom List: Nausea

Symptoms: Light headed, nausea, limb weakness, "Sparkly" vision to the point of loss of vision, vomiting.

Other Meds: None

Current Illness: None

ID: 1286169
Sex: F
Age: 86
State: PA

Vax Date: 03/01/2021
Onset Date: 05/02/2021
Rec V Date: 05/04/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

Symptom List: Injection site pain

Symptoms: Patient with no reported past medical history or past surgical history presented to ED and found to have massive bilateral pulmonary embolism. Upon presentation, patient was confused and lethargic. The morning of the event, niece reports that patient was in her usual state of health this am and had gone downstairs to the kitchen this afternoon, when she was downstairs she began complaining of nausea and generalized back pain. Her niece went to grab her things to take patient to the hospital but when she returned she found the patient laying on the floor due to weakness and pain, no reported fall or trauma. Chest/Abd/Pelvis CT Angio was significant for large PE in R and L main pulmonary arteries. No family history of DVT/PE.

Other Meds: None

Current Illness: None

ID: 1286171
Sex: M
Age: 34
State:

Vax Date: 04/25/2021
Onset Date: 05/01/2021
Rec V Date: 05/04/2021
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: No known allergies

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

Symptoms: This patient was admitted on 5/1/21 with chest pain. He was found to have an inferior STEMI with a thrombotic lesion in the proximal circumflex artery that was stented. He was also found to have a chronic right gastrocnemius deep vein thrombosis on a lower extremity ultrasound on 5/3/21. He is currently undergoing a hypercoagulable workup. There is potential concern that the thromboses may have been related to his COVID vaccine, as he received the second dose on 4/25/21.

Other Meds: Multivitamin

Current Illness: None

ID: 1286172
Sex: F
Age: 38
State: PA

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/04/2021
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: Latex

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

Symptoms: Congestion, stuffy nose, store throat, things taste funny, fever x1 day, diarrhea Cough - benzonatate (TESSALON) 100 mg capsule; Take 1 capsule (100 mg total) by mouth 3 (three) times a day as needed for cough for up to 7 days - guaiFENesin (MUCINEX) 600 mg 12 hr tablet; Take 2 tablets (1,200 mg total) by mouth 2 (two) times a day as needed for cough for up to 7 days

Other Meds: clobetasoL (TEMOVATE) 0.05 % cream cyclobenzaprine (FLEXERIL) 5 mg tablet diphenhydrAMINE (BENADRYL) 25 mg capsule hydrOXYzine HCL (ATARAX) 25 mg tablet(Expired) ibuprofen (MOTRIN) 800 mg tablet naproxen (NAPROSYN) 375 mg tablet rOPINIRole

Current Illness: None

ID: 1286173
Sex: F
Age: 67
State: MI

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/04/2021
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: Bees and penicillin

Symptom List: Tremor

Symptoms: Patient called stating she received her 2nd dose of Pfizer vaccine 4/29/21 and later that evening she started with hives on her shoulders which spread to her chest, severe diarrhea starting around midnight, severe joint pain, fatigue and headache which all lasted until Saturday when she began to feel much better. Patient is not concerned at this time - she called so that we could report to VAERS on her behalf.

Other Meds:

Current Illness:

ID: 1286174
Sex: M
Age: 50
State: AZ

Vax Date: 04/22/2021
Onset Date: 04/25/2021
Rec V Date: 05/04/2021
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: Erythema, Pruritus

Symptoms: Localized swelling at injection area a couple of days afterwards and continued pain in the entire arm up to 2 weeks after second dose. Left arm felt as if there was a torn muscle and 10 days after second dose, a large bruise appeared running lengthwise from armpit to below the interior elbow. the torn muscle feeling is subsiding though and seems to be getting better day by day.

Other Meds: none

Current Illness: none

ID: 1286175
Sex: M
Age: 24
State: PA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: NKDA

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

Symptoms: Pt brought to med obs #1 via stretcher in trendelenburg position d/t brief LOC after receiving vaccine. Reports h/o syncope with previous injections, last episode approximately in high school, per his report. Reports tunnel vision with nausea, diaphoresis, and tingling sensation to BUE. Pt regained consciousness prior to arrival in med obs. Pt offered and accepted water, declined snack, reports he ate PTA. PA-C at bedside to assess patient. Orthostatic VS obtained. VSS. No s/s of distress noted. Pt refused wheelchair, opting to ambulate to exit with staff escort. VS are as follows: 1344: BP 93/58, HR 80, RR 18, O2 sat 98% on RA 1349: BP 105/71, HR 79, RR 20, O2 sat 96% on RA 1354: BP 95/65, HR 72, RR 18, O2 sat 98% on RA 1359 (lying): BP 126/76, HR 89, RR 18, O2 sat 100% on RA 1404 (sitting): BP 115/82, HR 66, RR 16, O2 sat 100% on RA 1405 (standing): BP 109/78, HR 86, RR 16, O2 sat 99% on RA

Other Meds: none

Current Illness: none

ID: 1286176
Sex: F
Age: 27
State: PA

Vax Date: 12/24/2020
Onset Date: 01/01/2021
Rec V Date: 05/04/2021
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: NKA

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

Symptoms: Cough started this am- took the first dose of the Covid vaccine on 12/24, Sore Throat, Headache, Generalized Body Aches.

Other Meds: Amphetamine-dextroamphetamine XR (ADDERALL XR) 25 mg 24 hr capsule; Levothyroxine (SYNTHROID) 50 mcg tablet; Norgestimate-Ethinyl Estradiol (ORTHO TRI-CYCLEN) 0.18/0.215/0.25 mg-35 mcg (28) per tablet; PARoxetine (PAXIL) 20 mg tablet

Current Illness:

ID: 1286177
Sex: M
Age: 32
State: CA

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: patient received Pfizer vaccine and within 5 minutes of administration had a syncopal episode while seated. Patient was diaphoretic and clammy during monitoring period. Vitals 147/87, HR 50, Spo2 100%. Patient reports prior syncopal episodes during blood draws and acupuncture as stated by girlfriend. Was sent to to Urgent care onsite for further monitoring.

Other Meds: None

Current Illness: n/a

ID: 1286178
Sex: F
Age: 69
State:

Vax Date: 02/27/2021
Onset Date: 03/11/2021
Rec V Date: 05/04/2021
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: Lisinopril

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

Symptoms: Chronic arthritis in shoulders, knees, wrists, and ankles (not present before vaccine)

Other Meds: Losartan, rosuvastatin, diltiazem, eliquis, metformin, HCTZ, metoprolol, omeprazole

Current Illness: None

ID: 1286179
Sex: F
Age: 45
State: MA

Vax Date: 04/29/2021
Onset Date: 04/30/2021
Rec V Date: 05/04/2021
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: Possible allergy to keratin

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

Symptoms: Patient reports having first dose Moderna vaccine 4/29/21. She started to have left eyelid swelling 4/30/21 which has progressed to mild facial swelling, 2 small hives on forehead and generalized pruritus. Advised to continue taking Claritin. She cannot tolerate Benadryl due to side effects. Started on prednisone taper and advised to go to ED if sx worsen

Other Meds: Xanax 0.25mg, dextroamphetamine 10mg, doxycycline 100mg, hydroxyzine 10mg PRN, loratadine 10mg

Current Illness: None

ID: 1286180
Sex: F
Age: 66
State: CA

Vax Date: 04/28/2021
Onset Date: 05/02/2021
Rec V Date: 05/04/2021
Hospital:

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

Lab Data:

Allergies: vancomycin

Symptom List: Pain in extremity

Symptoms: Full body rash developed 4 days following injection. Red and itchy. Located on back, arms, buttocks, legs. Pt came to clinic for treatment of rash. No breathing difficulties.

Other Meds: Nifedepine, Losartan, gabapentin, trazadone, estradiol

Current Illness: none

ID: 1286181
Sex: F
Age: 28
State: MI

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 05/04/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: After leaving vaccine site, patient felt throat swelling. She took Benadryl herself and felt relief.

Other Meds: N/A

Current Illness: N/A

ID: 1286182
Sex: M
Age: 48
State: HI

Vax Date: 04/02/2021
Onset Date: 05/01/2021
Rec V Date: 05/04/2021
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: Pt tested positive for covid infection on 5/3

Other Meds:

Current Illness:

ID: 1286183
Sex: M
Age: 64
State: NJ

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: PATIENT BECAME FAINT ANDTHEN ADMIN UNRESPONSIVE AFTER RECEIVING VACCINE . STARTED TO SWEAT . EPIPEN WAS ADMINISTERED AND PARIENT SLOWLY RETURNED TO NORMAL. PATIENT STATED THAT THEY HAVE REACTION TO INJECTIONS OR NEEDLES AND IT HAS HAPPENED BEFORE AND CONSIDERS IT PSYCOLOGICAL.

Other Meds:

Current Illness:

ID: 1286184
Sex: F
Age: 51
State: MO

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 05/04/2021
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

Symptom List: Vomiting

Symptoms: Pain, redness, swelling, rash and knot at injection site, 102.6 fever, tiredness, muscle pain, chills, nausea and headache. The arm pain, swelling and rash took 7 days to resolve. All other symptoms resolved 24-48 hours later with NSAID pain reliever.

Other Meds: No

Current Illness: No

ID: 1286185
Sex: M
Age: 16
State: KS

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 05/04/2021
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: Denies any.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Too young. Mom reports child experienced body aches and tiredness starting the evening after getting vaccinated and ending the afternoon the day after vaccination.

Other Meds: None

Current Illness: Denies any.

ID: 1286186
Sex: F
Age: 40
State: NJ

Vax Date: 04/27/2021
Onset Date: 05/04/2021
Rec V Date: 05/04/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Severe pain in the left arm where vaccine was taken Swelling at the vaccine site Redness at the vaccine site

Other Meds: Tylenol

Current Illness: None

ID: 1286187
Sex: F
Age: 59
State: WA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 05/04/2021
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: Numerous antibiotics, Vitamin B complex

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hypertension, Tachycardia, Febrile (over 100.4) for 18 days, chills, severe systemic muscle & joint pain, burning pain, golf ball size lymph nodes, difficulty breathing, cough, asthma exacerbation, lungs sounds - wheezing, productive cough, fatigue, flushing face (magenta colored), severe weakness, lethargy, mild peripheral edema, dizziness, decreased urine output, diarrhea, painful injection site, nausea, change in dreams.

Other Meds: None

Current Illness: None - although patient relates having high fever, cough, HA, joint pain after first injection for 5 days. First injection was on 3/10/2021

ID: 1286188
Sex: F
Age: 71
State: OK

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

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

Lab Data:

Allergies: Alphagan, Aspirin, Codeine, Latex, Amlodipine, Metoprolol Succinate

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

Symptoms: Patient had headache, balance issues, and erratic blood pressure

Other Meds: Losartan 25 mg tablet once a day, Vitamin D3 1000 IU tablet twice a day

Current Illness: N/A

ID: 1286190
Sex: M
Age: 44
State: TX

Vax Date: 04/30/2021
Onset Date: 05/02/2021
Rec V Date: 05/04/2021
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: None

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

Symptoms: apparent vaccine-induced thrombocytopenia purpura covering 80% of body. No other adverse effect - no fever, good 02.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm