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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1293221
Sex: F
Age: 29
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/06/2021
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: mixing error occurred, patient may have been given just diluent. Patient was revaccinated 5/4.

Other Meds:

Current Illness:

ID: 1293222
Sex: F
Age: 26
State: PR

Vax Date: 05/05/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
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: no have allergies and patient said is not allergic to any medication or food

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient contacted the pharmacy to report that she had been vaccinated in the morning ( 9:30 am) and was presenting lip swelling at that time (7:03 pm). She said she had taken Benadryl and we recommend that she go to the hospital for evaluation as she had not improved at all. we have tried to contact the patient we have left a message but we have not received a call back

Other Meds: no medical condition reported

Current Illness: no medical condition

ID: 1293223
Sex: M
Age: 65
State: MA

Vax Date: 03/30/2021
Onset Date: 04/15/2021
Rec V Date: 05/06/2021
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: Tinnitus - a noticeable, constant ringing in my left ear. Noticed in mid-April, following second dose. No treatment at this time but will inform my PCP.

Other Meds: Vitamin D3 supplement at 4000 U/day True Niagen NAD+ supplement at 300 mg/day

Current Illness: None

ID: 1293224
Sex: M
Age: 53
State: IN

Vax Date: 05/05/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
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: BURNING BEHIND KNEES AND IN ARMPITS

Other Meds:

Current Illness:

ID: 1293225
Sex: F
Age: 41
State: NJ

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

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

Lab Data:

Allergies: Shellfish and Penicillin

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

Symptoms: I took the vaccine 3:30pm around 7pm - 8pm I started having chest lain and my body started getting numb so i took Benadryl and went to sleep, next day i got up with my body numb and sharp chest pain on my chest left side. My left arm was red and swollen, the whole arm on the left where i took the vaccine. My tongue started getting swollen so i took Benadryl again. That night i went to sleep than i got up around 1:30am with burning sensation on my left side chest(heart) , i woke up twice with that. Next day i called my doctor than she told me to take 2 Tylenols and 1 Benadryl which i did than fet better all day. Today I didn't took anything in the morning but i felt chest pain on the left side and face was getting swollen than i took Benadryl and Tylenol

Other Meds: None

Current Illness: No

ID: 1293226
Sex: M
Age: 25
State: CA

Vax Date: 03/19/2021
Onset Date: 05/02/2021
Rec V Date: 05/06/2021
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: Sumatriptan

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

Symptoms: Patient was diagnosed and tested Positive for Covid 19 despite receiving vaccine on 3/19/2021 SARS-COV-2, QUALITATIVE, NAA (COVID-19), KP LAB Component 2 d ago Comments SP SOURCE NP/OP CORONAVIR PAN 2019-NCOV, NAA, QL COVID DETECTED Abnormal See comments Specimen Collected: 05/04/21 10:07 AM

Other Meds:

Current Illness:

ID: 1293227
Sex: F
Age: 26
State: NM

Vax Date: 04/20/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
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: Seasonal allergies

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 26 year old nonverbal with known refractory intractable epilepsy, spastic quadriparesis cerebral palsy, developmental delay, presented to ED with the concerns of seizures by the mom. Patient was recently seen in the urgent care for UTIs. Her current AED include: Clobazam 5 mg BID, Oxcarbazepine 600 mg BID and Lorazepam 1mg qhs. Patient is being followed by Dr. in the epilepsy clinic. Patient is being admitted to neurology service due to concern for new type of seizure witnessed at home characterized by smiling and staring. Similar events captured during the evening of 4/30 are without electrographic correlate. In the setting of bowel regimen that was held due to endoscopy and worsened bowel gas pattern seen on KUB at time of admission. these new events were initially have EEG correlated abundant bursts and runs of high amplitude 5-6 Hz theta with occasional bifrontal sharp waves; multiple pushbutton events (predominantly smiling and staring) without definitive epileptiform discharge or seizure. She was initially loaded with Keppra 600 mg (20mg/kg) in the ER, and after the concerns of the EEG we Loaded with lacosamide 60mg with scheduled lacosamide 30mg BID liquid and increased Clobazam to 10mg while continuing Oxcarbazepine 600 mg BID and home Lorazepam 1 mg qhs. on 5/2/2021 no more EEG concerns of dischrges. will be discharged home and cont to follow with Dr on 5/4/2021

Other Meds: Lorazepam, midazolam, oxacarbazepine, clobazam, Vit D3, probiotic, calcium, gas x, antiacid , tylenol

Current Illness: bell's palsy, cerebral palsy, scoliosis, epilepsy, epileptic seizures, cognitive impairments visual impairment developmentally delay, neuronal migration disorder.

ID: 1293229
Sex: M
Age: 79
State: FL

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 05/06/2021
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: None

Symptom List: Pharyngeal swelling

Symptoms: Patient had vaccine on 4/6/2021 and on 4/8/2021 he went to the hospital for bright red blood from his rectum to the point of running down his leg. He was admitted to the hospital 4/8/2021 to 4/9/2021.

Other Meds: Unknown

Current Illness: None

ID: 1293230
Sex: M
Age: 26
State: NC

Vax Date: 04/07/2021
Onset Date: 05/03/2021
Rec V Date: 05/06/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received J&J covid vaccine on 4/7/2021. Patient presented to the ED on 5/3 for right arm swelling with redness. Patient was found to have proximal right upper extremity DVT extending to right subclavian vein along with bilateral PE in the ED. The provider noted the patient had no risk factors other than receiving the vaccine, requested a hematology/oncology consult for evaluation hypercoagulable , patient started on bivalirudin while HIT work-up completed plan to transfer to oral anticoagulation upon discharge.

Other Meds:

Current Illness:

ID: 1293231
Sex: M
Age: 67
State: OH

Vax Date: 04/15/2021
Onset Date: 04/26/2021
Rec V Date: 05/06/2021
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: penicillin and sulfa drugs

Symptom List: Diarrhoea, Nasal congestion

Symptoms: awoke 4/26/2021 with double vision and slight dizziness; saw eye doctor 4/29 and was told I was experiencing palsy in my 3rd Cranial nerve; saw eye surgeon 5/4/2021 after my right eyelid went completely shut, he confirmed issues with 3rd Cranial nerve. Now wearing eye patch on right eye to prevent double vision and I have follow up appointment on Tuesday, May 11.

Other Meds: Entresto- 24-26mg, 1 tab x 2 - amiodarone 200mg tab 1 per day - atorvastatin 40mg tab 1 per day - metoprolol succinate 25 mg tab 1 per day - aspirin 81mg chewable 1 per day - cetirizine 10 mg tab 1 per day - Nexium 20mg tab 1 tab every oth

Current Illness: None

ID: 1293232
Sex: M
Age: 43
State: MO

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/06/2021
Hospital: Y

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: Severe neurological and cognitive decline. Patient is currently unable to walk unassisted and is between a walker and a wheelchair. His cognitive function has also been affected to the point that some days he is unable to process how to even feed himself.

Other Meds: Oxycodone

Current Illness: none

ID: 1293233
Sex: M
Age: 48
State:

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

Symptom List: Rash, Urticaria

Symptoms: tenderness to injection site with a minor pink rash, benadryl 50mg given immediately then 50mg BID PRN x48 more hours, encouraged ice and Tylenol for comfort

Other Meds:

Current Illness:

ID: 1293234
Sex: F
Age: 24
State: PA

Vax Date: 01/11/2021
Onset Date: 01/15/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Fever or Chills Cough Fatigue Muscle or body aches Headache

Other Meds: cetirizine (ZyrTEC) 10 mg tablet norgestimate-ethinyl estradioL (ORTHO-CYCLEN) 0.25-35 mg-mcg per tablet PNV no.95/ferrous fum/folic ac (PRENATAL ORAL)

Current Illness:

ID: 1293235
Sex: F
Age: 45
State: MN

Vax Date: 04/18/2021
Onset Date: 04/19/2021
Rec V Date: 05/06/2021
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: None known

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

Symptoms: 24 after injection onset right lip swelling, tongue swelling and cheek swelling. First time angioedema in life. Required ER and Decadron, Benadryl ranitidine. Symptoms recurred 4/28/2021 requiring 2nd ER visit but no new intervention. Had 2 similar episodes between the ER visits.

Other Meds: metoprolol succinate (TOPROL-XL) 50 mg 24 hr tablet sertraline (ZOLOFT) 100 mg tablet bupropion

Current Illness: None

ID: 1293236
Sex: F
Age: 51
State: PA

Vax Date: 02/20/2021
Onset Date: 03/07/2021
Rec V Date: 05/06/2021
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: NKDA, Seasonal

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

Symptoms: Emergency room transfer to telemetry; admited from 3/7 to 3/18/21 with centralized Chest Pain that radiated to her right neck and shoulder, shortness of breath associated with the pain, loose stools - took baby aspirin. Cardiology consulted: heart catheritization was performed and negative; Dischareged to home with AmLODIpine, aspirin, storvastatin, famotidine, imdur; follow up with PCP and cardiologist

Other Meds: Apple Cider Vinegar 500 mg, Ibuprofen 800 mg, Vitamin C Gummie 120 mg, Womens Multivitamin, Sumatriptan Succinate 25 mg, Gabapentin 300 mg, Tizanidine HCL 4 mg, Famciclovir 250 mg, Hair/Skin/Nails/Biotin

Current Illness: Postmenopausal bleeding, Allergic rhinitis, Fracture of tooth, Raynaud's disease, Dental caries, Arthralgia of the upper arm, Adjustment disorder with mixed emotional features, Vitamin D deficiency, Disturbance in sleep behavior, Insomnia, Pain in limb, Low back pain, Moderate recurrent major depression, Generalized anxiety disorder, Internal hemorrhoids without complication

ID: 1293237
Sex: F
Age: 65
State: IL

Vax Date: 03/06/2021
Onset Date: 04/02/2021
Rec V Date: 05/06/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient is a 65 year old female with a PMH significant for asthma, htn, Metastatic/stage IV C( pT4a, pN0, pM1c) moderately-differentiated mucinous adenocarcinoma of the appendix (grade 2), KRAS mutation positive, BRAF negative, MMR protein intact, with abundant mucin, peritoneal carcinomatosis; cytoreductive surgery with debulking of peritoneal implants, peritoneal stripping, cholecystectomy, hyperthermic intraperitoneal chemotherapy with mitomycin C on 9/27/19, followed by exploratory laparotomy with abdominal washout, primary repair of perforated small bowel 10/2/19, with disease progression, on palliative modified FOLFOX 6 since 8/31/2020 who presents for sob, cough x 2 wks getting progressively worse. States home oxygen sensor dropping to mid 80's and extememely sob. Had 2nd Covid vaccine early March. Sx began about 2wks ago with +ve covid testing, fevers, diarrhea. That has since improved.

Other Meds: tylenol, albuterol, breo ellipta, eliquis, lomotil, imodium, c, coreg, B12, Klor-con, protonix

Current Illness:

ID: 1293238
Sex: F
Age: 21
State: NC

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/06/2021
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: NA

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

Symptoms: Client complained of dizziness and visual changes @ 10:52 am. Client placed in supine with legs elevated. BP 114/78 Pulse 84. Client recover and placed in chair at 11:10 am. Tolerated. BP 109/87 pulse 97. Client able to ambulate independently out of vaccine clinic at 11:20 am.

Other Meds:

Current Illness:

ID: 1293239
Sex: F
Age: 61
State: MN

Vax Date: 04/06/2021
Onset Date: 04/20/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: Tegaderm

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient received her second Pfizer COVID-19 vaccine on 4/6/21. She developed neutropenia that was found on 4/20/21 (neutrophils 0.8) and resolved by 4/27/21 (neutrophils 4.0). Her chemotherapy was held by 1 week due to neutropenia, but otherwise she did not have any negative effects from this. The timing of the neutropenia did not coincide with her chemotherapy. She received Halaven, 3/15/21, 3/22/21 and 4/6/21. She did not have any issues with neutropenia with her first two doses, nor has she had issues with neutropenia with the doses administered on 4/27/21 and 5/4/21.

Other Meds: Halaven, acetaminophen, Buspar, calcium +vitamin D, Celebrex, Voltaren gel, gabapentin, Dilaudid, lidocaine patches, Ativan, Ritalin, OxyContin, MiraLax, Senna-S, Zoloft

Current Illness: leiomyosarcoma

ID: 1293240
Sex: M
Age: 42
State: PA

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The morning after injection my left arm had the expected soreness but additional numbness, weakness, and poor coordination in my arm, hand, and fingers progressively moreso toward my pinky. It has been consistently the same for 17 days.

Other Meds: Adderall 10mg

Current Illness: None

ID: 1293241
Sex: F
Age: 35
State: IL

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: Erythromycin Inapsine

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

Symptoms: Within 2 hours I couldn't move my arm and was crying out in pain for 12 hours. I contacted my doctor after 1 week due to the level pain and limited range of motion in my left arm. I can not raise my arm higher than a 45? in any direction. I was able to get in to see him on April 26th. He prescribed Diclofenac Sodium and Tramadol. He gave me an order to start physical therapy.

Other Meds: Birth control: sprintec

Current Illness: None

ID: 1293242
Sex: M
Age: 43
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/06/2021
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: mixing error occurred, patient may have been given just diluent. Patient was revaccinated 5/4.

Other Meds:

Current Illness:

ID: 1293243
Sex: F
Age: 46
State: CA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 05/06/2021
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: I experienced extreme teeth and jaw bone pain for a couple days after the vaccination, until I started taking antibiotics. It might be unrealted.

Other Meds:

Current Illness: mild irritation of teeth due to getting braces, breast cancer survivor, completed chemo 1 yr prior

ID: 1293244
Sex: M
Age: 74
State: FL

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
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: seafood tamsulosin

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

Symptoms: Itchy head to toe rash that began the day after second dose. took oral benadryl & applied anti itch cream & symptoms lasted 8 days

Other Meds:

Current Illness:

ID: 1293246
Sex: M
Age: 53
State: NJ

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: High fever 103.5 for two days with headache and nausea. Day 3 previous symptoms were gone but developed hives down left arm and both legs. Utilized Benedryl gel for hives. Utilized Tylenol for fever and headache.

Other Meds: welbutrin

Current Illness: none

ID: 1293247
Sex: M
Age: 43
State: CA

Vax Date: 04/08/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Injection site pain, Menorrhagia

Symptoms: pt states he noticed he had a rash on the left side of his chest and stomach. He started getting a pounding headache with mild fever, body aches and chills. His headache was getting worse and no medicine he took helped with the pain. On 5/1/2021 he went to Urgent Care on in. He was diagnosed w/ Shingles. He had blood work that was negative. He was prescribed Valtrex and Ibuprofen and told to FU w/ PCP. He had a tele visit w/ his PCP on 5/6/21. He was prescribed more Valtrex and Ibuprofen and ordered more blood work. He still has a rash and still feels weak but is getting better.

Other Meds: advair, albuterol, metformin

Current Illness:

ID: 1293248
Sex: F
Age: 62
State: IN

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 05/06/2021
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: Fever, chills, headache, body aches, nausea, itching and re splotches on chest, face, arms, upper back. Took Benedryl and Aleve after onset of symptoms. Lasted 3 days, fine now.

Other Meds:

Current Illness:

ID: 1293249
Sex: F
Age: 60
State: CO

Vax Date: 04/25/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies: None reported

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Moderna COVID-19 Vaccine EUA: during telehealth encounter nine days after vaccination patient reports a lump under the collarbone. The provider documented arm redness and a diagnosis of cellulitis and prescribed antibiotics.

Other Meds: conjugated estrogens, diazepam, ibuprofen, levothyroxine, losartan-hydrochlorothiazide, metronidazole cream, nitrofurantoin, olopatadine ophthlamic

Current Illness: None reported

ID: 1293250
Sex: F
Age: 46
State:

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient stated she received second Moderna vaccine on 4/28, and later that day started feeling sick. She stated she had chills, headache, sore arm, achy body, and was feeling hot and cold, but did not take her temperature. She stated then she thinks fever went away but on Sunday she took her temperature and it was 100 F, almost 101, but took Advil and it went down. She stated she still does not feel well today.

Other Meds:

Current Illness:

ID: 1293251
Sex: F
Age: 47
State:

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient with dizziness, hot arm, sore throat. He was administered Benadryl 25mg and IV fluids

Other Meds:

Current Illness:

ID: 1293252
Sex: M
Age: 52
State:

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Pt had "tingling" on his throat. Bilateral rash on arms. Elevated B/P 170's. Nausea and vomiting Pt was given 25mg Benadryl. Pts b/p lowered. Nausea and vomiting resolved.

Other Meds:

Current Illness:

ID: 1293253
Sex: M
Age: 48
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: mixing error occurred, patient may have been given just diluent. Patient was revaccinated 5/4.

Other Meds:

Current Illness:

ID: 1293254
Sex: F
Age: 59
State: IA

Vax Date: 04/20/2021
Onset Date: 05/03/2021
Rec V Date: 05/06/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Redness around site of injection but no pain. Recommended some benadryl to help with the reaction at site of injection

Other Meds: flexeril, klonopin, amitriptylline, neurontin, trazodone.

Current Illness: N/A

ID: 1293255
Sex: F
Age: 24
State: KS

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/06/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Progress Notes: Registered Nurse; Pt reports rash covering both arms next day after first dose of Pfizer vaccine. Pt applied hydrocortizone cream and ice packs and rash cleared up in 24hrs. Pt in 30 min observation for her second COVID vaccine shot.

Other Meds:

Current Illness:

ID: 1293256
Sex: F
Age: 22
State: GA

Vax Date: 04/19/2021
Onset Date: 04/21/2021
Rec V Date: 05/06/2021
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: sulfa

Symptom List: Tremor

Symptoms: Two days after receiving my first dose of the vaccine I started having tachycardia. I have never had this before and it concerned me. Almost 3 weeks later and I?m still having tachycardia. I still have to get my 2nd dose of the vaccine but I am scared to now.

Other Meds:

Current Illness:

Date Died: 05/04/2021

ID: 1293257
Sex: M
Age: 74
State:

Vax Date: 02/27/2021
Onset Date: 04/08/2021
Rec V Date: 05/06/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: J96.01 - Acute respiratory failure with hypoxia (CMS/HCC) R57.9 - Shock (CMS/HCC) A41.9 - Sepsis, unspecified organism

Other Meds:

Current Illness:

ID: 1293258
Sex: U
Age:
State: NM

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

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: VIAL WITH 4 DOSES POSSIBLY MIXED WRONG

Other Meds:

Current Illness:

ID: 1293259
Sex: F
Age: 32
State: NY

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

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

Lab Data:

Allergies:

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

Symptoms: Redness of injection site

Other Meds:

Current Illness:

ID: 1293260
Sex: M
Age: 77
State: NY

Vax Date: 02/23/2021
Onset Date: 04/01/2021
Rec V Date: 05/06/2021
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: ACE inhibitor's-cough Rosuvastatin-unknown Fluorescein dye-facial flushing

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Recently referred to clinic on May 6 for a diagnosis of bilateral posterior uveitis made by retinal ophthalmology for which he is being treated with ocular steroids. Original diagnosis of bilateral posterior uveitis was made by retinal ophthalmology around April 29.

Other Meds: Spironolactone, fluticasone, celecoxib, nebivolol, multivitamin, ipratropium-albuterol, telmisartan, omeprazole, fluticasone-salmeterol, azelastine

Current Illness: Hypertension, macular degeneration

ID: 1293261
Sex: M
Age: 38
State: NV

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/06/2021
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: n/a

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

Symptoms: My symptoms are muscle soreness, knee, and joint pain and unable to bend knee forward or backward without experiencing pain.

Other Meds: n/a

Current Illness: n/a

ID: 1293262
Sex: M
Age: 46
State: WI

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/06/2021
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: Penicillin Valacyclovir Spinach Shellfish Derived Animal Dander

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

Symptoms: The day after the shot I began having severe abdominal pain, muscle and nerve pain, and shortness of breath. The abdominal, muscle, and nerve pain began at around 10:00am. The shortness of breath began around 2:00-3:00 in the afternoon and lasted for 30-45 mins (longer than the 20mins listed in the attending ER physician's report), at which point my wife called for an ambulance and I was taken to the emergency room of Hospital. I was prescribed diphenhydrAMINE injection 25 mg, droperidoL injection 1.25 mg, ketorolac injection 15 mg, and another pain killer by the paramedics that I do not see listed in the record. Although not to the same degree, I have continued to have gastrointestinal cramping since the second vaccination. This is a worsening of a condition (IBS) that I had previously, but which had mostly been in remission since beginning Mirtazapine in Fall 2019 subsequent to a heart attack on 8/7/19. I am meeting with my primary physician, Droctor, on 5/10/21 and contacted, my gastroenterologist, on 5/5/21.

Other Meds: Dexilant 60 mg capsule gabapentin 100 mg capsule (3x) mirtazapine 7.5 mg tablet mirtazapine 15 mg tablet aspirin 81 mg DR tablet metoprolol succinate 25 mg 24 hr tablet lisinopril 5 mg tablet rosuvastatin 20 mg tablet cholecalciferol 125

Current Illness: N/A

ID: 1293263
Sex: F
Age: 70
State: FL

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/06/2021
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: Pain in extremity

Symptoms: Patient reported dizziness, her vital signs remained stable. She was closely monitored , her dizziness subsided, left vaccination site accompanied by friend in stable condition.

Other Meds:

Current Illness:

ID: 1293264
Sex: F
Age: 41
State: GA

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Syncope

Other Meds:

Current Illness:

ID: 1293265
Sex: F
Age: 53
State: GA

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

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

Symptoms: On 05/05/2021 at 08:43 A Moderna vaccine was given to patient by another nurse. The Vaccine was open on 05/04/2021 at 2:20 pm. After giving the vaccine the nurse told this nurse she had given a vaccine that was on the vaccine cart and stated she did not know it was not a new vial because it was on the cart. The incident was reported to the Clinical Director and Moderna Manufacture. The client was monitored for thirty minutes and she showed no reactions. Viability of the vaccine was not decided.

Other Meds: None known

Current Illness: None

ID: 1293266
Sex: M
Age: 17
State: LA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
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: Father and Mother filled out paperwork at site as his age of 18. He was given the vaccine of Moderna (not currently approved for less than 18) when putting information in state immunization program, clerk noted his age was populating 17. Individual still on site waiting his 15 minutes and family was still on site. Asked again and they verified is birthdate but that he was 18 not 17.

Other Meds:

Current Illness:

ID: 1293267
Sex: F
Age: 61
State: PA

Vax Date: 01/12/2021
Onset Date: 03/11/2021
Rec V Date: 05/06/2021
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: PenicillinsShortness of breath / Dyspnea ErythromycinNausea and Vomiting NaproxenNausea and Vomiting Nsaids (Non-steroidal Anti-inflammatory Drug)Nausea and Vomiting PrednisoneNausea and Vomiting TopiramateRash

Symptom List: Vomiting

Symptoms: SOB

Other Meds: ALPRAZolam (XANAX) 0.5 mg tablet diclofenac sodium (VOLTAREN GEL) 1 % gel diclofenac sodium (VOLTAREN) 1 % gel FLUoxetine (PROzac) 40 mg capsule propranolol LA (INDERAL LA) 60 mg 24 hr capsule SUMAtriptan (IMITREX) 100 mg tablet SUMAtriptan

Current Illness:

ID: 1293268
Sex: F
Age: 41
State: WA

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 05/06/2021
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: N/A

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Nightmares, lucid dreaming, sleep disturbances

Other Meds: None

Current Illness: None

ID: 1293269
Sex: F
Age: 48
State: VA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 05/06/2021
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: Doxycycline

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

Symptoms: Heart palpitations, shortness of breath, lymph nodes swollen. I went to my PCP on 4/14 due to severe shortness of breath. I went to urgent care on 4/15 for severe shortness of breath. At the urgent care the did a chest X-ray and EKG and they were both fine. The doctor prescribed a 5 day course of prednisone to calm the inflammation down in my lungs. After two days of taking the prednisone the shortness of breath was worse. On 4/19 I went to the Emergency Room because of the shortness of breath and pain in my back and sides. The doctor ordered a CT Scan of my chest and lungs and labs. The test showed no blood clots but the blood test that determines if you have a clot or that will lead a doctor to get a CT Scan was elevated. The doctor said I was basically ok because I did not have any blood clots. She said I was experiencing some type of respiratory issue. On 4/22/21 I saw an allergist to see if I had some type allergic reaction to the vaccine. My allergist said there was no way to test the components in the vaccine but he did test me for other things. On 4/26/21 I followed up with my PCP and he gave me Maloxicam and a pain medication to take if I needed it. I was in so much pain in my sides that I couldn?t put my arms down comfortably. I continued taking two Tylenol?s every 6 hours. On 4/30/21 I saw my pulmonologist to discuss my symptoms and he talked about the prednisone suppressing my immune system so the one shot that I did get won?t really cover me. He changed my inhaler earlier this year and he said he should have left it where it was because of the time of year and my allergies. My allergist put me back on symbicort and my pulmonologist agrees and he want to keep me on it until next year. I started to feel better on 5/1/2021/ . I did not get the second vaccine because I was afraid. I have never been so sick in my entire life and none of the doctors could really tell me what happened.

Other Meds: Multi vitamin, Zinc, Vitamin C, Vitamin D3

Current Illness: Asthma, Arthritis, Allergies, Slight torn meniscus

ID: 1293270
Sex: M
Age: 61
State:

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/06/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: mixing error occurred, patient may have been given just diluent. Patient was revaccinated 5/5

Other Meds:

Current Illness:

ID: 1293271
Sex: M
Age: 15
State: TX

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: given to a 15 year old. only approved in 16+

Other Meds: n/a

Current Illness:

Date Died: 05/05/2021

ID: 1293272
Sex: F
Age: 61
State:

Vax Date: 04/21/2021
Onset Date: 05/05/2021
Rec V Date: 05/06/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: This 61 year old white female received the covid-19 vaccine on 4/21/21 and died on 5/5/21.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm