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: 1323476
Sex: F
Age: 49
State: OH

Vax Date: 04/01/2021
Onset Date: 04/03/2021
Rec V Date: 05/17/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Saturday April 3,2021 shortness of breath went to hospital on April 12th with multiple unprovoked PE's Stayed in hospital 6 days and released without oxygen Given blood thinners to take for life Right side of heart damaged due to blood clots

Other Meds: Venlafaxine 225mg. Tylenol 500mg, lisinopril 12.5mg, fenofibrate 160mg, Zyrtec 10mg, Peridox 1 ounce, Hydroxyzine 25mg (as needed), Cpap, amlodipine

Current Illness:

ID: 1323477
Sex: F
Age: 46
State: GA

Vax Date: 04/14/2021
Onset Date: 05/10/2021
Rec V Date: 05/17/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Morphine Tetracycline

Symptom List: Anxiety, Dyspnoea

Symptoms: I started having shortness of breath and went to the emergency room. It was determined I had blood clots in both lungs and I was prescribed blood thinners for the next 3-6 months

Other Meds: Lomaira 8 mg Fluoxetine 25mg Charlotte 24 FE Claratin Diphenhydramine HCI, 25mg

Current Illness:

ID: 1323478
Sex: M
Age: 57
State: MO

Vax Date: 05/07/2021
Onset Date: 05/11/2021
Rec V Date: 05/17/2021
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: Valium and Fish

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

Symptoms: Developed shingles on the scalp migrating down to the right eye, blisters on the eyelid and surrounding the eye, swelling below the lower eyelid.

Other Meds: Cyclobenzaprine, Gabapentin, Hydroxyzine, Ibuprofen 800mg, Lisinopril, Metformin, Omeprazole, Tramadol, Benadryl, Calcium, Docusate, Iron, Multivitamin, Ultra-Move-Free.

Current Illness: None

ID: 1323479
Sex: M
Age: 19
State: WI

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: patient received second dose of moderna vaccine 12 days after first dose.

Other Meds:

Current Illness:

ID: 1323480
Sex: F
Age: 41
State: CA

Vax Date: 04/03/2021
Onset Date: 04/17/2021
Rec V Date: 05/17/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: 4/17 Onset of tingling nerve pain in toes, fingers, back. Not resolved yet completely. 4/19 Elevated BP 4/21 Hypertension and some leg weakness 4/22 ER Visit - EKG and Blood test showed no emergency. No medications administered. Released with advice to follow-up with a neurologist. 4/23 - 4/26 Increased tingling pain and weakness 4/27 Virtual Neurologist appointment - unable to diagnose, allows scheduling of in-person visit 4/28 Neurologist prescribed Gabapentin 300mg per day for 3 days, 300mg/3000mg for the next 3 days, 300mg/300mg/300mg per day after 4/29 - 5/3 Weakness so bad that going up and down hills or stairs is risky and painful. Only slow movements are possible. 5/4 In-person visit with Neurologist. EMG and physical test confirm peripheral system impaired. Diagnoses Guillian-Barre Syndrome and facilitates same day hospital admittance. Hospital administers steroid IV, blood tests, Chest X-Ray, Covid Nasal test. 5/5 Lumbar test performed successfully. Results show high protein consistent with Guillian-Barre. Treatments began that night for a series of 5 nightly treatments. 5/6 Tingling increased. Take 300/300/600 of Gabapentin. Leg strength improved. 5/7 - 5/9 Small improvements in leg strength and tingling. Determined PT and OT are not required. 5/10 Discharged to continue Gabapentin at home. 5/13 Tingling decreased slightly. Took Gabapentin 300/300/300 5/17 Still some tingling

Other Meds: Norgestimate and Ethynyl Estradiol Tablets USP 0.25mg / 0.035 mg AmLODIPine 5 mg D3 4000IU VitaFusion Women's Multivitamin

Current Illness: None

ID: 1323481
Sex: F
Age: 21
State: TX

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/17/2021
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: no known allergies

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

Symptoms: Patient vaccinated on 5-13-21 Moderna as second dose. Patient's first dose was Pfizer vaccine on 4-9-21. She did not bring her immunization card. She stated on COVID vaccine screening form that her first dose was Moderna. She signed all Moderna Consent forms. In the late afternoon on 5-13-21 Su Clinica received call from patient that 1st dose was Pfizer.

Other Meds: Xopenex HFA Dulcolax Miralax

Current Illness: abdominal pain constipation Anxiety Asthma

ID: 1323482
Sex: F
Age: 54
State: SC

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Shortness of breath, rash at injection site and going down the arm

Other Meds: Xanax, Hydrocodone, Lexapro

Current Illness: NA

ID: 1323483
Sex: F
Age: 57
State:

Vax Date: 05/13/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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 known

Symptom List: Pharyngeal swelling

Symptoms: COVID arm. Red rash, with hard hot swelling, itchy.

Other Meds: multivitimin, D3 supplement

Current Illness: None

ID: 1323484
Sex: M
Age: 37
State: KS

Vax Date: 04/13/2021
Onset Date: 04/23/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt. reported to the emergency room c/o DIARRHEA and SWELLING OF LEFT FACIAL CHEEK. Informed dr. that he had received the MODERNA vaccine recently (10 days prior). their records did not acknowledge that the doctor identified the reaction as "allergic", but confirmed diarrhea as a diagnosis. Dr. informed pt. to proceed with 2nd Moderna vaccine, but to inform pharmacy of the incident so that he may be observed closely for a reaction.

Other Meds: SERTRALINE; ALLOPURINOL; MELATONIN (OTC)

Current Illness: NONE

ID: 1323485
Sex: F
Age: 25
State: WA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin and other ?cillins?

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Unbearable pain in lower back/legs

Other Meds: Birth control pill

Current Illness: None

ID: 1323486
Sex: M
Age: 31
State: IN

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: High Fever - 99 to 101 ?F: lasted for day and half. Intense Pressure in head and Headache: Tylenol, and ice pack had little to no effect on it. Same time schedule as other symptoms. Slight stomach sensitivity: same time schedule as other symptoms.

Other Meds: Alprazolam 1mg XR, Adderall 30mg XR

Current Illness:

ID: 1323487
Sex: M
Age: 36
State: IN

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Fever, body aches, chills, fatigue.

Other Meds: Lithium

Current Illness: Covid

ID: 1323488
Sex: F
Age: 29
State: PA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Around noon, pt has redness and swelling to injection site, complains it was itchy and hurt, was given hydrocortisone cream and 1 Benadryl for relief, eval by nurse and PA

Other Meds: hydroxyzine hcl 50mg, fluticasone propionate 50mcg, and meclizine hcl 25mg

Current Illness: no

ID: 1323489
Sex: M
Age: 58
State: NY

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/17/2021
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: iodine

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

Symptoms: Dizziness and headache started about 1-2 hours after shot. Felt like I was going to fall when I stood up. Last about 12 hours. Very sore arm at the injection site.

Other Meds: none

Current Illness: none

ID: 1323490
Sex: F
Age: 45
State: TX

Vax Date: 05/01/2021
Onset Date: 05/10/2021
Rec V Date: 05/17/2021
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: Diflucan

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

Symptoms: Extreme Sexual arousal with intense blood rush feeling to genitals lasting 4 days. Very uncomfortable even after intercourse.

Other Meds: Bupropion Escitalopram Valtrex

Current Illness: None

ID: 1323491
Sex: M
Age: 55
State: MI

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: PATIENT RECEIVED PFIZER FOR 2ND DOSE BUT MODERNA FOR 1ST DOSE. MODERNA INFO LOT:002C21A

Other Meds: N/A

Current Illness: NONE

ID: 1323492
Sex: M
Age: 86
State: WY

Vax Date: 03/01/2021
Onset Date: 05/10/2021
Rec V Date: 05/17/2021
Hospital: Y

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: Currently hospitalized with ARDS

Other Meds:

Current Illness:

ID: 1323493
Sex: F
Age: 35
State:

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/17/2021
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: Client received dose 1 of the Moderna COVID vaccine (lot 016C21A, exp 5/22/2021) at 1300. At 1305, patient's husband told EMT and PHN that the patient was not feeling well. Patient reported feeling anxious, nauseous, tremulous with blurry vision. Patient reported a history of syncope related to anxiety. Patient denied medical conditions or allergies. Patient takes vitamins. Vital signs: O2 99%, pulse 70, respirations 12, blood pressure 114/72. At 1310, EMT and PHN monitored patient as she transferred unassisted from the chair in the observation area to the zero-gravity recliner laying down. Patient reported she had eaten breakfast and did not work out previous to coming. At 1315, vital signs O2 99%, pulse 57, respirations 12, blood pressure 112/74. PHN offered Benadryl but patient declined. PHN encouraged patient to follow up with her provider and when to contact 911. Patient reported feeling better with symptoms improved. Patient ate a cookie, drank water, both from the vaccine site, and her own Gatorade. Patient requested to sit up, EMT positioned the patient sitting up at 1325. Patient reported mild dizziness, tingling in her feet, difficulty focusing visually, nausea returned, and new left leg numbness. Vital signs: pulse 69, O2 99%, blood pressure 118/84, respirations 12. PHN encouraged patient to drink water. Patient reported having similar reactions when anxious in the past. Patient focused on breathing and meditation to ease anxiety. Patient reported wanting to leave, PHN encouraged patient to wait for 30min since start of symptoms. Patient declined. PHN encouraged patient to follow up with her provider and when to call ED. Patient's husband left to bring the car up to the front curb. EMT walked patient out to the car. patient left walking with steady gait at 1337.

Other Meds: vitamins

Current Illness:

ID: 1323494
Sex: F
Age: 28
State: CA

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The patient had a vasovagal reaction to the vaccine within minutes of receiving the vaccine. She was given smelling salts, water, juice, chocolate over a period of 30 minutes and observed while remaining seated. She stayed at the pharmacy for an additional 30 minutes and once she felt better, she left.

Other Meds: N/A

Current Illness: N/A

ID: 1323495
Sex: F
Age: 22
State: VA

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Fever Tmax 103, associated nausea and malaise

Other Meds: Amoxicillin

Current Illness: Acute Otitis Media

ID: 1323496
Sex: F
Age: 25
State:

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 05/17/2021
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: seasonal allergies only

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

Symptoms: next day--9:00 am - chills, muscle aches 10:00 am - fever 100.5C while on Acetaminophen fever, chills, severe muscle aches, tiredness continuing all day two days following second dose--extremely swollen lymph nodes under left arm and on left side of throat (same side of body as injection site)-painful to raise arm and painful to swallow swollen lymph nodes persisted until four days following second dose

Other Meds: Cetirizine hydrochloride 10mg (daily allergy medication) Low-Ogestrel (birth control pill)

Current Illness: none

ID: 1323497
Sex: F
Age: 40
State: TX

Vax Date: 03/18/2021
Onset Date: 04/10/2021
Rec V Date: 05/17/2021
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: Since receiving the second dose of CoVid vaccine, my left are has not stopped hurting. It is not continuous, however it has been significant enough to distract me for my daily task. It gets worse at night, especially when I am sleeping. My functionality of that arm has been negatively affected as well. I am not able to comfortably lift the arm sideways as high and not able to lift heavy objects as well.

Other Meds: None.

Current Illness: None.

ID: 1323498
Sex: M
Age: 24
State: PA

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Augmentin

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

Symptoms: Headache, chills, sore arm, diarrhea, tiredness

Other Meds: None

Current Illness: None

ID: 1323499
Sex: M
Age: 43
State: RI

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 05/17/2021
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: N/A

Symptom List: Injection site pain, Pain

Symptoms: Light head/dizzy/spins/nausea/vomiting/body and head ache and pains/chills/101.4 fever lasted for over 30 hours followed by headaches/fatigue that lasted an additional few days. Currently on day 4 with occasional head pain and general fatigue.

Other Meds: Albuterol, Cingulaire

Current Illness: N/A

ID: 1323500
Sex: F
Age: 73
State: TX

Vax Date: 02/09/2021
Onset Date: 02/10/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: some antibiotics

Symptom List: Injection site pain, Menorrhagia

Symptoms: diarrhea several times per day for 2-3 months

Other Meds: amlodipine best, metoprolol succ, atorvastatin, fluticasone

Current Illness:

ID: 1323501
Sex: M
Age: 98
State:

Vax Date: 03/06/2021
Onset Date: 05/04/2021
Rec V Date: 05/17/2021
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: N17.9 - Acute kidney failure, unspecified Altered Mental Status

Other Meds:

Current Illness:

ID: 1323502
Sex: F
Age: 39
State: IN

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
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: Fever that lasted 4 hours. headache and fatigue that lasted 16 hours. Took Advil which helped symptoms.

Other Meds: Lexapro, progesterone birth control pills, allertek, melatonin

Current Illness: None

ID: 1323503
Sex: F
Age: 38
State: CA

Vax Date: 03/19/2021
Onset Date: 03/27/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin, clindamycin, Paxil, band-Aid adhesive, spiders, dogs, Lilly pollen, mildew

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Significant lip swelling, rash around and inside mouth, swelling roof of mouth, sensitivity inside mouth and throat, itching around outside mouth and chin, pressure behind face and neck, anal itching, pain, and swelling

Other Meds: Daily: Benadryl, women?s multivitamin, saccharomyces boulardii probiotic, vitamin C As needed: ibuprofen, albuterol

Current Illness: No illnesses

ID: 1323504
Sex: M
Age: 60
State: IL

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Moderate headache, joint stiffness, muscle aches and skin sensitivity began 8 hours after injection and lasted 36 hours.

Other Meds: None

Current Illness: None

ID: 1323505
Sex: F
Age: 28
State: VA

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Augmentin and penicillin

Symptom List: Nausea

Symptoms: itchy small hives and rash all over body

Other Meds: prenatals (recently had a baby on 05/01/2021)

Current Illness: N/A

ID: 1323506
Sex: F
Age: 61
State: CA

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Allergic to ?exotic? mushrooms

Symptom List: Injection site pain

Symptoms: Constant Tinnitus in both years that sounds like a white noise machine or a fan and clogged ears beginning some time in April not precipitated by a cold or infection that I know of. 2nd Vaccine was March 15.

Other Meds: Wixela 250/50, nasacort, estradiol, progesterone, montelukast, allegra, prilosec, vitamins: calc/magnesium, C, D3, B12

Current Illness:

ID: 1323507
Sex: F
Age: 69
State: OR

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: Dairy

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

Symptoms: I started with joint pain in my wrist and shoulders and hips mostly that continued to get worse and worse and lasted for three weeks. In the past I had Lyme disease and feel like my joints are weakened and had the most reaction from the vaccine.

Other Meds: No

Current Illness: No

ID: 1323508
Sex: F
Age: 74
State:

Vax Date: 03/02/2021
Onset Date: 04/12/2021
Rec V Date: 05/17/2021
Hospital: Y

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: N17.9 - Acute kidney failure, unspecified

Other Meds:

Current Illness:

ID: 1323509
Sex: F
Age: 81
State: TX

Vax Date: 05/09/2021
Onset Date: 05/10/2021
Rec V Date: 05/17/2021
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: no allergies

Symptom List: Tremor

Symptoms: PAIN, SWELLING, ITCHING REDNESS

Other Meds: one a day vit.

Current Illness: none

ID: 1323510
Sex: F
Age: 52
State: UT

Vax Date: 03/10/2021
Onset Date: 03/20/2021
Rec V Date: 05/17/2021
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: Penicillin; Lyrica/ Omeprazole - not allergic but found out that I had an RX match test and these don't function well with me; or no affect on me. No longer on them. Cortizone - may also not be effective on me. I'm allergic to dairy - affects sinuses

Symptom List: Erythema, Pruritus

Symptoms: Soreness in my left arm at the injection site area. I treated with ibuprofen. It was fine the next day - used a lot of motion to help. I rubbed it and I guess I wasn't suppose to. I had no other issues until my typical seasonal allergies but a week an a half later - Saturday, I noticed I was having symptoms and was notified by a family member, that family member on Tuesday after I started having symptoms that they had a positive test. So I got tested at a Rapid Test site. I had productive cough and sinus congestion and some chest pain and shortness of breath. That went on for about a week and a half. I contacted my physician after the positive COVID test and because I have asthma related to the Hiatal hernia - and I increased to maximum dosage on Advair. That worked. Mucinex with Sudafed to dry that out. And started to use Cool Mist Humidifier and had that in my room constantly and I did self isolate to my bedroom during that time. Vicks vapor rub on my chest. I wasn't running a fever - it varied slightly but it never went over 99. My highest temperature I think was 98. I monitored my O2 with finger monitor - as I had shortness of breath doing stairs. Lowest around 88 but then it would return to 96 or 97 in about 15 minutes. Follow up with doctor (primary care doctor) - telemed appt.

Other Meds: Lyrica; Tizanidine; Omeprazole; Cimetidine; Advair; Singulair; Magnesium; Calcium; Nasacort - nasal spray

Current Illness: seasonal allergies

ID: 1323511
Sex: F
Age: 68
State: NJ

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Lactose intollerant, Erithromycin, Niaspan, Vicryl sutures, Furadantin

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

Symptoms: Fever higher than 100.3

Other Meds: Atorvastatin, Losartan, Hydrocholothiazide, Allopuronol, Sertraline, Montelukast, Zetia, Baby aspirin - 81 mg, Prilosec, Omega 3 with Vitamin D supplement, Centrum for Women, Zinc, Vitamin C, Biotin, Elderberry

Current Illness: no

ID: 1323512
Sex: F
Age: 66
State: NY

Vax Date: 05/02/2021
Onset Date: 05/06/2021
Rec V Date: 05/17/2021
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: IV contrast dye codeine

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

Symptoms: No chest pain prior to receiving second Pfizer shot on May 2, 2021 had headaches and dizziness for 2-3 days after. On May 6, 2021 woke up to sharp pain in left side of chest -- went to work anyway --by 11:00a.m. I left to go wherein an EKG was perform. Was told to go to the emergency room as the diagnosis was "Atrioventricular block, Mobitz type 2. My son took me to Emergency Room where another EKG was performed, chest xrays and lots of blood was drawn. Bloodwork was fine - xray showed a spot on lung that was there for 15years (it's being monitored) I do not know what the results of the EKG was.. left emergency room after waiting close to ten hours. Waiting for appointment with a cardiologist.

Other Meds: Venlafaxine 37.5 mg Levothyroxine 0.100mg omeprazole lisinopril 10mg

Current Illness:

ID: 1323513
Sex: F
Age: 61
State: FL

Vax Date: 04/25/2021
Onset Date: 04/26/2021
Rec V Date: 05/17/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt reports after receiving her vaccines and for the past 3 weeks she is still in a lot of physical pain, difficult to walk, and lots of muscle and joint pain in the side she received the vaccine. She has not been able to sleep and her brain feels foggy, states the her memory has been affected severely. Pt also reports still having diarrhea, vomiting and coughs sometimes. At time of call pt also reports she is feeling shaky. Pt states all these symptoms she is experiencing is all because of the vaccine. Pt reports she took Tylenol, and did not help. Pt reports that she called her MD today and was told she should still get her second vaccine.

Other Meds: Metoprolol Alprazolam Losartan Pristiq Levothyroxine OTC - Ibuprofen tablets

Current Illness:

Date Died: 05/16/2021

ID: 1323514
Sex: M
Age: 54
State: GA

Vax Date: 05/14/2021
Onset Date: 05/16/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: NONE LISTED

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

Symptoms: Son came into Health Dept this morning to report that his father began throwing up and having diarrhea Saturday morning(05/15/2021) which progressed through the day. States did not want to go to the Hospital but wanted to wait to see his MD at the Dialysis center on Monday (05/17/2021). On Sunday(05/16/2021) nausea and vomiting and diarrhea was worse and now with cough noted. States was washing his hands and fainted, EMS was called and he died that morning.

Other Meds: NONE LISTED ON CONSENT

Current Illness: NONE LISTED

ID: 1323515
Sex: F
Age: 28
State: CA

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Dizziness, pt feeling "very slightly faint". c/o left side of neck muscle pain. Seen by Dr. To stretch, mobilize left arm. Increase fluid intake. Pt stable & released from vaccination site

Other Meds:

Current Illness:

ID: 1323516
Sex: M
Age: 65
State: MN

Vax Date: 03/14/2021
Onset Date: 05/10/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Tested positive for COVID >14 days after fully vaccinated

Other Meds:

Current Illness:

ID: 1323517
Sex: M
Age: 60
State: PA

Vax Date: 05/07/2021
Onset Date: 05/14/2021
Rec V Date: 05/17/2021
Hospital:

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

Lab Data:

Allergies: hyperactive if I digest Steroids

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

Symptoms: Got up on Friday morning and almost fell over and had to be careful not to fall while walking to bathroom to get a shower. That night I was dizzy and could not lay down and especially could not lay on side so I propped up pillows and slept upright. Same thing Saturday night but less. Some thing on Sunday night but much less. Just a little spaced out on Monday and slight headache. CAlled doctor, no call back yet but I did not want to go to ER. So far it is going in the right direction. Had minor headache initially, night 2, but tylenol worked to relieve.

Other Meds: Allegra. Take CalMax every other night that has magnesium, calcium and vitamin D.

Current Illness:

ID: 1323518
Sex: F
Age: 71
State: IN

Vax Date: 05/15/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Codeine

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

Symptoms: Sore arm, pink/itchy area below where shot was given. Slight flu like symptoms: achy, slight fever, tired, but didn't feel bad enough to stay in bed. Two days after shot, all symptoms gone except sore arm and pink/itchy area below where shot was given.

Other Meds: Levothyroxine Sodium .112mcg Lisinopril 40mg Rosuvastatin 20mg Carvedilol 12.5mg HCTZ 12.5mg

Current Illness:

ID: 1323520
Sex: F
Age: 69
State: ID

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/17/2021
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: ? Lisinopril, Clarithromycin and Penicillin (Anaphylaxis) ? Simcor, Lipitor, Crestor, Statins and Ace Inhibitors (Puritis, Facial Edema with statins) ? Codeine and Erythromycin (Nausea and vomiting)

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

Symptoms: Back began mildly itching by late evening on 5/13. In the morning when I woke, my back was wet where a blister had developed and popped. The blister was about the size of a 50 cent piece. It continued oozing until about noon. I could see some welts had developed but could not see all of my back.

Other Meds: ? Eliquis 2.5 mg/2x day ? Levothyroxine 100 mcg/day ? Omeprazole 40 mg/day ? Metoprolol 25 mg/day Chelated Magnesium 200 mg/day Brain Dynamics

Current Illness: None

ID: 1323521
Sex: F
Age: 97
State:

Vax Date: 01/18/2021
Onset Date: 05/12/2021
Rec V Date: 05/17/2021
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: D69.6 - Thrombocytopenia, unspecified

Other Meds:

Current Illness:

ID: 1323522
Sex: M
Age: 13
State: CO

Vax Date: 05/13/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: sore throat, fatigue starting the day after administration, still ongoing

Other Meds: Pt's mom says he has had fatigue, sore throat, since receiving the vaccine, has been given tylenol but says it has not helped

Current Illness: none

ID: 1323523
Sex: F
Age: 62
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/17/2021
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: Lightheaded

Other Meds:

Current Illness:

ID: 1323524
Sex: F
Age: 17
State: WI

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/17/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient was vaccinated at the age of 17 with the Moderna Covid-19 vaccine. No adverse events with vaccination.

Other Meds: No

Current Illness: No

ID: 1323525
Sex: F
Age: 63
State: MI

Vax Date: 02/25/2021
Onset Date: 05/05/2021
Rec V Date: 05/17/2021
Hospital: Y

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

Lab Data:

Allergies: Demerol, Amitriptyline, prozac, naproxen, ibuprofen, tramadol, codeine

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: May 5 ,2021 patient became dizzy, diarrhea, syncopal poor appetite, feeling lethargic, having chills. "I couldn't keep anything down"

Other Meds: none

Current Illness: none

ID: 1323526
Sex: F
Age: 36
State: NY

Vax Date: 04/12/2021
Onset Date: 05/15/2021
Rec V Date: 05/17/2021
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: Ibuprofen and amoxicillin

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

Symptoms: 36-year old female presents with 3 day(s) of mild rash that is worsening. Patient has associated rash (small patch if vesicular rash between shoulder blades), and erythema. Patient denies chills, fatigue, fever, swelling, itch (skin), drainage, and warmth. PMH Herpes Zoster 20 years ago; rash on back similar to current outbreak. Had COVID-19 Pfizer COVID-19 vaccination second dose 3 weeks ago. TREATMENT: valacyclovir 1 gm. 3x per day for 7 days. When blisters break keep skin clean and dry.

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm