VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0952666
Sex: F
Age: 61
State: IL

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: Chest XRay,

Allergies: Thimerosol, diclofenac, wasabi, penicillin

Symptoms: Patient because flush and hives appeared on chest and face. Patient reported palpatations. Denied respiratory distress. Diphenhydramine and EpiPen given. Patient taken to the ED and was improving when she arrived. Monitored in the ED with continuous BP, pulse ox and cardiac monitoring.

Other Meds:

Current Illness:

ID: 0952667
Sex: F
Age: 22
State: WI

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: None

Allergies: Report reaction to either Oxycodone or the PEG 3350 KCL Na Bcb that she was given during a gall bladder surgery. These were given at the same time. Also has Hay fever

Symptoms: Complaints of feeling dizzy/light headed, scratchy throat, chest tightness and a rash on her neck. Pulse ox on RA 99%. Facility Nurse sat with her for 1.5 hours and then she returned to work. Was seen by doctor but not an official office visit.

Other Meds: Juelber

Current Illness: ER visit on Dec 16, 2020 for heart palpatations

ID: 0952668
Sex: F
Age: 50
State: CA

Vax Date: 01/08/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: Penicillin

Symptoms: Redness swelling and welting 5 days after the vaccination

Other Meds: None

Current Illness: None

ID: 0952669
Sex: M
Age: 86
State: CA

Vax Date: 01/15/2021
Onset Date: 01/17/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: n/a

Allergies: n/a

Symptoms: diarrhea, fatigue, head down to buttocks felt like it was burning up, felt like the flu

Other Meds: n/a

Current Illness: n/a

ID: 0952670
Sex: F
Age: 48
State:

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: On 1/14/21 I took ibuprofen at 400. By 9am I was starting to feel achy and had chills. The symptoms progressed throughout the day. I felt feverish and the symptoms worsened. Chills, flush, all over body aches including headache. I went to buy some ibuprofen since I forgot to bring any with me. I felt better after I took the medicine.

Other Meds:

Current Illness:

ID: 0952671
Sex: F
Age: 39
State: IA

Vax Date: 12/22/2020
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital: Y

Lab Data:

Allergies: none

Symptoms: EDD July 4, 2021 January 15th baby no longer had a heartbeat after two previous visits confirming heartbeat and EDD.

Other Meds: Tylenol lovenox Fluoxetine Folate Prenatal MVI magnesium

Current Illness: none

ID: 0952672
Sex: F
Age: 61
State:

Vax Date: 01/12/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: Ilosone, papaya

Symptoms: 61 y.o. female who arrived by Home presented to the emergency department for Evaluation of syncopal episode. Patient reports earlier this morning at 330 she awoke to go get a glass of water, states that she felt significantly weak and felt that she would drop the glass of water she was going to get it. She describes mild associated lightheadedness but denies vertigo, visual disturbance, chest pain, dyspnea. She that went to ambulate to the living room so she lied on the couch, but does not exactly remember what happened after this. She remembers that there is a chair and she thinks she may have fallen forward and hit her head against a chair and fell down to the ground. She notes that she had currently has a fat lip and feels slight abrasions on her knees bilaterally. History is notable for hypertension, dyslipidemia, states has been compliant with her medications. No recent illnesses, cough, colds. She underwent vaccination 3 days ago for COVID with the majority of vaccine and reported 2 days ago she had mild body aches and myalgias, however at present states she feels largely asymptomatic. She was encouraged to present to the emergency department at the request of her coworkers Laboratory work-up largely unremarkable. CT head no acute process. EKG my read sinus rhythm, normal PR, QRS, QTc, no ST segment changes or T wave inversions concerning for ischemia. Discussed the work with the patient recommended that she follow-up as an outpatient with her primary care provider, also provided with a Zio patch and recommend to follow-up with cardiology. Patient extravascular fat study with plan felt comfortable for discharge home. Discharged in stable condition

Other Meds: trazodone, bupropion, lisinopril, hydrochlorothiazide, cetirizine, fluticasone propionate, Montelukast, cyclobenzaprine

Current Illness:

ID: 0952673
Sex: F
Age: 49
State: OH

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: n/a

Allergies: Sulfa

Symptoms: After the vaccination I left after my 15 minute observation and noticed that my lips and the tip of my tongue was numb. As the day progressed the numbness spread out to my cheeks and to the tip of my nose. The next day the numbness was still there, but was going away except for the tip of my tongue. As of today I still have the feeling (as if I burned my tongue and a metallic taste). Food does not taste as good as before.

Other Meds: Cymbalta. Had just finished Keflex 2 days prior to vaccination

Current Illness: Had a tympanoplasty on 12/29/20

ID: 0952674
Sex: F
Age: 35
State: IL

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: N/A

Allergies: n/a

Symptoms: 1. WITHIN MINUTES OF THE VACCINE ADMINISTRATION IN MY LEFT ARM, I HAD LEFT SIDE NECK TENSION AND LEFT SIDE UPPER BACK TENSION 2. AT 9:15PM (DAY OF VACCINE ADMINISTRATION), I DEVELOPED A METALLIC TASTE PAIRED WITH A NUMB FEELING IN MY MOUTH (TONGUE, HARD PALATE). 3. THE METALLIC TASTED LASTED ~30 HOURS POST VACCINE ADMINISTRATION 4. THE MUSCLE TENSION IN MY NEXT AND UPPER BACK SUBSIDED ~2 DAYS POST VACCINE ADMINISTRATION

Other Meds: 75mg SERTRALINE (daily)

Current Illness: n/a

ID: 0952676
Sex: F
Age: 38
State: NC

Vax Date: 01/07/2021
Onset Date: 01/17/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: N/A...just the Vaccine shot

Allergies: Allergic to RAW Carrots, pollen and oak trees

Symptoms: Red, sore, swollen, bumpy patch at injection site. It is hot to the touch as well.

Other Meds: Topomax, Lamictal, Abilify, Prozac, Probiotic, Prilosec and Emergen-C

Current Illness: N/A

ID: 0952677
Sex: M
Age: 60
State: NY

Vax Date: 01/07/2021
Onset Date: 01/11/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: Sonogram on 1/14/2021

Allergies: None

Symptoms: DVT in right leg 4 days after injection, severe pain in thigh/calf, difficulty walking Placed on Xarelto 15mg 2X daily for 21 days and then 20mg daily for 9 days. Next Doctor visit is 1/26/2021 at 9:00am Next scheduled Covid 19 vaccine is scheduled for 2/5/2021 at 7:15am

Other Meds: Valsartan 160mg daily Alfuzosin 10mg daily Aspirin 81mg daily

Current Illness: None

ID: 0952678
Sex: F
Age: 38
State: MI

Vax Date: 01/08/2021
Onset Date: 01/12/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: no

Symptoms: Tough, red, itchy, warm circle around the area of the injection sight. The area continues to increase by the day. It has now been 10 days since the vaccine and the area is the size of a small apple.

Other Meds: no

Current Illness: no

ID: 0952679
Sex: F
Age: 39
State:

Vax Date: 01/07/2021
Onset Date: 01/10/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: fever chills and soar throat 3-4 days after vaccine-covid negative

Other Meds:

Current Illness:

ID: 0952680
Sex: F
Age: 34
State:

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Approximately 3 hrs after vaccine administration - developed full body aches, chills, malaise. Next day these symptoms persisted and also developed stomach ache/nausea, fatigue, mild tachycardia, headache, and fever that peaked at 101.7 then broke before going to sleep. Day 2 post vaccine, continued fatigue and headache as well as sharp stomach pain/cramping. Day 3 post vaccine, fatigue and headache relieved with Tylenol - mild nausea about half the day before resolving.

Other Meds:

Current Illness:

ID: 0952682
Sex: F
Age: 85
State: WV

Vax Date: 01/07/2021
Onset Date: 01/17/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: Penicillin, narcotics, latex, eats shellfish without problems but can not peal shrimp or crabs. Makes her nail soft and her fingers burn.

Symptoms: Ten days after administration complained of sharp pain at injection site. 11 days after - site painful, itching, and 2 1/2 in diameter red area.

Other Meds: Eliquis, valsartan, B12, risperidone, D3, donepezil, melatonin, memantine

Current Illness: Dementia

ID: 0952683
Sex: F
Age: 28
State: AZ

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: N/a

Allergies: Penicillin erythromycin Zithromax Augmentin Omnicef codeine bactrum doxycycline

Symptoms: After almost 15 minutes of receiving vaccine, my mouth, inside and outside, tongue and face wer very tingly and cold. It came from no where. I could even feel it on the top of my mouth. I did not have any trouble breathing or swallowing, it felts like everything fell asleep and that I chugged ice cold water. It lasted for about 40 minutes.

Other Meds: Vitamin C, zinc.

Current Illness: None

ID: 0952684
Sex: F
Age: 39
State: TX

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: CHLOROQUINE

Symptoms: In the evening after the shot, I went to bed and woke up with bad body aches, terrible fever and headaches too. I couldn?t eat anything as I was feeling sore in my mouth. My taste buds were gone. I did take some pain killers(Ibuprofen) that helped me feel better. The symptom?s last for about two days.

Other Meds:

Current Illness:

ID: 0952685
Sex: F
Age: 55
State:

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: woke up the next day feeling nauseous, by 12 noon I had a fever 100.4 feeling very tired malaise and headache. This feeling lasted for 24 hours. By Friday afternoon I was feeling better and by Saturday no reactions. Arm was sore for 24 hours

Other Meds:

Current Illness:

ID: 0952686
Sex: F
Age: 33
State: IN

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: None

Allergies: Sulfa drugs

Symptoms: Local reaction: burning, stinging, redness, swelling and itching at injection site 1 week after injection.

Other Meds: Nuvaring Pepcid Prozac Multivitamin Hair skin and nail vitamin Probiotic Cranberry supplement

Current Illness: None

ID: 0952687
Sex: F
Age: 44
State: AZ

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: None.

Allergies: None

Symptoms: My face started to go numb and feel tingly. My ears also felt plugged, as if I were changing elevations. The effects lasted for a little over an hour.

Other Meds: Women's vitamin, low dose aspirin (81mg), Vit C (1000mg)

Current Illness: None

ID: 0952689
Sex: F
Age: 64
State: TN

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/18/2021
Hospital: Y

Lab Data: 2 EKG,CT Scan, Chest X-ray, 2 sets bloodwork

Allergies: No

Symptoms: After I received the vaccine went home rested temp went up one time 99.0. The next day woke up heart was pounding check my BP 150/80 laid back down. I woke up around 5pm my BP had elevated to 160 (don't remember diastolic reading) pulse rate normal limits. I informed my spouse of what was happening called 911. At the hospital checked vitals, EKG, CT Scan, Chest X-ray, Blood work and Potassium was low took 2 Potassium pills. I went back home on 12/31 returned to work did fine that day. On New Years day everything started back again discomfort went back to ER. I felt like force in my chest the doctor collected my information and I was placed on a low dose BP medication until I return to my PCP, cardiologist(stress test). I followed up with PCP via Telehealth about my BP concerns, my dosage was increased to 25 mg and due to my symptoms I was placed on leave from work 2 wks. I also have a appointment scheduled with Neurologist.

Other Meds: Estrogen, Vit D, Multivitamin, Elderberry

Current Illness: UTI (one month prior)

ID: 0952690
Sex: F
Age: 32
State: MA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: Celiac disease gluten allergy

Symptoms: severe myalgias in back, neck, elbows, knees, hips, wrists, and finger chills excessive tiredness

Other Meds: Spironolactone for acne

Current Illness: none

ID: 0952691
Sex: F
Age: 62
State: TX

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: None

Allergies: Tetracyclines

Symptoms: Patient was diagnosed with covid 19 on 12/28/2020, and received monoclonal antibody infusion on 1/11/2021. Patient had marked yes on questionnaire that she had received monoclonal antibody infusion within 90 days and patient was accidently still given the Modena vaccine on 1/16/2021. Patient was seen by our on call provider, who discussed with patient what had happened and reassured patient that no significant reaction was expected. Doctor discussed with another provider about vaccine series and timeframe. The patient will defer second dose till after 4/11/2021.

Other Meds: Pro Air inhaler Amlodipine 5 mg daily Celebrex 200 mg every morning Vitamin D3 5000 units daily Hyoscyamine 0.125 mg 1 tablet by mouth 4 times daily before meals Metformin 500 mg daily Multi - vitamin daily Telmisartan 80 mg daily Topa

Current Illness: Covid 19 diagnosed on 12/28/2020. Patient received monoclonal antibody infusion on 1/11/2021 and received Moderna vaccine on 1/16/2021

ID: 0952692
Sex: F
Age: 46
State: IN

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: sulfa, lisinopril

Symptoms: SWELLING IN ARM THE SIZE OF A BASEBALL. Redness the size of a quarter that is increasing daily. Now the size of a baseball and growing. hot panful and tender to touch

Other Meds: Prozac, metformin, hydrocodone, carveilol

Current Illness:

ID: 0952693
Sex: F
Age: 34
State: AR

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Headache, chills, body aches

Other Meds: None

Current Illness: None

ID: 0952694
Sex: F
Age: 51
State: CA

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: sulfa antibiotics

Symptoms: Night sweats, intense muscle soreness in upper back-- not just arm, but mostly neck. Also tiredness

Other Meds: none

Current Illness: none

ID: 0952695
Sex: F
Age: 78
State: AL

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: none

Allergies: No

Symptoms: nausea

Other Meds: Losartan, Estradiol, Diltiazem, Duloxetine, Tylenol, Calcium, Preservision, Cosamin DS, Biotin

Current Illness: Seasonal allergies, toenail yeast infection, osteoarthritis

ID: 0952697
Sex: F
Age: 61
State:

Vax Date: 01/13/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: i1/13/21 at about 2;45 pm, I had my second Covid vaccination. had pain on site on left arm 1/14/21 woke up feeling a little tired, went to work. went home early at 1:30 pm, feeling a little chilly. no fever. 1/15/21 in the morning noted pain on Left armpit ( injection site is left arm), pain from left shoulder blade to right shoulder blade. took advil. In the afternoon, about 4:00 pm, noted some swelling and soreness on left armpit. took Advil.. 1/16/21, Called employee health to report this. Advised to take advil and monitor and call pcp if symptoms persists.

Other Meds:

Current Illness:

ID: 0952698
Sex: F
Age: 42
State: MA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: Two negative Covid tests, first on 1/11, second on 1/13/21.

Allergies: N/A

Symptoms: Vaccine given at 8am on 1/5/21. The same afternoon, burning feeling in chest and head, flushed feeling, slight chest tightness and headache started. The symptoms have been returning daily since then. No fever, blood pressure, SpO2 and heart rate in the normal range.

Other Meds: Received the Moderna Covid vaccine, first dose on 1/5/21. Mild redness and soreness at vaccination site on right arm for 2 days. The afternoon of the vaccination, I had burning feeling in my head and upper chest with headache, slight feelin

Current Illness: N/A

ID: 0952699
Sex: F
Age: 0
State:

Vax Date: 12/12/1963
Onset Date: 01/18/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The patients arm swelled up light a ballon. Immediately after the shot. Monitored for 10-15 minutes swelling went down and was advised to take a Benadryl

Other Meds:

Current Illness:

ID: 0952700
Sex: F
Age: 53
State: CA

Vax Date: 01/04/2021
Onset Date: 01/13/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: Visited MD Stat urgent care on Friday, 1/15/21, for medical attention as directed by my Primary MD. No lab tests were drawn at that time. Seen by MD Stat urgent care MD.

Allergies: Pet dander/fur

Symptoms: Pain at injection site Day 2, which resolved. On 1/13/21, 10 days after injection, large welt at site, approximately 9 x 19 cm. With severe itching, pain and swelling. Redness continued to enlarge for days expanding all around upper RT arm. Required medical attention, IM abx of Rocephin, po antibiotics of Bactrim, Keflex. Prednisone 60 mg taper. Also had headache, fatigue for week after.

Other Meds: Symbicort inhaler Advil

Current Illness: Sinus infection

ID: 0952701
Sex: F
Age: 45
State: CA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: n/a

Allergies: NKA

Symptoms: nausea, lump/swelling under left arm/breast, headache severe, body aches at the slightest touch, painful eyes from 1/15-1/17 w/ headache severe, loss of appetite, nausea lasting from 1/15-present day.

Other Meds: hctz, atenolol, lisinopril, levothyroxine

Current Illness: N/A

ID: 0952702
Sex: U
Age: 24
State:

Vax Date: 01/05/2021
Onset Date: 01/10/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: FULL BODY RASH 5 DAYS AFTER VACCINE

Other Meds:

Current Illness:

Date Died: 01/16/2021

ID: 0952704
Sex: M
Age: 79
State: OK

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: Covid 19 : negative and pt lungs clear, all else unknown to reporter -- Daughter

Allergies: N/A

Symptoms: Daughter call in for VAERS report to file for father whom committed suicide 1/16/2021 in the AM after reportable ae of COVID 19 vaccine administered 1/14/2021. Patient sought care twice at ER; first visit by ambulance around 5PM and Friday 1/15/2021 Medical Center: Emergency Room. 1st Discharge summary diagnosis: adverse reaction to COVID shot; 2nd Discharge summary diagnosis: adverse reaction to COVID shot, fever, Panic Disorder-- ER. Medical Center Discharge summary diagnosis: Adverse reaction to the vaccine, acute anxiety. Reportable patient symptoms at, 1st visit : fever, shaking stomach cramps, breathing issues. Medical Center -- No fever, confusion and dementia type, patient would not stay in patient bed; patient would get up and sit down again repeatedly, agitated and anxious. Attempted to urinated hospital bed. Patient committed suicide in home.

Other Meds: Daughter does not know all medications to list at time of reporting

Current Illness: Pneumonia 12/20 not Covid19 related

ID: 0952705
Sex: F
Age: 44
State: TN

Vax Date: 12/26/2020
Onset Date: 12/28/2020
Rec V Date: 01/18/2021
Hospital:

Lab Data: blood work and CT (due to medical history)

Allergies: none

Symptoms: Migraine started 2 days after first dose, came back worse 3 days after dose

Other Meds: lorazepam, Zyrtec, Flonase, Astelin, magnesium glycinate

Current Illness: migraines

ID: 0952706
Sex: F
Age: 32
State: TN

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/18/2021
Hospital:

Lab Data: Chest X Ray (12/25/2020), EKG (12/25/2020)

Allergies:

Symptoms: Patient experienced swelling in her hands and feet and chest pain. Treatment included a strong dose of aspirin. Swelling went down within hours of treatment and rest.

Other Meds: None

Current Illness: None

ID: 0952707
Sex: M
Age: 38
State: NH

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: NKDA

Symptoms: Anaphylaxis (urticaria, tongue swelling, subjective difficulty breathing) starting approx. 24hrs first moderna dose. No prior episodes of anaphylaxis/allergic rxn. Treated with Benadryl 100mg PO (prior to arrival, pt administered), famotidine 20mg IV, Epinepherine 0.3mg IM. Monitored in ED, complete resolution of symptoms, discharged home.

Other Meds: colchicine

Current Illness: None

ID: 0952709
Sex: F
Age: 63
State: FL

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: na

Allergies: Sudafed, morphine

Symptoms: Vaccine received on 1-7-21. On 1-15-21 woke with blood blister at injection site, shadow bruising over most of upper arm, and large (greater than golf ball) inflamation at anterior shoulder/arm (believe may have been a lymph node. Shadow bruising disappeared within few hours. Blood blister disappeared within a day. Enlarged golf ball size area anterior shoulder/arm swelling reduced, but still present. no signs of any of these things prior to appearance on 1-15-21. No injury sustained to cause.

Other Meds: synthroid, tylenol, Vit D ,

Current Illness: na

ID: 0952710
Sex: F
Age: 93
State: MO

Vax Date: 01/10/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: none

Allergies: Cephalosporins, Oxycontin, Penicillins, Pseudoephedrine,

Symptoms: On 1/14/2021 resident began having a loose nonproductive cough. Lungs clear. Increased shortness of breath, Afebrile. Complaints of Left sided rib pain. Resident currently on hospice. Started Duonebs every 6 hrs. Resident also began having loose stools as well.

Other Meds: Senna Plus, Med Pass 2.0, Aspirin, Metoprolol Tartrate, Pepcid

Current Illness: COVID-19 11/9/2020

ID: 0952711
Sex: F
Age: 59
State: TX

Vax Date: 01/06/2021
Onset Date: 01/14/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: I started feeling achy in my shoulders and neck, and my injection site is swollen, red, itchy and feeling bruised. Today I feel slightly better, but I was running a low grade fever of about 100 when I got home in the afternoon. My symptoms have not yet cleared up today, still sore, itchy and red patch on the arm.

Other Meds:

Current Illness:

ID: 0952712
Sex: M
Age: 68
State:

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Hives, Itching on left arm, and both legs. Stated the left leg was worse. He took Benedryl and it resolved.

Other Meds:

Current Illness:

Date Died: 01/16/2021

ID: 0952713
Sex: M
Age: 64
State: MO

Vax Date: 12/30/2020
Onset Date: 01/12/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: PCR and antigen test

Allergies: PCN, Zithromax, Flomax

Symptoms: Weakness, Low O2, death. Positive for COVID on 1/12/21, dies on 1/16/21

Other Meds:

Current Illness:

ID: 0952715
Sex: M
Age: 65
State: PA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Headache & Chills for 24 hours starting on 13 Jan 2021 @ 19:30. Sore Left upper arm for 3 days following the vaccination.

Other Meds: Atorvastatin, Lisinopril, bupropion, multivitamin, fish oil, fiber

Current Illness: None

ID: 0952716
Sex: F
Age: 75
State: CA

Vax Date: 01/17/2021
Onset Date: 01/17/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Headache Sore left arm

Other Meds: None

Current Illness: Parkinsons Disease

ID: 0952717
Sex: F
Age: 60
State: MO

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Clammy, sweating and rash to BUE and chest. Patient will be seeing PCP for treatment.

Other Meds:

Current Illness:

ID: 0952718
Sex: F
Age: 57
State: TX

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/18/2021
Hospital:

Lab Data: Tested for Covid and Influenza will see md this afternoon for severe rash

Allergies: nkda, sensitive to Gluten so avoid

Symptoms: Treated for type B influenza despite having flu shot Sept 31/2020. Treating redness all over since shot with benadryl watching food intake and vitamin intake. Worst break out lasting about 2.5 hours severe with shaking, sweating nausea and discomfort, high blood pressure and dizziness. Benadryl didn't seem to help within 30 mins. Had rash still all evening on arms and face

Other Meds: Tirosint 25mcg- 1 po am for low thyroid Azelastine- 2 sp en bid Montelukast ? 1 po qhs Mucinex 1200mg bid Airborne- 3 po am and occasionally pm calm gummies ? 3 qam b-total ? 1ml qam N-A-C Sustain 600 mcg qam Milk Thistle 350 mg qam Niacin

Current Illness: Jan 7 test positive for Flu type be complete timeline to follow Dec 30 @ 6:30 pm break out in rash all over Dec 31 @ 6:30 pm repeat of night before Eating very little but cut out non organic food I had been eating craisains Jan 1 and 2 no issues when at work eating before and after work not during due to all those surrounding me traveling to see family during break and to try and avoid breaking out at work. Jan 3- eat Mexican dish with Salsa from Serranos from restaurant take out ? break out in rash all over around 7 pm Jan 4 ? eat organic sausage homemade with tomato base break out in rash Jan 5- coughing at work, achy at home, difficulty breathing at night do not sleep most of the night Jan 7 get tested for both Covid and Flu test positive for Type b Flu. Had Flu shot Sept 31, 2020 Eating only organic homemade food or breakfast tacos (eggs, bacon, potato and cheese) from Waterloo, oatmeal, or homemade organic potato soup with non cured bacon. Occasionally drinking Lactose free milk or watered down yogurt when stomach upset at night with gas and burping. Off from work for 10 days to get better sore and tired and having trouble regaining strength. Jan 16- work 11 hour day without issues still sore and limping so take a salt bath when get home. Have organic homemade sweet potatos with califlower rice and beans for dinner to change things up a bit Jan 17- eat breakfast taco at 8:45 am and take vitamins at 11:35 am break out in rash starting at head and working down to the feet. Take 2 benadryl at 11:45 per receipt no fatigue due to p

ID: 0952719
Sex: F
Age: 42
State:

Vax Date: 12/30/2020
Onset Date: 01/08/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies:

Symptoms: 1/8/21 Rt arm swelling, warm. Dx'd localized vaccine reaction

Other Meds:

Current Illness:

ID: 0952720
Sex: F
Age: 26
State: AZ

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: N/A

Allergies: Allergy to ALL tree nuts, food sensitivity to plant proteins

Symptoms: Received second dose of vaccination at approximately 4:50 PM. Awoke at 2:30 AM with mild fever, body aches, chills, and nausea. Got out of bed for to drink fluids; after walking around for approximately 10 to 15 minutes I experienced a blood pressure drop resulting in me passing out on my bathroom floor. Prior to passing out attempts to regulate breathing and placing head between my legs failed to keep me conscious. Unknown duration of time spent passed out on floor; eventually was able to walk back to bed upon waking and lying on floor for additional 5 minutes (conscious). Awoke again at 8 AM with mild fever, chills, and body aches, while experiencing mild drops in blood pressure (no nausea). Symptoms ceased the following day of 1/16/2020.

Other Meds: 60 mg by Vance capsule taken at 6:30 AM day of vaccine

Current Illness: N/A

ID: 0952721
Sex: F
Age: 33
State: CO

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data:

Allergies: Allergic to Lamictal

Symptoms: Fatigue, chills, mild fever, headache, injection site pain, swollen lymph node

Other Meds: Keppra, Prenatal vitamins

Current Illness: None

ID: 0952722
Sex: F
Age: 27
State: ME

Vax Date: 01/06/2021
Onset Date: 01/09/2021
Rec V Date: 01/18/2021
Hospital:

Lab Data: 1/15: COVID negative, mono negative, strep negative. Inflammatory markers were normal.

Allergies: Penicillin, amoxicillin, gluten, dairy, corn, potato

Symptoms: Throat swelling and chest tightness three days after administration of vaccine. Symptoms were managed with over the counter antihistamines until 1/11 when the antihistamines were not working and my throat was swollen and tight, my chest was tight and my voice was horse. I got prescribed prednisone on 1/11 and have been on a long taper of that, with scheduled benadryl, pepcid and zyrtec.

Other Meds: Lamotrigine

Current Illness: None

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm