VAERS 2021 Database www.vaers.hhs.gov

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

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1375091
Sex: F
Age: 51
State: CO

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever, chills, nausea, loss of consciousness, vomiting WHILE UNCONSCIOUS (which seriously could have killed me if I hadn?t passed out in a seated position, slumped with my back against the wall; I could have choked on my vomit if I had passed out lying down!).

Other Meds: Venlafaxine 37.5 mg

Current Illness:

ID: 1375092
Sex: M
Age: 78
State: NE

Vax Date: 03/20/2021
Onset Date: 05/25/2021
Rec V Date: 06/04/2021
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: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Moderna COVID19 Vaccine EUA Hospitalized inpatient 2 days for bronchitis/COPD.

Other Meds: magnesium oxide, metoprolol, metformin, budesonide, folic, cholestyramine, protonix, finasteride, potassium chloride, tamsulosin, furosemide

Current Illness:

ID: 1375093
Sex: M
Age: 18
State:

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

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

Symptoms: Patient fainted within 15 minutes of vaccination. Felt better after resting and was released to home.

Other Meds:

Current Illness:

ID: 1375094
Sex: F
Age: 25
State: MD

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies: Nil

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient received her second dose of the Moderna Covid-19 Vaccine 22 days after administration of First dose on 12/30/2020.

Other Meds: Nil

Current Illness: Nil

ID: 1375096
Sex: M
Age: 36
State: TN

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: Arm pain that continued for weeks, eventually referred to ortho shoulder specialists. Diagnosed with SIRVA. Sending him to physical therapy now.

Other Meds: n/a

Current Illness: n/a

ID: 1375097
Sex: M
Age: 62
State:

Vax Date: 04/12/2021
Onset Date: 05/26/2021
Rec V Date: 06/04/2021
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:

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

Symptoms: G51.0 - Bell's palsy

Other Meds:

Current Illness:

ID: 1375098
Sex: F
Age: 57
State: MA

Vax Date: 03/30/2021
Onset Date: 04/14/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: see above.

Allergies: Sensitivities to gluten, dairy, cane sugar & corn.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: On 4/14/21 experienced increased ringing in left ear & a hard hit of dizziness. Slowly improved over days. On 4/20, had right ear (my good ear) sudden loss of hearing along with a feeling of pressure & fullness. Thought it was a cold, treated w/some improvement w/decongestant. Hearing dropped out one more time before recovering. About 6 days later had a short course of antibiotics for a slight sinus infection (ears looked fine) . On 5/10/21 - had constipation & was pushing on the toilet & got another (worst one yet) hit of dizziness. I have had my PPPD for 9 years including tinnitus in left ear & occasional sinus infections and I have NEVER had anywhere near the amount of issues that I experienced after my 2nd shot including the increase in tinnitus. Since 5/10 I have had an unprecedented amount of near dizziness and off balance issues & am embarking on a course of supplements to improve gut/mucosal health; immune support.

Other Meds: Levothyroxine 75 mcg per day, Allegra 60 mg per day, multi-vitamin 1x daily, fish oil, Quercetin for allergies, Ashwagandha every other day. PhytoB-L 4x drops for hormones - low dose.

Current Illness: Headcold almost gone by 2nd Pfizer shot (3/30/21)

ID: 1375099
Sex: M
Age: 13
State: PA

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Woke up with headache at 9am. Fatigue, achy, sweats and chills starting around 10am and ongoing at present time of 245pm. Vomiting three times (as of now) between 12pm and 245pm.

Other Meds: Prozac, Guanfacine, Focalin

Current Illness: None

ID: 1375100
Sex: F
Age: 47
State: KS

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: None

Allergies: Allergic to sulfa drugs and lanolin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Had a headache for 13 days after the first Pfizer COVID19 shot which started the day after the shot. I rarely have headaches so this was really noticeable to me. I'm not sure if this is an adverse reaction or not, but wanted to report it just in case. I was told that headaches are common close to after getting the shot, but I didn't expect it to last that long. After my 2nd shot on 4/22/21 I had flu like symptoms that started about 12 hours after the shot and lasted for a day.

Other Meds: Allegra and Flinstones multivitamin

Current Illness: None

ID: 1375101
Sex: M
Age: 12
State: MD

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
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: Dizzy,nauseated Brought via wheelchair to medical screening for evaluation by medics. No interventions Left in stable condition at 13:03 p.m. Recorded by RN

Other Meds:

Current Illness:

ID: 1375103
Sex: F
Age: 22
State: KY

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

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

Lab Data: None

Allergies: Metronidazole

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

Symptoms: Patient started feeling tingling and tightness at the throat, with some tachycardia approximately 20 minutes into the vaccination (Admin: 13:43). Due to area of concern and weight, patient was administered (2) tablets of diphenhydramine 25 mg [Geri-Dryl Allergy Relief by Geri-Care] at 13:07 from our travel clinic's emergency kit. Patient reports that they had tachycardia and nervousness prior to the vaccine by 10 minutes. After further inquiry, patient had a recent asthma attack 3-days ago that was also newly diagnosed then. Patient did not have a rescue inhaler but has a prescription on hand. After, 45 minutes of watchful waiting and 32 fl. oz. of water during observation, patient was "feeling fine" and able to converse normally (with laughter), no lightheadedness or further throat sensations.

Other Meds: NEXPLANON

Current Illness: Asthma Attack (3 Days Prior)

ID: 1375104
Sex: F
Age: 14
State: SD

Vax Date: 06/02/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
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: bananas

Symptom List: Rash, Urticaria

Symptoms: itchy, burning, tingling rash on both feet up to the ankles

Other Meds: sertraline Sprintec birth control

Current Illness: none

ID: 1375105
Sex: F
Age: 13
State: WA

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

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

Lab Data: none

Allergies: none

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

Symptoms: Pt missed her menstrual cycle this month. She has been menstruating regularly since age 11 and 5 months without ever missing a period.

Other Meds: Daily multivitamin

Current Illness: none

ID: 1375106
Sex: M
Age: 1
State: PA

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 06/04/2021
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: none

Allergies: none

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

Symptoms: Expired vaccine given. No treatment. No need for revaccination. As per call to Merck these are supported through 6 months after date of expiration. Potency remains unchanged.

Other Meds: nystatin

Current Illness: none

ID: 1375107
Sex: M
Age: 18
State: NY

Vax Date: 05/21/2021
Onset Date: 06/03/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: none

Allergies: ASPARTAME CEFDINIR AMOXICILLIN

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

Symptoms: This is a rash on her left arm encircling this spot check the vaccine Covid 19 and she had the vaccine 1 week ago in the retroperitoneum a day or 2 of that and is now fading away

Other Meds: ALLEGRA ASMANEX NASACORT

Current Illness:

ID: 1375108
Sex: F
Age: 82
State: AZ

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

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

Lab Data: None

Allergies: Latex.

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

Symptoms: Rash on right arm after second shot at first injection site. Burning. Hot.welted. soreness.off and on. Itchy too..its better now. Does not itch anymore but still has redness.

Other Meds: Metropolo. Plavix. Valsartin. Atrostatin. Claritan. Benedryl

Current Illness: CAD. Hypertension.

ID: 1375109
Sex: M
Age: 71
State:

Vax Date: 04/04/2021
Onset Date: 04/23/2021
Rec V Date: 06/04/2021
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: Nontraumatic subarachnoid hemorrhage, unspecified Hemorrhagic cerebrovascular accident (CVA)

Other Meds:

Current Illness:

ID: 1375111
Sex: M
Age: 22
State: NJ

Vax Date: 06/03/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies: Pollen

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fever, chills, and aches started around 1AM the night of the vaccination. Shortly after coughing, wheezing, shortness of breath, and dizziness began and lasted until about 8AM. It was severe enough that I almost went to the ER. But my rescue inhaler was helping to control the coughing some. This was by far the worst ~8 hours of my life. I have never felt anything like it, and I had Covid earlier this spring and it was not nearly as bad.

Other Meds: Xanax, Zyrtec, multivitamins

Current Illness: COVID-19 - Apr 22 first positive test

ID: 1375112
Sex: M
Age: 14
State: WI

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: CLIENTS MOTHER REPORTS CHILD HAD HEART PALPITATIONS AFTER RECEIVING SECOND DOSE. EXACT TIME AND HOW LONG PALPITATIONS STARTED AND LASTED UNKNOWN. CLIENTS MOTHER INFORMED STAFF CHILD WOULD RECEIVE SECOND DOSE AT HIS DOCTORS OFFICE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1375113
Sex: F
Age: 15
State: CO

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

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

Lab Data: None

Allergies: None

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

Symptoms: Immediately after the patient received the vaccine, the patient turned pale and said, "I feel a little dizzy and my vision is blurry." The patient fainted and ended up having a seizure. Once the patient regained consciousness, the patient was nauseated and vomited. Minutes later she had another seizure but immediately came out of it. We asked the patient if this happen to her during the first dose and she said it did not. The patient does not have a history of epilepsy. The patient's mother did say she had the exact same reaction when she had braces put on. The patient sat in the waiting room for 30 minutes while drinking water. Before the patient left, we had check up on her and she said she felt completely fine. I (the pharmacist) called the mother a couple of hours later to check up on the patient. The mother said she felt fine as if nothing ever happened. I did recommend to her that her daughter gets checked up at urgent care today just to be on the safe side. The mother said she has an appointment with her primary care next week.

Other Meds: N/A

Current Illness: None

ID: 1375114
Sex: F
Age: 15
State:

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/04/2021
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: Patient fainted immediately after vaccination, and was described as having seizure-like activity. Patient felt better after resting and drinking juice; refused transport to hospital and was released to home.

Other Meds:

Current Illness:

ID: 1375115
Sex: F
Age: 20
State:

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

Symptom List: Unevaluable event

Symptoms: At approximately 1040 patient reported dizziness and dry mouth to co-lead nurse. Nurse assessed patient vitals: blood pressure 110/70 mmHg, pulse 84 beats/minute and SpO2 98%. Patient denied itchiness, rashes, hives, shortness of breath, difficulty swallowing, and difficulty breathing. Patient stated " I don't drink water". Patient given water and advised to stay 30 minutes for observation. At 1045, patient vitals reassessed: blood pressure 110/70 mmHg, 84 beats/minute, and SpO2 98%. At 1101, patient reassessed. Patient reported she felt better and vitals were 100/60 mmHg, pulse 80 beats/minute, and SpO2 99%. Lead nurse educated patient on signs/symptoms of when to seek emergency care, signing up on v-safe, and to follow up with primary care provider. At 1105, patient left facility with steady gait and unlabored respirations.

Other Meds: None reported

Current Illness: None reported

ID: 1375116
Sex: F
Age: 64
State: MI

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/04/2021
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: none

Allergies:

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

Symptoms: Evening she received shot she became sweaty, dizzy, nauseated and vomited. Lasted "a few days". She took over the counter Dramamine which helped. The vomiting only lasted 1 day- the dizziness lingered. She denied being evaluated by her PCP.

Other Meds: Dramamine

Current Illness:

ID: 1375117
Sex: M
Age: 91
State:

Vax Date: 02/19/2021
Onset Date: 04/14/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: 1/20/21 - INR 2.1 2/17/21 - INR 2.6 3/17/21 - INR 2.2 4/14/21 - INR 3.1 5/5/21 - INR 4.4 5/21/21 - INR 3.8 (10% dosage reduction at this visit) 6/4/21 - INR 2.1 on lower dose.

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Increase in INR value. Patient previously stable and well controlled on warfarin. Dosage decrease required. Stable on 2.5mg daily since 2018. Dosage reduced to 2mg daily.

Other Meds:

Current Illness:

ID: 1375119
Sex: F
Age: 76
State: NC

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies: Augmentin (Nausea, Itching) Lyrica (Confusion) PCN (Rash, Pruritus) Wellbutrin (Shakes) codeine (Anaphylaxis) diltiazem (Swelling)

Symptom List: Injection site pain, Menorrhagia

Symptoms: Medic responded emergency reference allergic reaction at vaccine clinic Medic to find 76/f seated in drivers seat, c/o nausea immediately after receiving vaccine. EMS standby staff on scene. Pt stated she had received vaccine approx 30 minutes prior to EMS arrival and began to feel ill <15 minutes later at which time standby EMS crew were alerted and in turn alerted transport. Pt has extensive list of allergies, including many antibiotics. Pt was A&OX4, pink warm and dry w/ good ABCs/PMS upon EMS arrival. Pt had no apparent life threats/injuries, was PEARL, equal lung sounds. Upon being placed in ambulance pt began to complain of dull ex pressure 2/10. 3 lead displayed sinus rhythm w/ PVCs which pt stated was her normal per pt cardiologist and that she was medicated for same with herbal medication.12 lead obtained, no elevation or depression noted, PVCs still noted, otherwise unremarkable. R-IV access attempted x2, good flash vein blew. 3 and 12 lead obtained to rule out cardiac involvement and monitor for changes. Given reference pt statement of positive ex pressure. Zofran considered, Medic was already at hospital when last IV was unsuccessful, PO zofran not given. No further interventions. Pt moved to stairchair via stand and pivot with assistance, secured via straps and moved to stretcher, pt placed in stretcher via stand and pivot with assitance, covered for comfort, secured via straps/siderails and moved to ambulance without incident. Pt and pt vitals monitored for duration of routine transport. Pt report called for prior to arrival. Upon arrival pt offloaded and moved to bed in ER via sheet draw without assistance. Pt care report given and pt care transferred to ER RN. Medic checked back in service. 76-year-old presenting with nausea and general malaise. Symptoms started about 15 minutes after receiving her COVID-19 vaccine around 2:30 PM. She has been nauseous but had no vomiting. Slight central chest discomfort with palpitations. Also feeling somewhat dizzy. She did not receive any medications. EMS was called and brought her to the ED. Denies any itchy skin, abdominal discomfort, sensation of throat swelling or pain. No wheezing or difficulty breathing. She has had anaphylaxis to medications in the past but she is unsure exactly which ones except for codeine. 76-year-old presenting with possible reaction to the Pfizer COVID-19 vaccine. Constellation of symptoms are not consistent with anaphylaxis but may represent a different type of allergic reaction. Will give Zofran for nausea, Benadryl, and observe. Basic labs and EKG. KG My interpretation of EKG Normal sinus rhythm. Normal axis and intervals. No acute ST elevations or depressions. Reexamination/Reevaluation Patient was observed for over an hour without any progression of symptoms. Her nausea improved with Zofran. No episodes of vomiting in the ED. Discharged with plan to follow-up with her PCP, continue symptom management at home. Diagnosis/Disposition Nausea without vomiting atient Instructions Continue your regular medications as prescribed. Use Zofran 4 mg every 8 hours as needed for nausea. Follow-up with your doctor within the next 1 to 2 days for recheck. Return to the ED if you develop severe difficulty breathing, severe chest pain, intractable nausea and vomiting or have other concerns. RX Given ondansetron: 1 tab, PO/SL, TID, nausea/vomiting, # 10 tab, 0 Refil(s)

Other Meds: lendronate 70 mg oral tablet 70 mg = 1 tab, PO (by Mouth), QMonday aspirin 81 mg oral tablet 81 mg = 1 tab, PO (by Mouth), Daily atenolol 25 mg oral tablet 25 mg = 1 tab, PO (by Mouth), BID atorvastatin 40 mg oral tablet 40 mg = 1 tab, PO (

Current Illness: Unknown

ID: 1375120
Sex: F
Age: 18
State:

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 06/04/2021
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 felt dizzy and momentarily lost consciousness immediately following vaccination. Patient felt better after resting and was released to home.

Other Meds:

Current Illness:

ID: 1375121
Sex: F
Age: 66
State: NY

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/04/2021
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: iodine, lactose, wheat, honey, bees, sulfer,elastic, grass, mold

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: fatigue, vomiting, diarrhea, headache, chills, fever, arm swelling,

Other Meds: xarelto

Current Illness:

ID: 1375122
Sex: F
Age: 72
State: NC

Vax Date: 06/02/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies: shrimp

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: woke up sweating, clothes wet; did not feel sick; changed clothes and went back to bed

Other Meds: Lumigan Centrum Silver

Current Illness:

ID: 1375123
Sex: F
Age: 53
State: OH

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received second dose on day 22. I spoke to patient at 2:40 on 6/4 and she is reporting sciatica, headache and has been sleeping all day. She said she had COVID and was in the hospital for 11 days and her symptoms started with sciatica.

Other Meds:

Current Illness:

ID: 1375124
Sex: M
Age: 14
State: TX

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

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

Lab Data: None

Allergies: None

Symptom List: Nausea

Symptoms: The patient had no adverse event to receiving the vaccination. Patient was 14 years of age at the time of the vaccination and received his vaccine prior to EUA approval for this age group. Mother brought this child in under his 16 year old brother's name in order for him to receive the vaccine.

Other Meds: None

Current Illness: None

ID: 1375125
Sex: F
Age: 73
State: KY

Vax Date: 05/28/2021
Onset Date: 05/28/2021
Rec V Date: 06/04/2021
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: Injection site pain

Symptoms: Patient received second dose of Moderna before recommended window (on day 21 instead of 28)

Other Meds:

Current Illness:

ID: 1375127
Sex: M
Age: 73
State:

Vax Date: 02/24/2021
Onset Date: 05/27/2021
Rec V Date: 06/04/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: I63.9 - CVA (cerebral vascular accident) (CMS/HCC)

Other Meds:

Current Illness:

ID: 1375128
Sex: F
Age: 70
State: MN

Vax Date: 03/03/2021
Onset Date: 03/05/2021
Rec V Date: 06/04/2021
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: None

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

Symptoms: Developed pruritic 2 days after immunization followed by diffuse urticaria over her back, chest, and groin. Started on antihistamines and prednisone which improved symptoms. Had no lip swelling, throat swelling, wheezes, cough, or respiratory symptoms.

Other Meds: Simvastatin, Venlafaxine, estradiol vaginal cream, multivitamin, vitamin D, probiotic

Current Illness: None

ID: 1375129
Sex: F
Age: 30
State: TX

Vax Date: 02/04/2021
Onset Date: 06/03/2021
Rec V Date: 06/04/2021
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: Tremor

Symptoms: Bells Palsy (loss of taste, dry eye, acute facial paralysis on right side of face)

Other Meds: Famotidine, sertraline 100mg, levothyroxine 100mcg, loratadine, multivitamins

Current Illness: None

ID: 1375130
Sex: M
Age: 14
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
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: Dog Dander, Egg White, Fish - Dietary, Milk, Soybean

Symptom List: Erythema, Pruritus

Symptoms: Patient received first dose of COVID vaccine earlier this morning. A few minutes later, felt some throat tightness. No hives, wheezing, face swelling. On exam, no stridor, wheezing, rash; posterior OP clear. Doubt anaphylaxis, most c/f allergic reaction. Mother notes food allergies, no prior epi pen use. No hypoxia. Tolerating PO and secretions. Treated with dose of 25mg PO benadryl and will transfer to ED for continued observation. No stridor, facial swelling, posterior OP swelling throughout observation in clinic prior to transfer to EMS care. Deferred epinephrine.

Other Meds: none

Current Illness: ASTHMA, UNSPECIFIED FOOD ALLERGY ATOPIC DERMATITIS

ID: 1375131
Sex: F
Age: 55
State: CA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/04/2021
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: Codeine, Epinephrine, Pineapple, Reglan, Sulfa, Tdap, Tomatoes

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

Symptoms: Due to allergenic history the patient was to be observed for 30 minutes. After 20 of the 30 minute observation the patient complained of tongue swelling, and some feeling of distress. Clinic RN and physician assessed patient and she was taken to the ED for evaluation and treatment.

Other Meds:

Current Illness: None

ID: 1375132
Sex: F
Age: 18
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient had syncopal episode within a couple of minutes following vaccination. Patient felt better after resting and drinking some juice, and was released to home.

Other Meds:

Current Illness:

ID: 1375133
Sex: F
Age: 60
State: MI

Vax Date: 06/01/2021
Onset Date: 06/02/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: n/a

Allergies: Aspirin, Betadine, Gabapentin, Glipizide, Hydrochlorothiazide, Latex, Morphine, Sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Local irritation to left deltoid including erythema, tenderness, warmth and swelling. She was advised to use OTC Benadryl 25mg every 4-6 hours, Advil OTC as needed and cold compress. Follow up with PCP in 5 days for recheck.

Other Meds:

Current Illness: unknown

ID: 1375135
Sex: F
Age: 72
State:

Vax Date: 03/20/2021
Onset Date: 04/10/2021
Rec V Date: 06/04/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: I63.9 - Acute CVA (cerebrovascular accident)

Other Meds:

Current Illness:

ID: 1375136
Sex: F
Age: 61
State: WI

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 06/04/2021
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: No e

Allergies: Keflex

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

Symptoms: Severe underarm and left breast swelling that lasted 5 days with pain, chills, fever, body aches and fatigue still present 7 days later

Other Meds: Oral contraceptives

Current Illness: None

ID: 1375137
Sex: F
Age: 66
State: TN

Vax Date: 05/08/2021
Onset Date: 05/13/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: None

Allergies: Gluten intolerance

Symptom List: Pain in extremity

Symptoms: Rash began at injection site around May 13, and by May 15 had spread significantly, up to a diameter of approximately 5 to 6 inches. The site was painful, an angry red, hot to the touch, itchy. A hard knot about the size of a half dollar was at the injection site. I took Aleve for the pain and put cortisone cream on the rash for relief. I had chills but no fever. The rash began subsiding around May 18. A "shadow" lasted after that but as of today, June 4, it's no longer visible. I can still feel a hard knot at the injection site, however, a little larger than a grain of rice. In addition, I have had a squeezing sensation in my head, like a hat that is too tight, that began shortly after the shot and is still there but to a lesser degree.

Other Meds: Fluoxetine, 20 mg 1xda Gabapentin, 100 mg 3xda Aleve as needed for pain

Current Illness: Seasonal allergies

ID: 1375138
Sex: M
Age: 66
State: VT

Vax Date: 04/07/2021
Onset Date: 04/14/2021
Rec V Date: 06/04/2021
Hospital:

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

Lab Data: ESR 65 CRP 151 Low titer positive RF All were 4/17/21

Allergies: Amrix, Atenolol, Desipramine, Lipitor, Lopid, Prozac, Zocor

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

Symptoms: Patient developed inflammatory polyarthralgias with elevated inflammatory markers

Other Meds: Ventolin, Flovent, Omeprazole, Flomax, Diltiazem

Current Illness: None

ID: 1375139
Sex: F
Age: 61
State: PA

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

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

Lab Data: NONE

Allergies: NONE

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

Symptoms: PAIN IN ELBOW LOWER ARM AND HAND

Other Meds: NONE

Current Illness: NONE

ID: 1375140
Sex: F
Age: 1
State: PA

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

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

Lab Data: none

Allergies: none

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

Symptoms: Expired vaccine given. No treatment. no need for revaccination. As per call to Merck these are supported through 6 months after date of expiration. Potency remains unchanged

Other Meds: none

Current Illness: none

ID: 1375142
Sex: F
Age: 17
State:

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 06/04/2021
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: Patient had syncopal episode within 15 minutes of vaccination. Patient felt better after resting and drinking some juice and was released to home.

Other Meds:

Current Illness:

ID: 1375143
Sex: F
Age: 45
State: IL

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

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

Lab Data: None

Allergies: Pine nuts

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Bone Aches, extreme fatigue, chills, nausea starting about 12:30 pm on June 3, 2021 and continued throughout night. Fatigue on June 4, 2021. Second dose of COVID shot administered May 4,2021.

Other Meds: Quetiapine Adderall Gabapentin

Current Illness: Bipolar Disorder OCDC

ID: 1375144
Sex: F
Age: 59
State: DC

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 06/04/2021
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: Nil

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

Symptoms: Patient received her second dose of the Moderna Covid-19 vaccine 23 days after administration of first dose of the same vaccine.

Other Meds: Nil

Current Illness: Nil

ID: 1375145
Sex: F
Age: 16
State: MN

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 06/04/2021
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: none

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 5/28 - swelling of right eyelid, 5/30 - swelling of left eyelid, burning eye pain, itchy, felt dizzy, trouble focusing, fatigue

Other Meds: Buproprion 150mg AdderallXR 20mg

Current Illness: none

ID: 1375146
Sex: F
Age: 61
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 06/04/2021
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: Vaccine Administration Error

Other Meds:

Current Illness:

ID: 1375147
Sex: F
Age: 15
State: ND

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

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

Symptoms: Fainted twice about three mins apart. Sprayed her with cool mist and gave her cold water. VS were taken by was 90/62 pulse was 82. Patient stated she hadn?t eaten anything this morning. Afterwards she was put into the van with air conditioner going and her mom went and got her some fruit from the gas station. Symptoms had resolved by time she went home. She was taken home by mother and was advised to call 911 if any other reactions occur.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am