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: 1302145
Sex: M
Age: 43
State: CO

Vax Date: 01/20/2021
Onset Date: 01/01/2021
Rec V Date: 05/10/2021
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: Yellow Jacket Venom , lobster

Symptom List: Dysphagia, Epiglottitis

Symptoms: Taste changes of bitter rubber band and metallic taste most prominent in morning.

Other Meds: None

Current Illness: None

ID: 1302146
Sex: F
Age: 53
State: FL

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: Extreme fatigue, chills, body aches, aching in joints - I did not seek treatment as I knew this was considered a possible side effect of second does. I am only reporting for statistical purposes. The symptoms lasted 2 full days.

Other Meds: none

Current Illness: none

ID: 1302147
Sex: F
Age: 74
State: FL

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/10/2021
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: latex

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

Symptoms: syncope, body aches, nausea

Other Meds: triamcinolone (KENALOG) 0.1 % ointment levothyroxine (SYNTHROID, LEVOTHROID, LEVOXYL) 75 MCG tablet

Current Illness: none

ID: 1302148
Sex: F
Age: 37
State: NY

Vax Date: 05/08/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
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: After the first vaccination, I had headaches that lasted for one week, extreme throbbing behind my right eye. Migraines, lethargy and exhaustion. After my second vaccine on Saturday, I woke up in the middle of the night vomiting violently with the chills, then a fever, headache and muscle aches.

Other Meds: none

Current Illness: none

ID: 1302149
Sex: F
Age: 55
State: IN

Vax Date: 05/08/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
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, Codeine, Peanuts, tree nuts, erythromycin, Fosamax,

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

Symptoms: Tempature 100, pain in arm, knot in arm at injection site, body ache,

Other Meds: Hormone patch, multi vitamins,

Current Illness: None

ID: 1302150
Sex: M
Age: 61
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: Pt complained of SOB. He had a normal pulse ox and RR. He was not exhibiting signs of angioedema or anaphylaxis.

Other Meds: none

Current Illness: none

ID: 1302151
Sex: F
Age: 43
State: CT

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 05/10/2021
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: Ciprofloxacin, cephalexin, bactrim, clarithromycin - GI intolerance/nausea/vomiting

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt reports frequent loose stools after vaccine administration from time of 2nd dose (end of January) until present. She was seen by a GI physician and colonoscopy was completed. Diagnosed with lymphocytic colitis, which the physician has related to vaccine receipt. No history of loose stools or lower GI tract issues prior to vaccine.

Other Meds:

Current Illness:

ID: 1302152
Sex: F
Age: 43
State:

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

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

Lab Data:

Allergies: None.

Symptom List: Pharyngeal swelling

Symptoms: Sore arm, fever, fatigue, body aches, and slight headache. Sore arm started the evening after vaccination while other symptoms started the next day. I received the shot on Monday morning and for the most part felt back to normal on Wednesday.

Other Meds: None.

Current Illness: None.

ID: 1302153
Sex: F
Age: 38
State:

Vax Date: 05/04/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Severe unprovoked anxiety Severe mood swings Inability to sleep for more than 4 hrs

Other Meds: None

Current Illness: None

ID: 1302154
Sex: F
Age: 29
State: FL

Vax Date: 05/07/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Hot, red, hard large circle of skin on arm around injection site. Itching and tight ?like a sunburn? about 4 inches in diameter. Possibly ?Covid arm? allergic reaction. Appeared 2 days after 2nd moderna shot (not experienced after first shot). Still experiencing 3 days out... Female and breastfeeding

Other Meds:

Current Illness:

ID: 1302155
Sex: M
Age: 46
State: PA

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, Lisinopril

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

Symptoms: Line of hives extending from top to bottom of back of the neck. Directly down center of the back of the neck. They are not itchy and are not raised much the following morning.

Other Meds: Metoprolol Tartrate, Escitalopram, Migrelief, Mucinex, Claritin, Abundant Earth brand whole food multivitamin

Current Illness:

ID: 1302156
Sex: F
Age: 36
State: PA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: I am a nursing mother and ended up with an inflamed, painful red breast on the side I received the shot several hours later. Knowing that covid-19 vaccine has not been tested on nursing mothers, I wanted to report side effects as I have noticed nursing peers also stating similar things. I believe this should warrant further data collection so nursing mothers can adequately prepare for this side effect. I had two nights of chills and fever and swollen breast with bruising. Took ibuprofen as well as natural mastitis remedy: sunflower lethicin. Pain has subsided and swelling has reduced.

Other Meds: None

Current Illness: None

ID: 1302157
Sex: F
Age: 48
State: NY

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/10/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Left arm pain, within a couple hours, Muscle pain, joint pain, vomiting, migraine, exhaustion, within 8-10 hours Arm tingling and numbness entire left arm and hand and partial right from Elbow to hand within 24-36 hours that is prolonged and does not seem to be getting better. Very difficult to use my hands.

Other Meds: Citalopram 20MG, Levothyroxine 137 MCG, Estrodiol 1MG, Fluticasone 50 MCG

Current Illness: Nine

ID: 1302158
Sex: M
Age: 18
State: GA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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:

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

Symptoms: Pt passed out just after getting the vaccine for 2 minutes

Other Meds:

Current Illness:

ID: 1302159
Sex: F
Age: 16
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: vasovagal

Other Meds: None

Current Illness:

ID: 1302160
Sex: F
Age: 25
State: IL

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

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

Lab Data:

Allergies: NONE

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

Symptoms: Above employee received her second dose of the Pfizer today. During the follow up assessment she was asked if she had any reactions from the 1st vaccination she claims that she reported to her manager that time that she can't move the right side of face and right eye twitching. She also verbalized that the eye twitching was intermittent for 4-5 days. Never consulted a doctor or ER visit. After vaccine administration she was required to sit for observation for 30 minutes. No reported reactions. Was advised to call the vaccine clinic or RN will call her for follow up. At 14:15 pm RN called above employee while still at work. She claims that the twitching started again on the right eye accompanied by slight throat tightness. Denies any c/o SOB, difficulty of swallowing. Instructed to go to ER but she verbalized she will go home and then go to urgent care if needed but still refused to go to the hospital ER.

Other Meds: NONE

Current Illness: NONE

ID: 1302162
Sex: F
Age: 17
State: TN

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 05/10/2021
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: Vaccine was given to early for age at 17 years, 11 months and 2 weeks.

Other Meds:

Current Illness:

ID: 1302163
Sex: F
Age: 41
State: PA

Vax Date: 01/18/2021
Onset Date: 01/21/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: FEVER., GENERALIZED BODY ACHES, CHEST PAIN/PRESSURE/TIGHNESS

Other Meds: Outpatient Medications fluconazole (DIFLUCAN) 150 mg tablet multivitamin 400 mcg tablet Clinic-Administered Medications levonorgestreL (MIRENA) IUD 52 mg

Current Illness:

ID: 1302164
Sex: F
Age: 64
State: CA

Vax Date: 04/30/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: etodolac; meloxicam

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: tinnitus right ear worse in AM

Other Meds: none

Current Illness:

ID: 1302165
Sex: F
Age: 16
State: NC

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

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

Lab Data:

Allergies:

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

Symptoms: Patient received 2nd dose of COVID vaccine on 5/5/21 outside of our clinic. Developed severe abdominal pain and emesis on 5/6/21 per family. Evaluated medical facility on 5/7/21 and abdominal pain was subsiding, able to tolerate PO intake by that time.

Other Meds:

Current Illness:

ID: 1302166
Sex: M
Age: 59
State: CO

Vax Date: 04/29/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
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: Minor arm pain, fatigue, headaches, lethargy, chills, sweating, 12-36 hrs after 1st and 2nd shots. Fatigue, headaches, lethargy 6-10 days after 2nd shot. Fatigue, headaches, lethargy, with chills and sweating 10 days after 2nd shot

Other Meds: simvastatin , valsartan-hydrochlorothiazide

Current Illness:

ID: 1302167
Sex: F
Age: 48
State: IN

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Latex sensitivity

Symptom List: Unevaluable event

Symptoms: Difficulty swallowing Extreme throat pain and feeling of obstruction in throat Difficulty sleeping and staying asleep

Other Meds: Atorvastatin Vitamins (multi, resveratrol, vitamin D, vitamin B3, reichi, probiotics)

Current Illness: None

ID: 1302168
Sex: M
Age: 67
State: NY

Vax Date: 03/22/2021
Onset Date: 04/15/2021
Rec V Date: 05/10/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Patient reports that he had a PET scan on 4/15/2021 for another condition and was told there was a "shadow" in a lymph node in his groin. He is scheduled for surgery so he will have a biopsy as a precaution later this week. He was also told it was not likely related to the vaccine, but they couldn't be certain. He reports that at the time of vaccination he did have "a bit of a sore arm" after, but no other side effects.

Other Meds:

Current Illness:

ID: 1302169
Sex: F
Age: 92
State: MO

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/10/2021
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: Sulfa Antibiotics;ACE Inhibitors;Calcitonin;Doxycycline;Alendronate;Risedronate

Symptom List: Injection site pain, Pain

Symptoms: Patient had received two prior doses of Pfizer COVID vaccine. That series was completed back in January. Patient is fine with no symptoms.

Other Meds:

Current Illness:

ID: 1302170
Sex: F
Age: 57
State:

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/10/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Swelling of site arm, increased heart rate, dizziness and weakness, hospitalization

Other Meds:

Current Illness:

ID: 1302171
Sex: F
Age: 15
State: TX

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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: Patient under age 16 was vaccinated with Pfizer, which is a vaccine error. She is age 15 and will be 15 when she gets the second vaccine. Troubleshooting: Scribe and vaccinator did not validate age. All parties ignored the age restriction/confirmation of birthdate that was put in place to prevent this type of error. Parent signed consent agreeing that she was at least age 16.

Other Meds:

Current Illness:

ID: 1302172
Sex: M
Age: 31
State: IN

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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: Penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: High fever 103F for over 10 Hours and low fever 100F for another 24 hours

Other Meds: No

Current Illness: No

ID: 1302173
Sex: F
Age: 18
State: GA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/10/2021
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: Pt passed out for few minutes, had seizures like symptoms

Other Meds:

Current Illness:

ID: 1302174
Sex: F
Age: 56
State: NJ

Vax Date: 04/28/2021
Onset Date: 05/04/2021
Rec V Date: 05/10/2021
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: Bactrim, Flagel,

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

Symptoms: pt says about 6 days later her left arm felt like it pins and needles in it the day after taking the vax that felt like paresthesia . On 5/4/2021 she went to the ER. She had multiple test and everything came back negative and everything was ruled out. She was prescribed steroids. On 5/8/2021 the numbness and tingling started on all 10 of her toes and right finger tips and she still has a numb arm. She will FU w/ her PCP on 5/10/2021 via tele visit.

Other Meds: levoxyl 150 mcg. amlodipine 2.5, oxycodone 5mg qhs,

Current Illness:

ID: 1302175
Sex: F
Age: 16
State:

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 05/10/2021
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: Pfizer-BioNTech COVID-10 Vaccine EUA. After receiving the first dose of Pfizer vaccine, patient experienced lightheadedness. This occurred within a couple minutes after administration of vaccine. VS include BP 116/63, P 84, O2 100%. Cetirizine 10mg PO administered at 1535. Patient felt comfortable with no additional or worsening symptoms upon leaving clinic.

Other Meds:

Current Illness:

ID: 1302176
Sex: F
Age: 15
State:

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

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

Lab Data:

Allergies: N/a

Symptom List: Injection site pain

Symptoms: Pt 15 years and 8 months at time of vaccination (under 16 years of age). No physical adverse events observed following vaccination. Mother was present with minor at time of vaccination.

Other Meds: N/a

Current Illness: N/a

ID: 1302177
Sex: F
Age: 43
State: NH

Vax Date: 04/29/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: swelling and large red hard bump on arm Sore and hot to touch - symptoms did not start until week after vaccination - as of today swelling has decreased and site is itchy and still red and sore

Other Meds:

Current Illness:

ID: 1302178
Sex: F
Age: 19
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
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: SOB, difficult to speak, chest tightness

Other Meds:

Current Illness: asthma, anxiety

ID: 1302180
Sex: F
Age: 27
State: VA

Vax Date: 05/04/2021
Onset Date: 05/06/2021
Rec V Date: 05/10/2021
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: Swollen lymph node near left collar bone.

Other Meds: Alayacen (oral birth control)

Current Illness:

ID: 1302181
Sex: F
Age: 63
State: PA

Vax Date: 03/30/2021
Onset Date: 04/15/2021
Rec V Date: 05/10/2021
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: No Known Allergies

Symptom List: Erythema, Pruritus

Symptoms: Acute hypoxic respiratory insufficiency secondary to Covid pneumonia with concerns for possible superimposed bacterial pneumonia. feeling increasingly sick, with fevers, nausea, chills, shortness of breath, loss of taste, and poor appetite. Please take Augmentin 1 g twice daily for 1 day. Please continue taking dexamethasone 6 mg once daily for the next 5 days. Please start taking Lipitor 40 mg once daily.

Other Meds: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler alum-mag hydroxide-simeth (MAALOX) 200-200-20 mg/5 mL suspension amLODIPine (NORVASC) 2.5 mg tablet apixaban (ELIQUIS) 5 mg tablet atenolol (TENORMIN) 50 mg tablet atorvastatin (LI

Current Illness: 63-year-old female with, type 2 diabetes mellitus non-insulin-dependent, hypertension, hyperlipidemia, peripheral vascular disease status post left SFA stent and left popliteal artery TPT bypass with recent angioplasty on 4/13/2020 one of the left tibioperoneal artery and left posterior artery and left lateral plantar artery which she is currently on Plavix, statin presenting with dyspnea with acute respiratory insufficiency found to have sepsis in setting of Covid 19 pneumonia.

ID: 1302182
Sex: F
Age: 17
State: PA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: none

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

Symptoms: syncope in observation area after vaccination, was sent to hospital for further evaluation

Other Meds: none

Current Illness: anemia

ID: 1302183
Sex: F
Age: 18
State: GA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Tingling and numbness in legs and arms

Other Meds:

Current Illness:

ID: 1302184
Sex: F
Age: 47
State: MI

Vax Date: 04/16/2021
Onset Date: 04/29/2021
Rec V Date: 05/10/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Woke up, got out of bed and by the time I reached the foot of the bed, the room spun and my body spun and fell to the ground. I couldn't get up, walk and ease the dizziness and nausea. I went to the ER since it was sudden and extreme - never had any problems with vertigo in my past - and am a healthy, avid daily runner/walker. I passed the neurological tests and left with anti-dizziness and anti-nausea meds.

Other Meds: Losartan Potassium

Current Illness: None

ID: 1302185
Sex: F
Age: 79
State: VA

Vax Date: 04/29/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: PCN

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

Symptoms: Client states she woke up this morning and noted left upper arm to be reddened and swollen. She came to health department to report adverse event. Upon inspection of left upper arm it was noted to be reddened, warm to touch, swollen and client states area was also itchy. Area measures 2 x 2.5 cm. Client noted she also just started taking Clindamycin today bid for 10 days for a gum abscess per her PCP. She was advised to try warm compresses to area and Benadryl topical for itching.

Other Meds: Lisinopril 5 mg bid ASA 81 mg qd Clindamycin bid x 10 days started 5/7/2021

Current Illness:

ID: 1302186
Sex: F
Age: 38
State: PA

Vax Date: 01/18/2021
Onset Date: 01/25/2021
Rec V Date: 05/10/2021
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: NKA

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

Symptoms: Fever or Chills Cough Fatigue Muscle or body aches Headache Sore throat Congestion or running nose

Other Meds: PREVIDENT 5000 SENSITIVE 1.1-5 % paste

Current Illness:

ID: 1302187
Sex: F
Age: 35
State: NJ

Vax Date: 05/08/2021
Onset Date: 05/09/2021
Rec V Date: 05/10/2021
Hospital:

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

Lab Data:

Allergies: Sulfa antibiotics

Symptom List: Pain in extremity

Symptoms: My joints hurt, my lungs felt like I am about to get bronchitis, extremely tired. Slept all day. Freezing cold for most of the day, then towards the end, my body felt like it was on fire.

Other Meds: Xulan, famotidine, B12 injection,

Current Illness:

ID: 1302188
Sex: F
Age: 38
State:

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

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

Lab Data:

Allergies: pheytoin, phenobarb

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

Symptoms: During 15 minute observation period, patinet fell from chair to carpeted floor with seizure lasting 4 mintues, airway maintained, EMS activated. Patient continues to have intermitent seizures till EMS arrived. Left with EMS. Chart review shows no arrival to a ED so unknown to patient outcome. Hx of mutiple ED and hospital admissions due to seizures. Patient notes states not always taking medications due to her work.

Other Meds: Clobazam, levetrazecetam, oxycarbamazepine

Current Illness:

ID: 1302189
Sex: F
Age: 61
State: NY

Vax Date: 04/09/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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 drugs, avocado, ragweed,

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

Symptoms: excessive fatigue went on for two weeks. would lay down for a 20 min nap and wake up 4 hrs later. Swollen glands under my arms. Hot flashes(which I've never had not even when in menopause) Flare up of my arthritis. Headaches. General feeling of malaise.

Other Meds:

Current Illness: none

ID: 1302190
Sex: F
Age: 15
State: PA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 05/10/2021
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: Patient gave a false birthday to show they were 16 years old at the time of vaccination. No adverse events were reported. The patient was actually 15 years old at the time.

Other Meds:

Current Illness:

ID: 1302191
Sex: M
Age: 0
State: FL

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/10/2021
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: None

Symptom List: Vomiting

Symptoms: Light headed

Other Meds: None

Current Illness: None

ID: 1302192
Sex: F
Age: 80
State: PA

Vax Date: 03/30/2021
Onset Date: 04/11/2021
Rec V Date: 05/10/2021
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: Sulfa (Sulfonamide Antibiotics)Swelling Naproxen Sodium Vicodin [Hydrocodone-acetaminophen]Itching

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: nasal congestion

Other Meds: ALPRAZolam (XANAX) 0.5 mg tablet aspirin (BAYER ASPIRIN) tablet atorvastatin (LIPITOR) 10 mg tablet calcium carbonate-vitamin D3 (CALCIUM 500 + D) 500 mg(1,250mg) -400 unit chewable tablet ELIQUIS 5 mg tablet meclizine (ANTIVERT) 12.5 mg ta

Current Illness: RV dysfxn

ID: 1302193
Sex: M
Age: 17
State: VA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/10/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: The first dose of the Moderna vaccine was administered to a 17 year old patient.

Other Meds:

Current Illness:

ID: 1302194
Sex: F
Age: 59
State: MI

Vax Date: 03/30/2021
Onset Date: 03/31/2021
Rec V Date: 05/10/2021
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: Seasonal environmental allergies, bee sting allergy

Symptom List: Injection site swelling, Limb discomfort

Symptoms: None with this injection

Other Meds: Calcium, tumeric, vitamin D, Zyrtec generic

Current Illness: None

ID: 1302195
Sex: F
Age: 17
State: NJ

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: There was NO adverse event. She is 17 years old (underage) and received the Moderna - 1st dose vaccine.

Other Meds:

Current Illness:

ID: 1302196
Sex: F
Age: 67
State: GA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/10/2021
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: Sulfur

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

Symptoms: A few minutes after receiving the shots I broke out into a sweat, the back of my neck was hurting, my vision was narrowing, I was having difficulty breathing, extremely nauseous, felt like I was passing out, trembling. Pharmacist helped me to lay down which took care of the nausea and relieved the passing out feeling. Still had difficulty breathing for several more minutes. BP was 100 over 80. About 30 minutes before I could get up and sit in a chair. Extremely weak. It was two hours before I was strong enough to drive home. Pharmacist offered several times to call an ambulance but since it was gradually improving, I declined.

Other Meds: Colesevelam Hydrochloride 625 mg; Diclofenac Sodium 1% Gel; Zenpep 5000 unit; Pantoprazole Sodium 40 mg; Methocarbamol 750 mg; Fluticasone Propionate Pro 50 mcg; Hydroxychloroquine Sulfate 200 mg; zinc; Vitamin D 5000; multi vitamin

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm