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: 1288712
Sex: F
Age: 16
State: IA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/05/2021
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: unknown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient 16 at the time of vaccine. Moderna not approved for under 18 yrs of age. No adverse affects noted by mother 24 hours later.

Other Meds: Unknown

Current Illness: no

ID: 1288713
Sex: M
Age: 58
State: PR

Vax Date: 04/13/2021
Onset Date: 04/14/2021
Rec V Date: 05/05/2021
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: Lost my Taste sense the following date after second vaccine shot.

Other Meds: Terbinafine HCL 250mg

Current Illness: Nail fungus

ID: 1288714
Sex: F
Age: 50
State: IN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: Downy fabric softener

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

Symptoms: Left arm soreness, fatigue, headache all began same day. Migraine, joint stiffness (elbows, hips, ankles), nose bleed, left armpit pain, fever, chills, night sweats began next day (5.4.21) and continued to 5.5.21. Adverse effects ongoing.

Other Meds: Propranolol, D3, Elderberry, Magnesium Glycate, Omepraezole

Current Illness: None

ID: 1288715
Sex: F
Age: 29
State: CO

Vax Date: 04/12/2012
Onset Date: 04/12/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Injection site was painful to the touch, hot, hard, and red. The redness swelled into a 3? area. After two weeks, the redness subsided, but there is still a hard ?knot? at the injection site, and it continues to be hard and painful if pushed.

Other Meds: Cranberry pills Glucosamine-Chondroitin Women?s 1 a Day Multivitamin Benadryl

Current Illness: None

ID: 1288716
Sex: M
Age: 57
State: IA

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

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

Lab Data:

Allergies: ORIGINAL ON FILE AT FACILITY

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

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180MCG OF PFIZER COVID 19 VACCINE IMx1.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1288717
Sex: F
Age: 42
State: NJ

Vax Date: 03/24/2021
Onset Date: 04/17/2021
Rec V Date: 05/05/2021
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: None

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

Symptoms: Bell?s Palsy (right side of face)

Other Meds: None

Current Illness: None

ID: 1288718
Sex: F
Age: 25
State: IN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: Fatigue beginning about 6 hours after the injection, fever and nausea beginning 12 hours after the injection and lasting 24 hours.

Other Meds: None

Current Illness: None

ID: 1288719
Sex: F
Age: 83
State: MI

Vax Date: 02/16/2021
Onset Date: 04/07/2021
Rec V Date: 05/05/2021
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: barium sulfate

Symptom List: Pharyngeal swelling

Symptoms: Presented to ED w/hx of harsh, nonproductive cough (4/7) & subsequent positive COVID-19 test (4/13) despite receiving Pfizer vaccines (1/21 & 2/16). Continued to have worsening cough w/occasional SOB, generalized weakness affecting daily activities and poor oral intake. Found to be febrile, hypotensive w/increased confusion. Imaging revealed opacity of R middle lobe & bilateral lower lobe consolidation concerning for pneumonia. Was admitted for additional management of sepsis & acute hypoxic resp failure secondary to COVID-19 on 4/22. Treated w/dexamethasone & started on ceftriaxone for asymptomatic Ecoli UTI. Pt ultimately discharged (4/29) w/extended antibiotic course for MSSA bacteremia w/ID follow-up on 5/24

Other Meds: amiodarone, apixaban, aspirin, fenofibrate, isosorbide,...metoprolol, oxybutynin, pantoprazole, potassium, rosuvastatin, sertraline

Current Illness: cognitive decline vs. dementia, HTN

ID: 1288720
Sex: M
Age: 54
State: IL

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 05/05/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: excruciating pain in lower right back for 24 hours. Still minor aches 4 weeks later After second dose, flu like aches everywhere for 24 hours, especially in my back.

Other Meds:

Current Illness: none

ID: 1288721
Sex: F
Age: 59
State: GA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 05/05/2021
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: no known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Immediately had strong metallic taste, accompanied by mild nausea. Began drinking lots of water, which did help. Lips became numb, but did not swell, no difficulty breathing or tightness in chest. Symptoms were mild, so no treatment was needed., so I went home to rest and hydrate. Continued to drink lots of water. Felt very fatigued and lips were numb for 4-5 hours post vaccine.

Other Meds: Multivitamin, C, D3, calcium, Hydrogen water with colloidal gold and platinum.

Current Illness: no known illnesses

ID: 1288722
Sex: F
Age: 37
State: CO

Vax Date: 03/20/2021
Onset Date: 03/23/2021
Rec V Date: 05/05/2021
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: Swollen and tender lymph nodes i left armpit for 7 days. This was a different pain from the injection site soreness I had too for a few days. From the lymph swelling my arm hurt for a full week.

Other Meds: None

Current Illness: None

ID: 1288723
Sex: M
Age: 69
State: MT

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 05/05/2021
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

Symptom List: Rash, Urticaria

Symptoms: Overall illness, fatigue, vomiting, joint pain, vertigo

Other Meds: citalopram, buprion, clonazapam

Current Illness: None

ID: 1288724
Sex: F
Age: 45
State: MO

Vax Date: 01/10/2021
Onset Date: 02/07/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies: Nickel

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

Symptoms: red nodule forms in arm, itchy, then improves, skin gets hyperpigmented and nodule resolves. Then new nodule appears in different location on arm. the hyperpigmented areas remain and are itchy. All in right arm.

Other Meds: none

Current Illness: none

ID: 1288725
Sex: F
Age: 26
State: VA

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

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

Symptoms: complaint of dizziness, light headed

Other Meds: unknown

Current Illness: Uknown- has history of dizziness and fainting. Currently seeing neurologist and per client has a tilt table test scheduled within the next few weeks.

ID: 1288726
Sex: M
Age: 49
State: FL

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

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

Lab Data:

Allergies:

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

Symptoms: Fever, chills, vomiting, severe headache, swollen lymph nodes and fatigue.

Other Meds:

Current Illness:

ID: 1288727
Sex: F
Age: 80
State: NJ

Vax Date: 04/29/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: iodine and PCN

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

Symptoms: vaccine 4/29/21 5/4/21 left arm red, painful, swollen and indurated

Other Meds: 9am meds: Escitalopram, Risabid, Amlodipine, Furosemide, Potassium, Vitamin C, D3, B12, folic acid, B1 and Zinc Sulfate

Current Illness: None

ID: 1288729
Sex: M
Age: 24
State: PA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/05/2021
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: Pt brought to med obs #1 via stretcher with c/o lightheadedness, tunnel vision, and brief LOC. Pt placed on floor with BLE elevated prior to stretcher arrival. Pt able to ambulate to stretcher without difficulty. Pt reports he felt better upon arrival to med obs #1. Reports he ate breakfast PTA. Accepted water, declined snack. VSS. Symptoms resolved. Sent home with parents. Escorted to exit with staff. VS are as follows: 1106: BP 124/75, HR 53, RR 18, O2 sat 99% on RA 1111: BP 134/71, HR 59, RR 18, O2 sat 98% on RA

Other Meds: none

Current Illness: none

ID: 1288730
Sex: F
Age: 47
State: CA

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

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

Lab Data:

Allergies: Sulfa

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Chills, uncontrollable shacking, nausea, extreme fatigue, on and off headaches,

Other Meds:

Current Illness: None

ID: 1288731
Sex: F
Age: 77
State: MD

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

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

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: presented to local ED lethargic, disoriented and unable to provide clear history on evening of 5/1/21 with severe frontal headache and increasing lethargy throughout the day. Admitted to hospital with suspected subacute stroke. Overnight developed LT sided weakness and RT gaze. Transferred to another healthcare facility on 5/3/21 with suspected seizure / encephalitis.

Other Meds: Glimepiride 2 mg daily Gabapentin 100 mg tid Glipizide 5 mg daily Oxybutynin 5 mg (not taking) Vit E vag supp 2 x week zocor 40 mg daily Maxide 37.5 / 25 mg daily

Current Illness:

ID: 1288732
Sex: F
Age: 48
State: NC

Vax Date: 03/28/2021
Onset Date: 03/31/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies: Minocycline

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

Symptoms: Fever blister outbreak that continued for 21 days despite regular use of Valcylovir prescription

Other Meds: Slow Fe supplement

Current Illness: N/A

ID: 1288733
Sex: F
Age: 30
State: IL

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, most meat

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

Symptoms: Terrible headache, chills, body aches, extreme fatigue

Other Meds: N/a

Current Illness: N/A

ID: 1288734
Sex: M
Age: 34
State: CA

Vax Date: 04/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/05/2021
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: PT HERE FOR 2ND DOSE OF PFIZER. RN NOTICED PT RECD FIRST DOSE TO LEFT TRICEPT RATHER DELTOID, RESULTING A BRUISED. NO OTHER SYMPTOMS REPORTED FROM PT.

Other Meds:

Current Illness:

ID: 1288735
Sex: M
Age: 77
State: PA

Vax Date: 04/09/2021
Onset Date: 04/19/2021
Rec V Date: 05/05/2021
Hospital: Y

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: No Known Allergies

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

Symptoms: Pneumonia due to COVID-19 virus Sepsis Shortness of Breath ? Weakness - Generalized ? Dizziness

Other Meds: aspirin 81 mg chewable tablet budesonide-formoteroL (SYMBICORT) 80-4.5 mcg/actuation inhaler ergocalciferol (VITAMIN D) 1,250 mcg (50,000 unit) capsule folic acid (FOLVITE) 1 mg tablet guaiFENesin (MUCINEX) 600 mg 12 hr tablet lisinopriL (Z

Current Illness: Essential hypertension Urinary retention Coronary artery disease involving native coronary artery of native heart without angina pectoris Blood glucose abnormal Anemia, unspecified type Stage 3a chronic kidney disease PMR (polymyalgia rheumatica) (CMS/HCC)

ID: 1288736
Sex: F
Age: 73
State: OR

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Moderna was administered as the 2nd dose in error. Patient should have received Pfizer.

Other Meds:

Current Illness:

ID: 1288738
Sex: F
Age: 22
State: IN

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

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

Lab Data:

Allergies: Red dye allergy, possible allergy to medications that are part of the cillin group such as Penicillin.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Several hours after the shot, I began to feel very hot all over my face and body. I got very dry to the touch and I became extremely thirsty. I also had full body tremors. When I woke up the next morning (5/4) around 10 a.m., I had a fever, headache, and serious brain fog. My legs ached, especially my hips and knees. The intense thirst and dryness also persisted. I felt lightly nauseous on and off. I took an extra strength Tylenol and drank a lot of water before sleeping again until around 4 p.m.. Once I woke up, I was still suffering from all the aforementioned symptoms, but with less severity. I had another extra strength Tylenol and drank water and a sports drink. I ate a granola bar right after the Tylenol and started to feel a little better. Then I got really hungry, so I ate a muffin and drank an energy+ juice drink that had 80mg caffeine derived from green and black tea. I started to feel a lot better after that, though I was still weak and experiencing aching in my legs and hips. I took another nap from 7 p.m. to 9 p.m. and then ate once more before going to sleep for the night around 1:30 a.m. I have woken up today (5/5) with a slight headache but no other symptoms save the injection site soreness that has also persisted since a few hours after the shot. A note for comparison: as reported, this is my 2nd dose. My first dose had no symptoms whatsoever aside from injection site soreness.

Other Meds: N/A

Current Illness: Not an illness, but I was on my period. I started it that day

ID: 1288739
Sex: F
Age: 33
State: IL

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

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

Lab Data:

Allergies:

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

Symptoms: Body aches, headache, fever/chills, nausea, enlarged lymph node at arm pit

Other Meds:

Current Illness:

ID: 1288740
Sex: M
Age: 31
State: MI

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Started with numbness and tingling throughout both legs and progressively worsening to severe full body burning/buzzing pain. Also experienced dizziness and slight loss of muscle strength/coordination. Difficulty breathing.

Other Meds:

Current Illness:

ID: 1288741
Sex: F
Age: 46
State: MI

Vax Date: 04/15/2021
Onset Date: 04/19/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: CLIENT STATES 4 DAYS AFTER 2ND DOSE MODERNA DEVELOPED "PARATHESIA" IN ARM SHOULDER DOWN - NOW IN WRIST AND CMC JOINT L ARM -

Other Meds: OCP AND VITAMIN D

Current Illness: NONE

ID: 1288742
Sex: M
Age: 66
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/05/2021
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: ORIGINAL ON FILE AT FACILITY

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

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IM.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1288744
Sex: M
Age: 28
State: LA

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: Moderna Covid-19 Vaccine EUA swelling and redness on arm around injection site fatigue

Other Meds: Omeprazole 20MG Montelukast 10MG

Current Illness:

ID: 1288745
Sex: F
Age: 36
State: PA

Vax Date: 03/31/2021
Onset Date: 04/02/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies: Ketamine, bentyl.

Symptom List: Injection site pain

Symptoms: On 4/2/21, experienced facial swelling. on 4/2/2021 and continuing to present, experienced whole body hives. On 5/4/2021 and continuing to present, experienced facial swelling.

Other Meds: Bupropion (300 mg), daily multi-vitamin.

Current Illness: None

ID: 1288746
Sex: M
Age:
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received less than half the dose of the vaccine due to a needle malfunction. He was then given another dose of the vaccine.

Other Meds:

Current Illness:

ID: 1288749
Sex: F
Age: 34
State: WA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/05/2021
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: None

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

Symptoms: Delayed period

Other Meds: Focalin

Current Illness: None

ID: 1288750
Sex: M
Age: 23
State: WA

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

Symptoms: Administered 0.5 mL of vaccine, not 0.3 mL

Other Meds:

Current Illness:

ID: 1288751
Sex: F
Age: 35
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Today is the first day, started in the early morning hours, Vertigo , off balance, dizziness... I?ve never had this before

Other Meds: Multivitamin, vitamin c, magnesium glyconate, b2, vitamin d, FLO brand and DISCIPLINE by a company called ZitSticka supplement ( one is for my menstrual symptoms and the other is for my skin

Current Illness:

ID: 1288752
Sex: M
Age: 56
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/05/2021
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: ORIGINAL ON FILE AT FACILITY

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

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IM.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1288753
Sex: M
Age: 75
State: MI

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

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

Symptoms: At this time patient has remained free of any s/sx of adverse reaction, reporting that he received the wrong dose of vaccine, on 5/4/2021 he was to receive 0.5ml of Jensen Covid vaccine and he received 2.5ml of the vaccine.

Other Meds: NA

Current Illness: NA

ID: 1288754
Sex: F
Age: 57
State: FL

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/05/2021
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: PCNH

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 5/5/2021 57 y/o female with past medical of hypertension and anxiety, who presents with headache, dizziness and lightheadedness post vaccination. Patient states that this is her 2nd dose in the two-dose series. Patient states that with the first vaccination she experienced fever, headache, chills and tiredness. Patient states that she received her vaccination to the Left arm. NP and Paramedics at patient side. Patient placed on wheelchair and vital assessed. Patient BP 180/100 R arm, 98% RA, 75 P. Patient states that she took Metoprolol this am but forgot to take her Hydrochlorothiazide. Patient also states that she fears needles. Patient was monitored with repeat vitals and patient remained hypertensive, 179/102 BP, 213/116, 189/109, 187/107, 197/110, 208/110 with all other vitals within normal limits. Within 20 mins of monitoring patient it was determined that patient should be transported to the emergency room via fire rescue. Fire rescue arrived on scene, advised patient that she should be transported to the ER but the patient refused. Patient aware of the risks involved, such as hypertensive crisis, stroke or cardiac event. Patient signed out Against Medical Advice. CNO and PM aware.

Other Meds: Metoprolol Hydrochlorothiazide

Current Illness:

ID: 1288755
Sex: F
Age: 46
State: NE

Vax Date: 04/22/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: Just a sudden onset of pain and tenderness in the area shot was administered 11 days after receiving 2nd dose, like receiving a shot all over again but the pain is more pronounced and lingering. No treatment as of right now just a dull pain that?s lasted 2 days so far.

Other Meds: Remeron

Current Illness: None

ID: 1288756
Sex: M
Age: 53
State: CA

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: DIZZY, DIAPHORETIC, EYES FLUTTERING, SYNCOPE, SEEN BY PARAMEDICS, BP 171/90 HR 97, BS: 99. PT HAS NO HX OF SYNCOPE, REFUSED TRANSPORT, AMA SIGNED.

Other Meds:

Current Illness:

ID: 1288757
Sex: F
Age: 52
State: PA

Vax Date: 12/29/2020
Onset Date: 01/03/2021
Rec V Date: 05/05/2021
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: Pain in extremity

Symptoms: Head cold, body aches, fatigue

Other Meds: FLUoxetine (PROzac) 20 mg capsule lisinopriL (ZESTRIL) 2.5 mg tablet(Expired)

Current Illness:

ID: 1288758
Sex: F
Age: 19
State: WI

Vax Date: 01/22/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: Client had a breakthrough infection. Test date was 5/3/21 and symptoms started 5/3/21. 2nd Dose Moderna 3-19-21 Lot Number 012A21A

Other Meds:

Current Illness:

ID: 1288759
Sex: F
Age: 31
State:

Vax Date: 02/10/2021
Onset Date: 05/01/2021
Rec V Date: 05/05/2021
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: Patient is a 31 y.o. female admitted on 5/1/2021 Please refer to the History and Physical report for information on presentation. 31-year-old female with no significant past medical history was admitted to the hospital due to left-sided flank pain radiating to the groin. CAT scan abdomen pelvis was done which showed 3 mm obstructing ureteric calculi leading to left-sided hydronephrosis. Additional nonobstructing stones of both kidneys were also noted. Patient was started on Flomax for pain management. UA was also grossly positive, patient was started on ceftriaxone. Urology was consulted, recommended stent placement if patient unable to pass stone. However patient was able to pass stone within 24 hours. Patient will be discharged home on Ceftin to complete 7 days course. Blood sugars were also noted to be elevated during her hospital course. A1c not back at the time of discharge. Patient was instructed to follow-up with her PCP, for results of A1c, and up titration of medication. Patient will be discharged on 500 mg Metformin. Patient understands the plan

Other Meds:

Current Illness:

ID: 1288760
Sex: F
Age: 72
State: MD

Vax Date: 04/28/2021
Onset Date: 05/01/2021
Rec V Date: 05/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Reported a buzzing in the ears that has been constant started 3 days after shot in the morning on 5/1/2021 and has not stopped since. She called today to report (5/5/2021) and it has not stopped she is currently still experience non stop tinnitus, pharmacist recommended visiting her physician to follow up.

Other Meds:

Current Illness:

ID: 1288761
Sex: F
Age: 23
State: IN

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

Symptom List: Vomiting

Symptoms: Fever, body aches, nausea

Other Meds: Birth control

Current Illness:

ID: 1288762
Sex: M
Age: 49
State: IA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/05/2021
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: ORIGINAL ON FILE AT FACILITY

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PREPARATION AND ADMINISTRATION ERROR. PATIENT RECEIVED 180 MCG OF PFIZER COVID 19 VACCINE IM.

Other Meds: ORIGINAL ON FILE AT FACILITY

Current Illness: ORIGINAL ON FILE AT FACILITY

ID: 1288763
Sex: F
Age: 61
State: IN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/05/2021
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: Aching muscles & bones, nausea for approximately 24 hours. Sore arm at site of injection for 48+ hours.

Other Meds: None

Current Illness: None

ID: 1288765
Sex: F
Age: 51
State: NC

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: high fever to 104 (reported by patient), chills, fatigue, HA, and body aches. Red, pruritic raised rash to entire R upper arm, extending into axilla and R side of chest, lasting days

Other Meds: benazepril 40 mg, HCTZ 12.5 mg, progesterone, trazodone 50 mg, vortioxetine 10 mg

Current Illness:

ID: 1288766
Sex: M
Age: 49
State: WA

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/05/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Administered 0.5 mL of vaccine, not 0.3 mL

Other Meds:

Current Illness:

ID: 1288767
Sex: F
Age: 39
State: NY

Vax Date: 03/01/2021
Onset Date: 03/24/2021
Rec V Date: 05/05/2021
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: Muscle fatigue, headache, for 1 day

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm