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: 1307655
Sex: F
Age: 49
State:

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: Nuts, tree pollen, soy

Symptom List: Dysphagia, Epiglottitis

Symptoms: Pt received second dose of Pfizer on 5/11/21 was in observation for 20 minutes and c/o itching, no rash visible. Benadryl 50mg IM given with good results. Pt stable.

Other Meds:

Current Illness:

ID: 1307656
Sex: F
Age: 53
State: MD

Vax Date: 01/26/2021
Onset Date: 02/10/2021
Rec V Date: 05/11/2021
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: latex, flu vaccine, amoxicillin, TMP/sulfa, aloe, lanolin, chemical sunscreen, sunshine, lactose, dust, mold, cats

Symptom List: Anxiety, Dyspnoea

Symptoms: Starting about 2 weeks after the second shot, I experienced intense episodic vertigo. Most of the time I had the sensation of spinning on my long axis. Triggering vertigo was somewhat random at first. Frequency and intensity gradually decreased, and then triggering of vertigo seemed to correlate with major changes in position. Eventually it occurred only when I was lying down and switched position from lying on one side to lying on the other (i.e., from left decubitus to right decubitus, or vice versa). Symptoms finally stopped in early May, so duration of symptoms was about 3 months. Very similar symptoms happened when I think I had COVID infection in February 2020 (not confirmed by a test, but the symptoms were consistent)--at that time, about 2 weeks after my initial symptoms, when the infection symptoms were almost gone, I started having similar intense vertigo. The difference the first time around was that the symptoms lasted only about a month. In addition to what I have described above, I had the more expected symptoms of fever, anorexia, intense migraine, intense migrating arthralgias, fatigue, and muscle pain in the neck and shoulder area. That started 12 hours after the shot and went on for 3-4 days. I experienced similar symptoms of lesser intensity and duration following my first COVID shot (12/30/20).

Other Meds: synthroid, claritin, atenolol, norethindrone iron, vitamin B12, probiotics, vitamin E, vitamin D

Current Illness: hypothyroidism, mild hypertension, eczema

Date Died: 04/23/2021

ID: 1307657
Sex: M
Age: 17
State: OH

Vax Date: 04/19/2021
Onset Date: 04/23/2021
Rec V Date: 05/11/2021
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: Death by suicide.

Other Meds: None

Current Illness: none

ID: 1307658
Sex: F
Age: 53
State: PA

Vax Date: 04/09/2021
Onset Date: 04/22/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: Scallops

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 4/29/2021 1. Localized edema 2. H/O factor V Leiden mutation 3. History of deep vein thrombosis (DVT) of lower extremity - patient had Johnson and John vaccine on 4/9/2021. She then developed bilateral leg pain with calf swelling, redness, and warmth about 1 week ago. Patient has a history of DVT and factor V Leiden mutation. She has previously been treated with Eliquis for DVT. Patient concerned for repeat DVT. Recommended bilateral venous dopplers. - VAS US Doppler Venous Lower Extremity Left; Future - VAS US Doppler Venous Lower Extremity Right; Future . Acute deep vein thrombosis (DVT) of calf muscle vein of left lower extremity (HCC) 5. H/O factor V Leiden mutation - patient diagnosed with a new DVT on 4/29/2021. She is currently anticoagulated with Eliquis 5mg 1 tablet BID with plan to continue anticoagulation for at least 6 months. Patient follows with hematology

Other Meds: Medication Sig Dispense Refill ? cholecalciferol, vitamin D3, (VITAMIN D3) 2,000 unit cap capsule Take 2,000 Units by mouth daily. ? famotidine (PEPCID) 40 MG tablet 1 tablet 2 (two) times a day. ? glucos sul 2KCl/msm/chond/C/Mn (GL

Current Illness:

ID: 1307659
Sex: F
Age: 44
State: MD

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: chloroquine

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

Symptoms: muscle ache, fatigue, sore throat, sinus, fever, chills, breathing issues, headache, sense of smell, exhausted, heart palpitations

Other Meds: vitamin d.c

Current Illness:

ID: 1307660
Sex: M
Age: 64
State:

Vax Date: 03/08/2021
Onset Date: 03/15/2021
Rec V Date: 05/11/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: J18.9 - Pneumonia, unspecified organism D69.6 - Thrombocytopenia, unspecified

Other Meds:

Current Illness:

ID: 1307661
Sex: F
Age: 16
State: NM

Vax Date: 04/16/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was given a first dose of Moderna vaccine at age 16.

Other Meds: Estradiol, Trazodone

Current Illness: Vertigo, Claustrophobia

ID: 1307662
Sex: F
Age: 48
State: NC

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

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

Lab Data:

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Immediately after injection, the patient developed a red rash about 2-3 inches in diameter surrounding injection site. She described it as being painful but denied any shortness of breath or systemic symptoms. I observed her for a few more minutes and she asked to leave. She said she was feeling ok and was going to go home and take some Tylenol.

Other Meds: Unknown

Current Illness: Unknown

ID: 1307663
Sex: M
Age: 43
State: KS

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 05/11/2021
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: PCN

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Per patient: Patient received vaccine around noon on the 12 of March 2021 at Community Church. Patient states about 10 -12 hrs later, began an adverse cardiac event. Patient states the day before he injured his knee at work and went to ED from an injury the day before. At the ED they gave Fentanyl and he got sick and told the nurse that he was experience chest pain. Felt burning or falling asleep sensation in arm and chest. Told the nurse he felt like he was having a heart attack. They came in ED with crash cart and confirmed that he was having a heart attack while in ED. Transported from church to hospital.

Other Meds: Plavix, Metoprolol, ASA, Atorvastatin

Current Illness: No

ID: 1307664
Sex: M
Age: 35
State: FL

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: Needle was loose at the hub. When injected the needle, most of the dose spilled on the patient's skin. Wasted that dose and administered another dose in the opposite arm.

Other Meds:

Current Illness:

ID: 1307665
Sex: F
Age: 55
State: MD

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Heart racing, heart was skipping beats for up to two weeks 3-4 times a day and about once every other day the 3rd week. Pains in legs.

Other Meds: Metropolol, lisinopril, baby aspirin

Current Illness: Atrial fibrillation, high blood pressure

ID: 1307666
Sex: M
Age: 22
State: TX

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/11/2021
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: On May 04, 2021 this 22-year-old male patient received his second COVID 19 vaccine on his right arm at 1705. On May 04, 2021 at 1755 the patient complained of pain at the injection site and was treated with acetaminophen 650 mg, the patient also requested acetaminophen on May 05, 2021 at 08:34, 14;49, and 20:50. On May 07, 2021, I spoke to the provider who stated the patient has not complained of pain from the injection site

Other Meds:

Current Illness:

ID: 1307667
Sex: F
Age: 45
State: IL

Vax Date: 04/07/2021
Onset Date: 04/16/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: Tequin

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

Symptoms: The following week my skin became easy on my torso and I small rash broke out on the 17th. I went to see my doctor on April 19th and they confirmed it was shingles. I was given medicine for my shingles. I called the County Health Department and they suggested that I push my second dose back until the outbreak was better. I also let me doctor know about this. They thought it was fine to push back and still get the second shot later. Currently planning to get second shot on 4/13. My age at time of the shot was 44 that auto calculator rounded up to 45 years old. I still have shingles now, but they are healing but still very painful. I had never had them before and was not and am not aware of any underlying health issues. Don't know if this is related to the vaccine, but since it happened so close I wanted to be sure to report it as suggested.

Other Meds: Atorvastatin, Amlodipine, Birth Control, Multi-Vitamin

Current Illness: No

ID: 1307668
Sex: F
Age: 59
State: TN

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

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

Symptoms: shortness of breath, dizziness and nausea

Other Meds: Flovent, Bevespi, Amlodipine, Lantus, Flonase, Protonix, Trulicity, Duloxetine, Metoprolol

Current Illness: none

ID: 1307669
Sex: F
Age: 72
State:

Vax Date: 03/24/2021
Onset Date: 03/26/2021
Rec V Date: 05/11/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: N17.9 - Acute kidney failure, unspecified R65.10 - Systemic inflammatory response syndrome (sirs) of non-infectious origin without acute organ dysfunction

Other Meds:

Current Illness:

ID: 1307670
Sex: F
Age: 82
State: WI

Vax Date: 04/26/2021
Onset Date: 05/04/2021
Rec V Date: 05/11/2021
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: NKDA

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

Symptoms: Patient admitted on 5/5/21 for suspected acute ischemic CVA after presenting with altered speech for a day (last known well on 5/4/21 PM). No CT evidence of an acute intracranial process. Her pacemaker precluded MRI evaluation. Pacer interrogated on 5/6/21 with AT/AF burden <0.1%. She was seen in consultation by neurology. Evaluation and clinical deficits were suggestive of acute ischemic CVA. Risk factors for CVA include age, HTN, Afib. Patient recently received her first COVID-19 vaccine (Pfizer) on 4/26/21. Patient?s symptoms improving with antiplatelet and statin therapies along with blood pressure management. Per Neurology consult, possible etiologies include cardioembolic versus atheroembolic versus thrombotic versus inflammatory related to recent COVID-19 vaccine. The neurologist specifically stated that ?The COVID vaccine was temporally close to this event. I have seen transient CNS inflammation from the vaccine--probability low but still possibility.?

Other Meds: atenolol (TENORMIN) 50 MG tablet Take 1 tablet by mouth daily. benazepril (LOTENSIN) 20 MG tablet Take 1 tablet by mouth daily. Coenzyme Q10 100 MG TABS Take 100 mg by mouth daily. fish oil 1000 MG CAPS Take 1,000 mg by mou

Current Illness:

ID: 1307671
Sex: M
Age: 76
State: UT

Vax Date: 02/10/2021
Onset Date: 02/19/2021
Rec V Date: 05/11/2021
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:

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

Symptoms: pt states his right leg had pain and tightness from the inner thigh to the knee. It was painful to touch. Pt went to his PCP Dr. on 2/22/2021. He had blood work and ordered a sonogram for legs to check for blood clot. He was told to use a topical cream Voltaren which did not help. The sonogram showed that he had multiple blood clots on this inside of this leg down to his calf and was prescribed Xarelto. The blood clots disappeared after a couple of weeks.

Other Meds:

Current Illness:

ID: 1307672
Sex: F
Age: 87
State: PA

Vax Date: 03/24/2021
Onset Date: 03/30/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: ParoxetineConstipation Sulfamethoxazole-trimethoprimNausea Only VenlafaxineConstipation

Symptom List: Ear pain, Hypoaesthesia

Symptoms: low oxygen, fatigued

Other Meds: alendronate (FOSAMAX) 70 mg tablet busPIRone (BUSPAR) 10 mg tablet cholecalciferol, vitamin D3, 50 mcg (2,000 unit) capsule cycloSPORINE (RESTASIS) 0.05 % ophthalmic emulsion docusate sodium (COLACE) 100 mg capsule ergocalciferol (VITAMIN D

Current Illness: Low vitamin D

ID: 1307673
Sex: F
Age: 64
State: NC

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt. states 7-8 hours after receiving vaccine she started feeling dizzy and her equilibrium was off and she had staggering. Pt. states she had dry heaves and on 05/09/2021 at 2-3am heart started racing. Pt. states she also had area on her back itching. Pt. states she thought about calling 911, but she did not and the heart racing quit. Pt. states she did not sleep during the night and she then was very tired and slept from Sunday morning until 5pm on Monday 05/10/2021. Pt. states she still has been extremely sleepy and tired. Pt. describes symptom like "narcolepsy". Pt. has not been to see a healthcare provider about her symptoms. Pt. states no difficulty breathing. Pt. did have left arm soreness

Other Meds: Xanax, Oxycotin, Gabapentin, Zovirax

Current Illness: None stated

ID: 1307674
Sex: F
Age: 18
State: WA

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

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

Lab Data:

Allergies: Unknown

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

Symptoms: Patient experienced syncope and fainted after leaving the immunization area. She hit her face and was treated by paramedics and released. Followed up with her at 1:00pm and she stated she was fine although tired.

Other Meds: Unknown

Current Illness: Patient mentioned low blood sugar and past history of syncope

ID: 1307675
Sex: F
Age: 59
State:

Vax Date: 03/11/2021
Onset Date: 03/15/2021
Rec V Date: 05/11/2021
Hospital: Y

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: K35.80 - Acute appendicitis, uncomplicated

Other Meds:

Current Illness:

ID: 1307676
Sex: M
Age: 29
State: CT

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: Unevaluable event

Symptoms: pt received the johnson and johnson shot at 3:00pm. He began passsing out and myself and his girlfriend helped him to the floor. I administered an epipen 0.3mg. Pt became awake immediately. 911 was called. bp 150/80 when EMT arrived.

Other Meds: alprazolam 1mg

Current Illness: anxiety

ID: 1307677
Sex: F
Age: 60
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/11/2021
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: Tiredness, muscle pain, headache, shivering, fever, nausea. Ibuprofen 800mg. Stayed resting. Effects resolved by 05/07/2021 pm

Other Meds: Simvastatin 80mg, Anoro Ellipta, Ibuprofen 400mg

Current Illness:

ID: 1307678
Sex: M
Age: 54
State: AL

Vax Date: 04/09/2021
Onset Date: 04/11/2021
Rec V Date: 05/11/2021
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 known

Symptom List: Injection site pain, Pain

Symptoms: Patient got injection on 4/9/21 and on 4/11/21 started having severe muscle weakness lasting about a week and a half. He said it was very severe for a few days requiring assistance to walk. Patient visited his doctor for evaluation and was told not to get second dose.

Other Meds: none known

Current Illness: none known

ID: 1307679
Sex: F
Age: 53
State: CA

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

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

Lab Data:

Allergies: AMLODIPINE, CODEINE, PENICILLINS CLASS, SHELLFISH

Symptom List: Injection site pain, Menorrhagia

Symptoms: PT COMPLAINS OF REDNESS, RASH TO BILAT ARMS. C/O ITCHING AND BURNING TO SKIN ON ARMS AND CHEST. CONSULTED WITH ON-SITE MD, WHO ORDERS BENADRYL 25MG PO. PT REMAINS STABLE AND MONITORED FOR ADDITIONAL 30MIN. DISCHARGED TO HOME IN STABLE CONDITION.

Other Meds:

Current Illness:

ID: 1307680
Sex: M
Age: 47
State:

Vax Date: 01/12/2021
Onset Date: 01/24/2021
Rec V Date: 05/11/2021
Hospital: Y

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: E87.1 - Hypo-osmolality and hyponatremia D69.6 - Thrombocytopenia, unspecified

Other Meds:

Current Illness:

ID: 1307681
Sex: F
Age: 47
State: NY

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

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Headache, body ache, fever, cough, nausea, Muscle weakness, fatigue, loss of appetite.

Other Meds: none

Current Illness: none

ID: 1307682
Sex: M
Age: 51
State: MD

Vax Date: 04/28/2021
Onset Date: 05/05/2021
Rec V Date: 05/11/2021
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: I experienced Diarrhea after a week and still have medium symptoms with nausea

Other Meds: Nexium

Current Illness:

ID: 1307683
Sex: M
Age: 59
State: WA

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
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: Morphine

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

Symptoms: Patient reported general malaise, possible low grade fever, myalgias, extreme fatigue beginning in the morning following his first dose of the Moderna vaccine the afternoon prior. Symptoms have persisted without improvement for 4 days. He recently recovered from Covid-19 illness that started on April 2oth and he had returned to work on May 3rd reporting that he was asymptomatic at that time. States his symptoms are consistent with symptoms he had when he was ill with Covid-19.

Other Meds: Unknown

Current Illness: Covid-19 April 20th-Returned to work May 3rd.

ID: 1307684
Sex: F
Age: 55
State: NY

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

Symptom List: Nausea

Symptoms: Reported hives and blisters to bilateral inner extremities. She also reported that blisters developed inside of her mouth. Accompanying symptoms were generalized weakness and an elevated temperature. She reported to have these symptoms on 04/13/2021 around 11:30am.

Other Meds: Garolle reports taking cozar and metformin daily.

Current Illness: None

ID: 1307687
Sex: F
Age: 76
State: NC

Vax Date: 04/21/2021
Onset Date: 04/30/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: penicillin, Levaquin, cipro, biaxin, iv dye; prednisone clindamycin, lisinopril, augmentin

Symptom List: Injection site pain

Symptoms: on post vaccine day #9 pt developed light bruising r antecubital [vaccine was l deltoid] and knots. she has had ongoing mild nontraumatic bruising here and sq nodular lesions ? clot. pt also has had generalized malaise and some mild shortness of breath with this and has generally felt sick.

Other Meds:

Current Illness: none

ID: 1307688
Sex: F
Age: 58
State: CO

Vax Date: 04/15/2021
Onset Date: 05/04/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: Seasonal allergies.

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

Symptoms: 1 day after shot 1: dizziness, earache, nausea, fever, bad headache. Continued for 10 days, days 5 onward short of breath upon exercise. After shot 2: 5 days of mild fever, tiredness. Starting 2.5 weeks post shot 2: Severe debilitating vertigo and disequilibrium and reduced hearing resulting in continuous vomiting for 36 hours and an Urgent Care visit. With OTC nasal sprays, antihistamines, decongestants, Dramamine, 5 days of tiny improvements. 2 days off the OTC meds worsening the vertigo and disequilibrium. I've never had earaches nor episodes of vertigo or disequilibrium before. I'm day 7 since this started, and I still can't drive or walk straight. It's very bad.

Other Meds: None

Current Illness: None

ID: 1307689
Sex: F
Age: 59
State: VA

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 05/11/2021
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: DMSO and lansoprazole

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

Symptoms: SIRVA - Shoulder injury related to vaccine administration. Left shoulder began having severe pain the day after the vaccine and every day after that. It is worse at night. It appears to be bursitis related to improper injection location. Severe restriction of arm movement. Severe pain. No history of pain in shoulder in entire lifetime.

Other Meds: zoloft and tagamet

Current Illness: none

ID: 1307690
Sex: F
Age: 54
State:

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: heart racing, patient states she runs high heart rate.

Other Meds:

Current Illness:

ID: 1307691
Sex: F
Age: 49
State: FL

Vax Date: 04/08/2021
Onset Date: 04/13/2021
Rec V Date: 05/11/2021
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: All Nsaids

Symptom List: Erythema, Pruritus

Symptoms: after about 5 days I developed a huge red welt at the injection site. The welt was about 5 inches in diameter and was hot and itchy. it lasted for a few days. I took Zyrtec and it got better after a few days.

Other Meds: Synthroid

Current Illness: none

ID: 1307692
Sex: F
Age: 66
State: NV

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/11/2021
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: Sulfa drugs

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

Symptoms: Twelve hours after I received the vaccine began to feel warm and flushed. My temporal digital thermometer registered 97.6. I then began to feel chills and body aches. With about 30 minutes I developed a bad headache and tried to rest. I took two Advil and had no relief. My heart felt like it was racing, however, I was not short of breath. I continued to self monitor and see if the Advil might help the headache. The headache and palpitations continued for the next 8 hours. I was extremely frightened. I came very close to calling 911. I continue to feel lightheaded, headaches and fatigue as of today 5/11/2021

Other Meds: Armour Thyroid, Probiotics

Current Illness: None on day of vaccination.

ID: 1307693
Sex: F
Age: 53
State: NC

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Tiredness fatigue muscle aches

Other Meds: Tylenol

Current Illness:

ID: 1307694
Sex: F
Age: 58
State: IL

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pain in the left upper arm....injection site

Other Meds: Mendoza

Current Illness: None

ID: 1307696
Sex: M
Age: 31
State: PA

Vax Date: 03/24/2021
Onset Date: 03/26/2021
Rec V Date: 05/11/2021
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: No Known Allergies

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

Symptoms: URI, bronchitis, allergic rhinitis, atypical pneumonia, community-acquired pneumonia, asthma exacerbation, COPD exacerbation, COVID-19, Other viral illness

Other Meds: None

Current Illness: None

ID: 1307697
Sex: F
Age: 59
State: MI

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: The patient received her second Moderna dose at the left deltoid on 04/17/2021 at 12:15 PM. she stated that at 8 pm of the same day she started feeling Pain, redness, sorness and swelling at the injection site. The symptoms started getting better within few days after the shot except for the pain that was consistent and increasing over days. the pain as she prescribed is in the middle of her upper arm muscle and gets worse when she lift her arm up. she tried to use aleve and aspirin but it seems it did not relieve her pain. After 3 weeks of injection she calls the pharmacy to report the incidence on 05/11/2021 stating that the pain after the injection is not going away and getting worse to the point she cannot even sleep at night.

Other Meds:

Current Illness:

ID: 1307698
Sex: M
Age: 74
State: KY

Vax Date: 02/05/2021
Onset Date: 05/08/2021
Rec V Date: 05/11/2021
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: Pain in extremity

Symptoms: patient tested positive for SARS-CoV-2 after having received complete series of Moderna COVID vaccination

Other Meds: triamterene-hydrochlorothiazide, omeprazole, pravastatin, aspirin, cholecalciferol, betamethasone cream, ketoconazole cream, melatonin, metformin, metoprolol succinate, triamcinolone acetonide cream, vesicare, voltaren gel, sulfasalazine, l

Current Illness:

ID: 1307699
Sex: F
Age: 61
State: WI

Vax Date: 04/08/2021
Onset Date: 04/26/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Two weeks after the 2nd vaccine, experienced lymph node inflammation which manifested itself in muscle twinges all over body.

Other Meds: Multi-vitamin, Vitamin D, Hormone Replacement, Statin (Simvastatin)

Current Illness: None

ID: 1307700
Sex: M
Age: 62
State: MD

Vax Date: 04/08/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient has ringing in the ears and hearing loss. Started after getting the Moderna covid shot

Other Meds: combivent respimat 20/100

Current Illness: none

ID: 1307701
Sex: F
Age: 71
State:

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: 5/11/2021 Client was observed post Covid-19 immunization for 30 minutes based on pre-vaccination screening . During the observation period, she experienced an adverse reaction with the following symptoms: headache. Assessment : Time of assessment 0841. Alert and oriented and Anxious. Actions taken: Vitals sign taken VAERS form obtained and completed by RN. 0841 Vs - BP-152/74. P- 81, O2- 98%, juice given- Blood glucose 115, recheck VS- BP- 159/78, P- 72, O2- 100% Medications administered: No medication administered. Disposition: Reports no further symptoms of adverse reaction after observation for 45 minutes. Discharged home. Immunizations Administered Name Date Dose VIS Date Route Pfizer COVID-19 Vaccine 5/11/2021 8:20 AM 0.3 mL 2/25/2020 Intramuscular Manufacturer: Pfizer, Inc Electronically signed by RN at 5/11/2021 4:06 PM Immunization on 5/11/2021 Detailed Report Note shared with patient

Other Meds:

Current Illness:

ID: 1307702
Sex: M
Age: 17
State: KY

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/11/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Issues with vision, went to eye doctor, referred to retina specialist. Hemorrhaging in the back of left eye. Appointment with pediatrician and pediatric Cardiologist. blood work and EKG done. Follow up with retina doctor on 5/14/21

Other Meds: Methylphenidate 30 mg, Buspirone 15 mg, Guanfacine 2mg

Current Illness:

ID: 1307703
Sex: M
Age: 64
State: LA

Vax Date: 04/06/2021
Onset Date: 04/27/2021
Rec V Date: 05/11/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: 64 yo M with PMHx HTN, HLD, Diverticulitis s/p sigmoid colectomy 6/2020, and Hep C who presented as a transfer from hospital due to acute onset R sided weakness with ICH found on CT scan. History taken from patient bedside. Around 8pm last night 4/27, patient felt acute onset of numbness and weakness to his right lower extremity as he was coming out of the shower. He then tried to sleep and had a restless night. He noticed ataxia with his right leg as he tried to walk around. In the morning, his right upper extremity became numb and weak as well and he decided to go to the ED. Upon arrival, CT Head showed "Acute hematoma of L Lateral thalamus 2 x 2.6cm with surrounding edema and mass effect".

Other Meds: Lisinopril, albuterol, alprazolam, sertraline, pravastatin

Current Illness:

ID: 1307704
Sex: M
Age: 0
State: FL

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 05/11/2021
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: Adverse Reaction Notes Patient reported lightheadedness which subsided after 10 minutes. His vital signs are stable BP 110/65,HR 75,Resp19,02sat 99%.Patient left vaccination site ambulatory in stable condition.

Other Meds:

Current Illness:

ID: 1307705
Sex: F
Age: 30
State: IN

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Covid-19 vaccine given to patient @ 4pm on 5/10/21. Patient started to feel hot within the 15 minute observation period. She claimed she felt well and left coming back to the pharmacy immediately explaining "something was not right." She had trouble breathing, hives, facial swelling, throat swelling, itching, flushing, shortness of breath, chest tightness, throat tightness, anxiety and sweating as well as tachycardia. 911 was called. Epi-pen was provided as recommended by 911 dispatch and per pharmacy Immunization protocol. Fire team arrived and gave the patient O2 and monitored stats. Emergency team arrived and took her to the Emergency room,

Other Meds: Multivitamin, vitamin C and vitamin D, folic acid, antioxidant, chewable fiber tablets

Current Illness: Upper respiratory infection 2 weeks prior requiring amoxicillin. Therapy completed 5/7/2021

ID: 1307706
Sex: F
Age: 16
State: CA

Vax Date: 05/05/2021
Onset Date: 05/07/2021
Rec V Date: 05/11/2021
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: Rash at site of injection site

Other Meds: none

Current Illness:

ID: 1307707
Sex: F
Age: 59
State:

Vax Date: 04/01/2021
Onset Date: 04/20/2021
Rec V Date: 05/11/2021
Hospital: Y

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: R65.10 - Systemic inflammatory response syndrome (sirs) of non-infectious origin without acute organ dysfunction E87.1 - Hypo-osmolality and hyponatremia

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm