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: 0920491
Sex: F
Age: 49
State: IN

Vax Date: 12/17/2020
Onset Date: 12/22/2020
Rec V Date: 01/05/2021
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: PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: Itchy rash developed on extremities and buttocks.

Other Meds: Zyrtec, Xyzal, Advair

Current Illness: none

ID: 0920492
Sex: M
Age: 28
State: TN

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Very similar symptoms to Renault?s syndrome. Pain and tingling in feet after exposure to cold water or ambient cold. It causes numbness and tingling in the extremities.

Other Meds: None

Current Illness: None

ID: 0920493
Sex: F
Age: 55
State: MA

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
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: Percocet (nausea / vomiting) Bactrim (vomiting)

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

Symptoms: PATIENT CAME IN TO GET FIRST DOSE MODERNA VACCINE AT APPROXIMATELY 1430, IMMEDIATELY AFTER DOSE GIVEN PATIENT SAID SHE HAD A "METALLIC TASTE" IN HER MOUTH BUT FELT FINE. AFTER SITTING FOR HER OBSERVASTION TIME, PATIENT STOOD UP AND BECAME SLIGHTLY DIZZY. BLOOD PRESSURE TAKEN WHICH WAS NORMAL FOR THE PATIENT, IN ADDITION PATIENT SAID SHE FELT FINE THROUGHOUT. PATIENT WAS GIVEN A CUP OF WATER AND WAS ABLE TO STAND AND WALK OUT OF CLINIC WITH NO ISSUE.

Other Meds: Unknown

Current Illness: Unknown

ID: 0920494
Sex: F
Age: 37
State: NY

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: Intolerances: wheat, corn, walnuts, sesame, diary

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Rash at injection site developed one week after receiving the vaccine. Rash is hot to the touch, a bit hard, and slightly itchy. Not sure if this is related but have a lot of muscle soreness and discomfort in upper back/neck/shoulder area since Sunday 01/03

Other Meds: Vyvanse 60mg Wellbutrin 300mg Lexapro 10mg Vylacyclovir 1/2 mg Glycopyrrolate 1mg (took for the first time on 01/04/21 - prescribed to help with sweating caused by antidepressants) 2,000 IU of Vitamin D3 Garden of Life Vitamin Code multivit

Current Illness: n/a

ID: 0920495
Sex: F
Age: 57
State: TN

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

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

Lab Data:

Allergies: Celebrex- causes mouth/lips to swell and break out in hives

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

Symptoms: Took aleve prior to receiving vaccine. Has known allergy to celebrex which causes mouth/lips to swell and break out in hives. Approx. 45 minutes later she became flushed, felt lightheaded/intoxicated/giddy/silly while driving home. She said she was extremely hungry ("like a big dose of steroids"). She states her ears were ringing and when she laid down at 2130 she could feel her heart beating throughout her body. This AM she reports feeling "hungover/groggy/nauseated". She denied any lip/tongue swelling, any lip or extremity tingling, difficulty breathing, any injection site redness/heat/swollen/painful area, fever, chills, or ever having a vaccine reaction previously. Spoke with individual w/pharmacy. Advised to report to VAERS. Not an expected reaction. Possibly related to aleve vs. covid vaccine.

Other Meds: Aleve prior to vaccine. Takes Omeprazole daily, Biotin supplement

Current Illness: None

ID: 0920496
Sex: M
Age: 53
State: OR

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
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: unknown

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

Symptoms: hx of anaphylaxis to MMR. during prolonged observation period developed sensation of heat across chest and into throat, and lip felt numb. had taken Benadryl prior to arriving to clinic. Started to improve but with concern of symptoms worsening once Benadryl wears off, he was directed to the ER by private auto. not permitted to drive himself, wife came and picked him up.

Other Meds: unknown

Current Illness: unknown

ID: 0920497
Sex: M
Age: 49
State: MO

Vax Date: 12/24/2020
Onset Date: 12/26/2020
Rec V Date: 01/05/2021
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: compazine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Dec 26 woke up at 0400 with fever 101.6 , chills, sever headache, body aches and very dizzy and nauseated sick for 3 days

Other Meds:

Current Illness:

ID: 0920498
Sex: M
Age: 34
State: NY

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

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

Lab Data:

Allergies: No known Allergies

Symptom List: Pharyngeal swelling

Symptoms: Patient complained of feeling dizzy after receiving vaccine. Patient stated he needs to lie down. Patient diaphoretic placed on stretcher. BP 105/65, HR 64, RR 14, SP02 95% RA. Patient felt better in stretcher. Talking

Other Meds:

Current Illness:

ID: 0920499
Sex: F
Age: 34
State: TX

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

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

Lab Data:

Allergies: PCN

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Vaccine at 1600hrs on 1/4/2021. Had hives, itching, arm soreness, chills, and body aches, at 1800hrs 1/4/2021. Could not sleep all night. Took Clear fast acting allergy relief 30ml next morning (1/5/2021). Hives and itching started on left wrist then right wrist. It then progressed to all over her body. She says it is like when she has a reaction to PCN.

Other Meds: Tylenol

Current Illness: No

ID: 0920501
Sex: F
Age: 50
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
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: Contrast Dye Erythromycin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: At 6:00 am on 1/5/2021, I woke up with a swollen face. Took a Benadryl. At 0630 I started vomiting Some SOB and wheezing I feel better after vomiting, Benadryl, and inhalers

Other Meds: Levothroid Glioizide Metformin Inhalers

Current Illness: None

ID: 0920502
Sex: F
Age: 56
State: SC

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: unknown

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

Symptoms: Developed a rash in the evening after dose #1...in the wrist area, circular around entire wrist...looks like a contact dermatitis. Left wrist Topicals not helping. Wears a watch on that wrist, but not that day.

Other Meds: unknown

Current Illness: unknown

ID: 0920503
Sex: M
Age: 42
State: TX

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/05/2021
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: No known allergies

Symptom List: Rash, Urticaria

Symptoms: Empoyee received his 1st dose of Covid-19 vaccine around 1535 on 12/17 at our vaccination clinic. Around 1545, while being monitored by a registered nurse, he leaned over and grabbed his head. The nurse asked if he was okay and he reported, "no". He stated that he felt nauseated. V/S obtained: B/P 158/80; pulse 99; resp 24; O2 sat 99% on RA; FSBS 267. Pupils were slow to react. Skin was flushed and red. Dr. was notified and assessed the employee. At 1558, the Dr. ordered Benadryl 50mg IM. This was given to employee in Left Deltoid IM at 1558 by RN. At 1559, patient complained of heache, chest tightness, being cold. At 1606, O2 sat was 99% on RA; B/P was 126/90. He reported that his headache was going away at that time and that the chest tightness was going away as well. Headache at that time was a 4/5 on pain scale. Recommended that he be checked at the ER. Between 1620-1625, first responders on site. At 1630, employee was transported to ER for evaluation. Status at time of transfer: Alert and Oriented; headache better, nausea getting better.

Other Meds: UKN

Current Illness: Did not disclose anything

ID: 0920504
Sex: F
Age: 27
State: MO

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Fever, chills, redness, swelling and tenderness at injection site, hardned knot at injection site

Other Meds:

Current Illness:

ID: 0920505
Sex: F
Age: 39
State: CT

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
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: Augmentin - hives

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

Symptoms: Several minutes following vaccine c/o feeling flushed and "really hot." She was hypertensive and tachycardic throughout the monitoring period following vaccine. She c/o headache, nausea, hot and cold, flushed, noted blotchy skin and shaking hands (noted prior to vaccine) Evaluated by physician on site and spouse was called to transport patient home. She was given instructions on when to return to the ED

Other Meds:

Current Illness:

ID: 0920506
Sex: F
Age: 31
State: FL

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
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: Penicillin, Z-pak

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

Symptoms: Red, hot, swollen arm within 12 hours. Subsided within approximately 48 hours. Reemerged hot, red, and itchy at day 7 post vaccine. Day after extreme fatigue and headache. Subsided within 24 hours.

Other Meds: Yaz, Nexium, Singulair, Zyrtec, Lexapro, Buspar

Current Illness: None

ID: 0920507
Sex: F
Age: 38
State: PR

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: CODEINA

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

Symptoms: PTE PRESENTA MAREOS Y BP ELEVADA. POR LO QUE REQUIERE SER EVALUADA POR MD DE TURNO.

Other Meds:

Current Illness:

ID: 0920508
Sex: M
Age: 45
State: NY

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: None

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

Symptoms: Pain at site of injection, fatigue, headache, muscle aches, chills, fever, injection site swelling, and nausea. Symptoms faded after 24 hours. Tylenol was taken for 102.4 fever.

Other Meds: None

Current Illness: none

ID: 0920509
Sex: F
Age: 28
State: MD

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Moderna COVID-19 Vaccine EUA 12/31-30 minutes after vaccine, headache, lightheaded, hot flashes (all day) 1/1- headache, nauseated, chills, lower back pain (all day) 1/2-headache, hot flashes (all day) 1/3-headache (all day) 1/4-headache (all day) 1/5-mild headache took NSAIDS and Acetaminophen everyday, all day long- no headache relief

Other Meds: Multi-vitamin, Zoloft

Current Illness: none

ID: 0920510
Sex: F
Age: 64
State: TX

Vax Date: 12/17/2020
Onset Date: 12/18/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: compazine

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Vaccine given on 12/17/20 went to ER on 12/18/20 . Started having diarrhea at 4am on 12/18/2020. Came in to work and felt short of breath and heart rate increased. She went to the ER. She was given a liter of fluid 0.9% NACL IV, and per employee all symptoms resolved and she was discharged. She reports no further problems.

Other Meds: Lisinopril, Liothyronine, insulin lispro

Current Illness:

ID: 0920511
Sex: F
Age: 60
State: MA

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Patient vaccinated at 0910, reported "feeling lightheaded and dizzy" around 0940. This RN assessed patient and took VS (O2sat: 100%, BP: 120/74 (RUA), RR: 16, HR: 67 bpm). Patient remained seated and was provided with water. Patient states she had not drank water at all this morning. Patient reported feeling better with no further adverse reactions and left observation room at 0949.

Other Meds:

Current Illness:

ID: 0920512
Sex: F
Age: 23
State: NY

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/05/2021
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: sulfa

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

Symptoms: cellulitus on left arm at injection site, fever for 24 hours, pain, cellulitus lasting a week that spread to another area of arm that was hot to touch and itchy

Other Meds: propanalol, zetia, liptior, prozac, buspar, fioriset, maxalt, zolfran, ibuprofen

Current Illness:

ID: 0920513
Sex: F
Age: 53
State: FL

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

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

Lab Data:

Allergies: Sulfa, losartan

Symptom List: Unevaluable event

Symptoms: Serious fatigue, runny nose, then into severe body aches and couldnt get warm and then waking in mid of night severly shivering for an hour and a half, temp was 100 f all the while taking 800mg ibuprofen q 6hrs since vaccine

Other Meds: Metoprolol succinate 50mg one tab at night. Claritin 10 mg at night. Docusate 3 capsules daily. Omeprazole 20mg at night. Vit C,D, Zinc. Biotin. 800 mg Ibuprofen every 6 hrs. ( started ibuprofen doses an hour after vaccination)

Current Illness: None - But had severe Covid end of June 2020 to the beginning of Aug 2020

ID: 0920514
Sex: M
Age: 57
State: ME

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: $ hours following the vaccination, I felt very faint and dizzy and nearly passed out. I checked my blood pressure, which was normal. My pulse rate was low (58). I remained dizzy and weak for the rest of the day, with some nausea, but no vomitting. My dizzyness and weakness gradually dissipated over the next 3 days.

Other Meds: omeprazole

Current Illness:

ID: 0920515
Sex: F
Age: 39
State: GA

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

Symptom List: Injection site pain, Pain

Symptoms: Patient having extreme chills starting at 6am. She took anti-inflammatory and came to work. Temp 97.8

Other Meds: metoprolol BCP

Current Illness: none

ID: 0920516
Sex: F
Age: 38
State: MI

Vax Date: 12/21/2020
Onset Date: 12/22/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: shellfish

Symptom List: Injection site pain, Menorrhagia

Symptoms: I felt fine initially just so soreness of my arm. The next day I started with the chills and a little bit of the headache, I just kinda figured it was a response to the vaccine and did not think much of it. Through the night I had fever (100.8F), chills and headache. I took some Excedrin and Wednesday morning I felt ok. I decided to go to work but the screening told me because I had fever in less than 24 hrs I could not go to work I had to report to the COVID hotline. They sent me to get tested because of the fever. I got tested at hospital and was tired the rest of the day but no fever and the next day I was ready to go to work but I had to wait for the test results that would come 24hrs later. The test came back positive. So I could not return to work until yesterday.

Other Meds: Metoprolol, Norvasc, Vitamin C and D3, Zinc, Multivitamin, B Complex

Current Illness: no

ID: 0920518
Sex: F
Age: 42
State: KY

Vax Date: 12/22/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
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: mold, various tree pollens

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Quarter size knot on arm followed by a red rash at injection site. Arm is hot to touch.

Other Meds: Multi-vitamin, Dymista nasal spray, allergy shots given every two weeks for seasonal allergies

Current Illness: N/A

ID: 0920519
Sex: F
Age: 43
State: KY

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: On 12/31/2020 patient noticed a "Golf ball sized" knot behind collarbone on left side (side vaccinated). She did go see her PCP because she didn't know what the knot was. She was told that it was possibly a swollen lymph node. She does have a follow-up appointment with PCP for further evaluation. She reports that it is getting better with each day. No treatment rendered by PCP.

Other Meds: Singulair & advair inhaler,

Current Illness: None

ID: 0920520
Sex: F
Age: 40
State: MO

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
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: Mild itching and tongue tingling at tip. Vital Signs 0746 - BP 112/79, HR 74, RR 18, Temp 98.4, SPO2 100% Vital Signs 0812 - BP 113/74, HR 78, RR 18, Temp 97.2, SPO2 99% Benadryl administered 0749 by, RN

Other Meds:

Current Illness:

ID: 0920521
Sex: F
Age: 54
State:

Vax Date: 12/04/2020
Onset Date: 12/06/2020
Rec V Date: 01/05/2021
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: Erythromycin. Percocet

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

Symptoms: Patient received her flu vaccine at a local pharmacy. Approx 3 days following she developed pruritic hyperpigmented and slightly scaly papules and plaques on distal bilateral LE and a single lesion on her left mid arm. No other symptoms. Symptoms improved, but continue.

Other Meds: Flonase 50mcg daily Singular 10mg daily Primrose oil for hot flashes Zyrtec 10mg daily Estradiol 0.5g daily Zinc Elder Berry Fish Oil Tumeric

Current Illness: None reported

ID: 0920522
Sex: F
Age: 48
State: MI

Vax Date: 12/31/2020
Onset Date: 01/01/2021
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: Walnuts, pollen, ragweed, cats, dogs, horses

Symptom List: Nausea

Symptoms: 1/1/21 thru 1/3/21 body chills fever 101-102 temp 1/3/21 @ 4am fainted with temp of 101.5

Other Meds:

Current Illness: allergies

ID: 0920523
Sex: F
Age: 47
State: MO

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Pt reported itchiness and tingling on her neck and back around 20 minutes after receiving vaccine. Pt given 25 mg of diphenhydramine tab, and she refused 2nd diphenhydramine tab. Pt reported cessation of itchiness and tingling 20 minutes after receiving diphenhydramine.

Other Meds:

Current Illness:

ID: 0920525
Sex: F
Age: 49
State: PA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: PCN - anaphylactic Codeine - urticaria Sulfa drugs - profuse vomiting and other GI disturbances Latex - anaphylactic Adhesives - topical dermatitis stinging insects - anaphylactic poisons: ivy, oak, and sumac - anaphylactic at times or extreme hypersensitivity to skin leading to burning, scarring, etc. Foods: onions, peppers, tomatoes, corn, milk Trees and flowers - pretty much all but worst are mums, roses, evergreens

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

Symptoms: Pain and swelling at injection site - 12/31/2020 to 1/2/2021 Decreased Pain and itching at injection site - 1/3/21 to present ******************************************************************** Headache - 12/30/2020 to present Fatigue/Tiredness - 12/30/2020 to present Arthralgia and Myalgia - 12/30/2020 to present Dizziness (Mild to Moderate) - 12/30/2020 to present Dry cough - 12/31/2020 to present Sore Throat - 12/31/2020 to present Swollen glands (Mild to Moderate) - 12/31/2020 to present Nausea - 12/30 and 12/31/2020 Diarrhea - 12/31/2020 Fever - 1/1/21 (1.6 degrees F above patient baseline) 1/3/21 (1.7 degrees F above patient baseline) 1/5/21 (1.4 degrees F above patient baseline) Chills - 1/1/21 to present

Other Meds: Protonix 40mg daily Atorvastatin 40 mg daily Escitalopram 10 mg daily Ajovy 225 mg/1.5mL every 30 days PRNs: Acetaminophen 1 g q 6 hours, Ibuprofen 800 mg q 6 hours, Ondansetron ODT 4 mg q 8 hours, Cyclobenzaprine 5 mg q 8 hours

Current Illness: N/A

ID: 0920526
Sex: F
Age: 42
State: CT

Vax Date: 12/25/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: keflex - hives mastisol - severe contact dermatitis

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

Symptoms: I had the normal shoulder pain for a couple days. Then day 6 developed extreme malaise with nausea. I kept saying it felt like my whole body was floppy and melting into the couch, and I couldn?t motivate to stand or do anything for 24 hours. Then myalgias and nausea continued for 2 days. Around the same time as the malaise, I developed a palpable indurated area under the vaccine site. Then day 8 my entire shoulder swelled up with overlying red leathery skin and axillary pain but no adenopathy. Day 10, back to normal except for some residual red pruritic skin extending down my arm.

Other Meds: none

Current Illness: none

ID: 0920527
Sex: F
Age: 42
State: IN

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: Dyclofenac

Symptom List: Tremor

Symptoms: headache, body/joint aches, sore lymph nodes, extreme chills, swelling at injection site, pain at injection site, redness at injection site, and nausea

Other Meds: Xyzal, Cymbalta 60mg

Current Illness: None

ID: 0920528
Sex: F
Age: 28
State: MN

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
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: Erythema, Pruritus

Symptoms: fever, aches, headache began 2 hours after vaccination but persisted over 48 hours. Tested for COVID per employee health policy on 12/31 - negative. Rash began 2 days after vaccination. was seen at Urgent care on 1/2/21, given prednisone. Rash worsened, fever broke. seen again 1/3/21 - given kenalog shot. tested for COVID-19 (negative). Rash continues to spread, headache improved but not resolved.

Other Meds: Iron supplement

Current Illness: ear infection 2 weeks prior - was treated with amoxicillin

ID: 0920529
Sex: F
Age: 46
State: MO

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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:

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

Symptoms: warm, painful to touch tightness of the skin, and itching ibuprofen and tylenol have been used, and ice packs to the area called employee health to notify January 1, 2021 at 3:40 pm. and left a message spoke with Staff in employee health on January 4th, informed of symptoms and was advised to fill out the RL and if symptoms persists call my primary physician

Other Meds:

Current Illness:

ID: 0920530
Sex: F
Age: 63
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/05/2021
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: I am letting you know that I had the first in the 2 part series of the COVID vaccine (Moderna) yesterday (Jan. 4, 2021 at 1500) afternoon. I woke this morning with side effects of fatigue, body aches, mild chills, increased cough, and loss of appetite.

Other Meds: None- occasional ibuprofen or acetaminophen

Current Illness: I had tested positive for COVID on December 22 and quarantined until December 31 (date it started was determined to be Dec. 20.) I didn't have as much aching then as I do now, which seems odd to me. I'm letting you know for your records.

ID: 0920531
Sex: F
Age: 61
State: GA

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: ITCHY, RED, RAISED AREA AT INJECTION SITE ABOUT A WEEK OUT. ABOUT 4CMX 3CM.

Other Meds: HORMONE REPLACEMENT THERAPY

Current Illness: NONE

ID: 0920532
Sex: F
Age: 62
State: OH

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

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

Symptoms: Fever : 100 at 7:30 am after Advil at 3:30 am; fever now 99.7 Headache Cold/ achy Very slight cough (normal)

Other Meds: Zn/coppr/lutein/zeaxan (PRESERVISION AREDS-2 PO fluticasone propion-salmeteroL 100-50 mcg/Puff inhaler Commonly known as: Wixela Inhub - Advair azelastine 137 mcg (0.1 %) Spray triamterene-hydrochlorothiazide 37.5-25 mg per tablet FLUoxetin

Current Illness: Asthma High Blood Pressure COVID-19 tested positive 11/16/20, sick until at least 12/16/20

ID: 0920533
Sex: M
Age: 45
State: NY

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: None

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

Symptoms: Pain at site of injection, fatigue, headache, muscle aches, chills, fever, injection site swelling and nausea. Symptoms subsided in 24 hours. Tylenol was taken for 102.4 fever.

Other Meds: None

Current Illness: none

ID: 0920534
Sex: F
Age: 32
State: MO

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Pain in extremity

Symptoms: Stated that within 30 minutes hands and feet swelled

Other Meds:

Current Illness:

ID: 0920535
Sex: F
Age: 37
State: KY

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
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: Itching started approx 2 hours after administration. Developed redness, swelling, pain and heat, progressively getting worse.

Other Meds: Effexor

Current Illness: None

ID: 0920536
Sex: F
Age: 30
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/05/2021
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: NSAIDs

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

Symptoms: Chills, nausea, rapid heartrate, dizziness, injection site pain. No relief of symptoms yet.

Other Meds: Sprintec

Current Illness:

ID: 0920537
Sex: F
Age: 67
State: AZ

Vax Date: 12/28/2020
Onset Date: 01/03/2021
Rec V Date: 01/05/2021
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: Intense itching in an area about two inches below injection site which started about six days after the first injection of Moderna vaccine. Also swelling ( a firm lump). Itching intense enough to disrupt sleep. Over the counter remedies did not help. Cold pack did not help.

Other Meds:

Current Illness:

ID: 0920538
Sex: F
Age: 65
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/05/2021
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: N/A

Symptom List: Vomiting

Symptoms: 12/31/20 extreme heavy drowsiness, sleepiness. Pt collapses and fell asleep after arriving home, Pt awoke 5-6 hrs later, feeling unwell body aches, headache, sinking feeling, restlessness , flushed feeling, 106. fever, loss appetite, bad taste in mouth weakness, congestions and Phlegm in lungs, sore arm also . Symptoms continue, feeing extreme restlessness and headache persists. Tylenol and ibuprofen taken for fever.

Other Meds: Morphine every 12 hrs, gabapentin

Current Illness: Sinus infection - cold

ID: 0920539
Sex: F
Age: 33
State: MA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/05/2021
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: Immediate onset of numbness and tingling in 4th and 5th digits, left hand. Followed by a burning pain Seen via telehealth 12/30/20 Recommended conservative measures Started on NSAIDs Examined 1/4/21 Script for PT provided

Other Meds: None

Current Illness: None

ID: 0920540
Sex: M
Age: 28
State: NJ

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/05/2021
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: Toradol

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

Symptoms: Patient had immediate facial flushing/redness Does have a history of anxiety and is not sure if he started to get anxious Seen in emergency department and was given IV Benadryl, steroids and was given an Epi pen Rx

Other Meds:

Current Illness:

ID: 0920541
Sex: F
Age: 17
State: NE

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/05/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: DEVELOPED HEADACHE, FEVER, CHILLS, BODY ACHES, NAUSEA. RESOLVED BY MORNING OF 12/31/20

Other Meds:

Current Illness:

ID: 0920542
Sex: F
Age: 59
State: MO

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/05/2021
Hospital:

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

Lab Data:

Allergies: Milk, Egg, Chicken

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

Symptoms: Mild itching and tingling Vital Signs 0708 - BP 146/85, HR 73, RR 16, Temp 97.3, SPO2 99% Vital Signs 0730 - BP 142/100, HR 77, RR 16, Temp 97.0, SPO2 99% Vital Signs 0750 - BP 152/89 Benadryl administered at 0715 by RN

Other Meds:

Current Illness:

ID: 0920543
Sex: F
Age: 45
State: AR

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

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

Symptoms: Immediately after shot for 20 minutes was tasting metallic taste and tingling in right pinky and ring finger. Around 11 pm started having metallic taste and cannot get rid of it. Woke up in middle of the night having diarrhea which still having symptoms this morning.

Other Meds: Remfresh only medication taken 1/2 tablet

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm