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: 1334184
Sex: F
Age: 43
State: IN

Vax Date: 05/05/2021
Onset Date: 05/16/2021
Rec V Date: 05/20/2021
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: Kiwi, medical adhesive on tape and bandages

Symptom List: Dysphagia, Epiglottitis

Symptoms: Shingles, beginning treatment with VALACYCLOVIR 3x daily for 7 days. 12 Norco tablets 5/325 for pain, Zofran for nausea.

Other Meds: Synthroid, Citalopram, Augmentin, Manuka Honey, Omeprazole, Probiotic

Current Illness: "COVID/MODERNA arm" reaction 10 days after first vaccination on 3/31/21 lasting 3 weeks, unknown stomach discomfort

ID: 1334185
Sex: M
Age: 69
State: MN

Vax Date: 03/03/2021
Onset Date: 03/19/2021
Rec V Date: 05/20/2021
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: I have had mild tinnitus for many years, but about three weeks following administration of Covid 19 vaccine, it seems to me that the tinnitus worsened' it is now twice as loud as it was prior to vaccination with Covid 19. It is present at this volume daily. Though I have inquired with various providers, seems there's no treatment. Also, not sure, but I have neuropathy in my fingers (from Diabetes?) which seems to have worsened at about the same time.. I have been getting it treated at a chiropractic office and still working on getting alternative treatment.

Other Meds: Metformin, Rosuvastatin, Glucosamine, Magnesium, Omega 3, Eye Vitamin, Vit C, D

Current Illness:

ID: 1334186
Sex: M
Age: 23
State: UT

Vax Date: 05/17/2021
Onset Date: 05/18/2021
Rec V Date: 05/20/2021
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: General seasonal allergies (pollen), but not manifest for some time prior to vaccination

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

Symptoms: Moderna COVID-19 Vaccine EUA Symptoms: Muscle tenderness at vaccination site, general achiness, fatigue, occasional difficulty breathing (felt like someone squeezing on my diaphragm and made it uncomfortable breathing for short periods of time. Started in the evening time, lasted a minute max each time, and occurred around 5 times before ceasing). Symptoms ended around 9 pm the same day they began

Other Meds: None

Current Illness: None

ID: 1334187
Sex: F
Age: 35
State: NM

Vax Date: 03/11/2021
Onset Date: 03/17/2021
Rec V Date: 05/20/2021
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: Tinnitus, bilateral

Other Meds:

Current Illness:

ID: 1334188
Sex: F
Age: 64
State: IL

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: Naproxen

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

Symptoms: I felt a tinge in my left bottom molar when the shot was injected. Later on in the evening my tooth started hurting. I think it?s related to the shot.

Other Meds: Synthroid

Current Illness: None

ID: 1334189
Sex: F
Age: 24
State: MT

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/20/2021
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: coconut

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

Symptoms: The evening patient received the vaccine started feeling feverish, tired, anxious, and experienced shortness of breath with the feeling of "throat closing" This resolved on its own, patient did not seek any medical care and patient was fine at the time of reporting to the pharmacy (5/20/21)

Other Meds: unknown

Current Illness: none known

ID: 1334190
Sex: M
Age: 41
State: AZ

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/20/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Within 24 hrs of receiving my Covid vaccination in my right shoulder I started to have joint pain there and throughout the rest of my body in other joints like my other shoulder and knees. The joint pain in all joints except my right injection site shoulder subsided. Almost a month later I still have significant right shoulder joint pain especially when working out at the gym. It feels more like a joint pain than a muscle pain. I have received injections for flu and other vaccines in both shoulders in the past and never had extended joint pain like this. I have been treating the pain with ibuprofen, heat and cold packs periodically and mostly after using it at the gym. There is a constant pain in the shoulder now that I mostly just deal with during the day. After the ibuprofen wears off the shoulder starts to hurt again. I have never had any issues with my right shoulder in my life.

Other Meds: Protein powder, OTC Allegra, and some ibuprofen.

Current Illness: None

ID: 1334191
Sex: M
Age: 66
State: PA

Vax Date: 04/07/2021
Onset Date: 04/26/2021
Rec V Date: 05/20/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: large quantity deep vein thrombosis: R leg extending to mid-IVC, pulmonary emboli, and LLE DVT

Other Meds: chlorthalidone, amlodipine, losartan, metoprolol, rosuvastatin, tamsulosin

Current Illness: low back pain ED visit end of April 2021, VATS for lung mass (no cancer) March 16 2021

ID: 1334192
Sex: F
Age: 52
State:

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: Patient felt light headed and started "seeing Spots". Patient reported extreme fatigue to observation RN in Observation area at 1045 am. RN elevated patient legs, gave juice, crackers, and water. After 30 min of observation and interventions, patient was still very fatigued and dizzy and was sent to the ED for follow-up

Other Meds:

Current Illness:

ID: 1334193
Sex: F
Age: 59
State: CA

Vax Date: 04/21/2021
Onset Date: 04/30/2021
Rec V Date: 05/20/2021
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: called health system call center on 4/30/21 reporting she received dose 2 on 4/21/21. has been having left arm pain since recieving vaccine. had mild relief with Prn tylenol. Patient was scheduled for urgent care visit for additional evaluation.

Other Meds:

Current Illness:

ID: 1334194
Sex: F
Age: 12
State: CA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt feeling dizzy & faint post vaccination (BP 101/64; HR 88; RR 16). Assisted to observation. VS stable (BP 103/65; HR 88; RR 15). No respiratory distress. Resting in bed quietly w/parents at bedside. Assessed at bedside by NP. Pt states she is ok & wants to go home. No discomfort & discharged pt home in stable condition.

Other Meds:

Current Illness:

ID: 1334196
Sex: F
Age: 34
State: IL

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Patient states are very swollen with red mark that has increased to golf ball size swelling. Reports swollen lymph nodes in the arm and tingling down arm

Other Meds: Duloxetine 60mg, D-apheta combo 15mg ER, Alprazolam 0.5mg, Bupropion 150mg XL, Advil during this reaction

Current Illness: none

ID: 1334197
Sex: F
Age: 16
State: TX

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 05/20/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Given to an underage patient - no symptoms, no adverse health events to report

Other Meds:

Current Illness:

ID: 1334198
Sex: M
Age: 33
State:

Vax Date: 03/19/2021
Onset Date: 04/28/2021
Rec V Date: 05/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: ascending weakness, areflexia, lack of sensation, progression to quadriplegia; GBS syndrome

Other Meds:

Current Illness:

Date Died: 03/07/2021

ID: 1334199
Sex: M
Age: 80
State: MO

Vax Date: 03/03/2021
Onset Date: 03/07/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: NIECE CALLED TO LET US KNOW PATIENT EXPIRED 3 DAYS POST VACCINE SHOT. NIECE STATED PATIENT HAD BREATHING ISSUES AND NOTES MENTION HEART ISSUES.

Other Meds:

Current Illness:

ID: 1334200
Sex: M
Age: 58
State: NJ

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 05/20/2021
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: sudden onset of right sensorineural hearing loss

Other Meds:

Current Illness: none

ID: 1334201
Sex: F
Age: 23
State: NE

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/20/2021
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 reported on prescreen.

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

Symptoms: Patient returned to clinic following discharge complaining of dizziness (5/10) and throat swelling (4/10). Vitals: BP 110/72, HR=53, RR=12, Sp02=100% on room air. Patient received liquid benadryl 50mg PO. Patient vitals remained the same 15min later, patient noted headache was worsening (7/10). At approximately 1hr post-vaccination (and 30min post benadryl), patient reported throat swelling remained 4/10, facial pain now 2/10, dizziness 5/10, and headache 6/10. Clinic staff recommended patient go to hospital for evaluation; discharged from clinic to boyfriend for transport to HCF.

Other Meds: None reported on prescreen.

Current Illness: None reported on prescreen.

ID: 1334202
Sex: M
Age: 58
State: NV

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt received J&J on 3/10/2021 from a different location, did not report this on consent form and was also given 2 doses of Pfizer. (4/20/2021 and 5/11/2021). Did not discover pt had received J&J until processing prescription after administration and insurance rejected claim.

Other Meds:

Current Illness:

ID: 1334203
Sex: M
Age: 67
State: NM

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Bloated when I ate food. I felt like I had something inside me and it started coming to the surface. It was a big blisters. I took photos and sent it to my doctor (girlfriend's daughter). Rash naval to back side of my back. Nasty blisters very itchy. Calamine lotion tried everything I could. I was trying antihistamine; and ibuprofen. It burned. She said it was shingles lasted 21 days. It cleared up a week before my second shot. I had the double dose of the Shingrix vaccine that you get all at one time. About 4 or 5 months (9/2020) before this Moderna injection. September of 2020, I believe. With no side affects after it.

Other Meds: Multi-Vitamins

Current Illness: No

ID: 1334204
Sex: F
Age: 48
State: MD

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: tree nuts, nitrofurantoin, metronidazole, linaclotide, latex, contrast, hydrochlorothiazide, gentamicin, doxycycline, coconut, chlorhexidine, amoxicillin, shellfish, aripiprazole, sulfa drugs, nebivolol, cefuroxime

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

Symptoms: tightness in her chest and some mild wheezing as well as a funny sensation in her throat gave benadryl 25 mg and methyprednisolone 125 mg IV one time symptoms improved after medications given

Other Meds: aspirin 81 mg daily, diltiazem 240 mg daily, benadryl 25 mg every 6 hours as needed, duloxetine 20 mg daily, epi pen as needed, esomeprazole 20 mg daily, famciclovir 500 mg daily, lamotrigine 50 mg ER daily, levothyroxine 88 mcg daily, med

Current Illness:

ID: 1334205
Sex: M
Age: 51
State: MD

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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 received second dose in series at 10 AM. At around 11:30 he came back to the pharmacy complaining of pain in his back upon breathing, and a "fuzzy" feeling in his tongue. I had an associate call 911, then I administered a 0.3 mg Epinephrine IM, and 50 mg of oral liquid diphenhydramine. The ambulance service arrived and transported him to the local hospital while he remained alert and oriented.

Other Meds:

Current Illness:

ID: 1334206
Sex: M
Age: 59
State: IN

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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: Without having taken any pain relievers directly before or after the vaccination, my temperature began to rise yesterday morning into afternoon from 97.1 up to 101.1. At 3:00 p.m. it began descending to 100.3. However, at 6:00 p.m. it quickly jumped up to 101.7. At this time, I took two Tylenol 500 mg caplets, which broke the fever. It was at 101.0 when I went to bed last night at 9:30 p.m. and was at 98.5 when I awoke at 5:00 a.m. Also, since I have had Covid-19 (beginning the morning of November 19th), I have had significant shoulder and knee pain; acupuncture helped alleviate the shoulder pain and shots from a doctor last week helped the knee pain. However, yesterday the pains returned in full force until I took the Tylenol; they are back to being detectable (and mild) as of this morning.

Other Meds: Synthroid 125 once per day

Current Illness: None

ID: 1334207
Sex: F
Age: 20
State: TX

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 05/20/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Had COVID -19 two weeks after the vaccine. Tired and really bad chills prior to testing positive to COVID 19 after vaccination.

Other Meds: Low ogestrel;

Current Illness: None

ID: 1334208
Sex: M
Age: 18
State: IL

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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 is 18 year old male who received his first dose of Pfizer COVID 19 vaccine. graduate intern, administered the dose and within the first minute, patient tensed up and passed out. He appeared to look like he had a seizure. Patient was passed out for less than a minute. When he came to, he said he fell asleep. He said he felt warm. We checked his Blood pressure and it 94/62 and pulse was 54. We called 911 and laid patient on a mat. He was given gatorade and a warm wash cloth. Paramedics arrived and rechecked BP. It was 110/66 and pulse was 66. They evaluated him and told him to have someone drive him home. Patient has not history of seizures and no history of adverse reaction to vaccine. He did receive a tetanus booster on 5/17/21. Only other medical history is asthma. He uses albuterol prn but has not had to use it for > 4 years.

Other Meds: None

Current Illness: None

ID: 1334209
Sex: F
Age: 17
State: TX

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Given to underage patient

Other Meds:

Current Illness:

ID: 1334210
Sex: F
Age: 45
State: TX

Vax Date: 05/13/2021
Onset Date: 05/14/2021
Rec V Date: 05/20/2021
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: Cipro

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

Symptoms: Hot at site, red, knot present, sore joints all over body, fatigue

Other Meds:

Current Illness: Htn Thyroid

ID: 1334211
Sex: F
Age: 40
State: NC

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient is in today for dose #2 covid vaccine. Injection was given at 0938 and then about 0933 patient told me that she is dizzy feeling. I had her get on the exam table and relax. Her vitals were 141/101, P:75, O2 100% at 0945. Staff came in and did an exam. Patient was asked to please call someone to pick her, which they will be here about 10:30. Per staff, I gave (1) 25 mg benadryl, at 1000, and then 1 to take home. Vitals at 0958 were 154/99 P: 71, and O2 100%. at 1020 vitals were 151/92 P: 72 O2: 99%. Staff came back in and checked patient and reviewed vitals. Patient was told that she could leave with her mom at 1030.

Other Meds: Allegra Allergy 180 mg tablet prescribed on 04-27-2021 Take 1 tablet every day by oral route. atorvastatin 40 mg tablet prescribed on 04-27-2021 Take 1 tablet every day by oral route. Benadryl 25 mg capsule administered on 05-20-2021 Take 1

Current Illness: On 4/27/21 Patient was seen for: Right ear pain. Extremely tired. Extreme mood swings with period. My left hand pain, numbness and some swelling when waking up 3-4 days of the week.

ID: 1334212
Sex: F
Age: 37
State: NY

Vax Date: 05/06/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I developed (possible) sudden sensorineural hearing loss 2 weeks after my second dose of COVID-19 vaccine on May 19, 2021. I started to experience a change of my hearing (reduced hearing) in the morning of May 19, 2021 in the left ear. No vertigo or dizziness, no fever, no discharge. The diagnosis is made by Dr. on May 20 2021. For completeness, I had a medical history of Guillain-Barre Syndrome in 2002, and Bell's Palsy in 2010. Both were mild cases and recovered with no sequela. I never took Flu shot because of the medical history. I am glad that I took the COVID-19 vaccine because I think it would be worse if this is a natural infection. It might be valuable if we can collect safety data for those who had GBS history, so people know what to expect and they can be proactive if things happen.

Other Meds: No

Current Illness: No

ID: 1334213
Sex: M
Age: 12
State: OH

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: NO KNOWN ALLERGIES

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

Symptoms: After vaccine was administered, patient was asked to wait for 15 minutes, at which time Parent notices that child had passed out, looked pale and unresponsive to name calling. I (pharmacist) was alerted to the event and I and couple technicians went out to assist patient. I elevated child's feet, supported head, took blood pressure and pulse. Child regained consciousness and was able to respond to name in less than two minutes. Child stated that he was hot and agreed to drinking cold water. I also applied cold compress to child's forehead and wrists. Child took sips of water and BP was continuously monitored. Parents stated that child looked much better and had regained color to his face. Child was monitored to 30 mins by the pharmacy team with no event before parents took child home.

Other Meds: NOT KNOWN

Current Illness: NOT KNOWN

ID: 1334214
Sex: F
Age: 17
State: OH

Vax Date: 04/21/2021
Onset Date:
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: nka

Symptom List: Nausea

Symptoms: none

Other Meds: none

Current Illness: none

ID: 1334215
Sex: M
Age: 52
State: CA

Vax Date: 05/05/2021
Onset Date: 05/07/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: Azithromycin (Diarrhea)

Symptom List: Injection site pain

Symptoms: Severe vertigo on Day-1 of the symptom -- room spinning. Bed bound for 14+ hours. Subsequently, symptom occurs whenever getting out of bed, and sometimes when changing body position. Symptom persists 15 days after vaccination.

Other Meds: None

Current Illness: None

ID: 1334216
Sex: F
Age: 16
State: IA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Moderna vaccine given to underage patient. She is 16. Informed her mother today (5/20/21) via phone call. Mom says she is feeling fine, other than her arm is sore. She verbalizes understanding regarding the error.

Other Meds:

Current Illness:

ID: 1334217
Sex: M
Age: 21
State: IN

Vax Date: 05/16/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: N/A

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

Symptoms: Course Rapid Tremors in Left Arm Only when Clenching Fist

Other Meds: N/A

Current Illness: N/A

ID: 1334218
Sex: F
Age: 41
State: OH

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/20/2021
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: amoxicillin/penicillin cipro tomato tide laundry soap lotion with raspberry scent or extract, but she can eat raspberries

Symptom List: Tremor

Symptoms: The patient developed itching about 10 minutes after receiving her second dose of Moderna vaccine. The itching spread up to her scalp and she notified the nurse. The nurse asked her to remove her mask and her left side of her face, her lip, and her tongue had started to swell. This progressed to some numbness on the left side of her body as well as her right hand. She also developed a hive or two on her back. The nurse wanted to administer epinephrine. The patient refused, but she did accept benadryl 25 mg oral. Then the nurse brought her next door to the emergency room. The ER physician documented the patient was having an allergic reaction. He administered 25 mg i.v. benadryl and gave the patient a prescription for a medrol dose pack if she needed it. She did not end up needing it. Her symptoms improved in the ER. The patient was observed 90 minutes and discharged. She states she went home and slept and when she woke she was fine.

Other Meds: antibiotic for dental work Clindamycin 150 mg, 1 capsule by mouth every 8 hours until gone. Qty 30. Started 4/27/21, and stopped on 5/5/21 when she had the reaction. ibuprofen 600 mg, 1 tablet every 6 to 8 hours as needed for pain

Current Illness: infected cavity in a wisdom tooth

ID: 1334219
Sex: U
Age: 62
State: NE

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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: pt denies

Symptom List: Erythema, Pruritus

Symptoms: 2nd dose given at 21 days

Other Meds: patient does not want to provide

Current Illness: History of cancer and kidney disease

ID: 1334220
Sex: F
Age: 62
State: NE

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/20/2021
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: Tetracyclines as reported on prescreen

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

Symptoms: Patient returned to clinic at 4:20pm - 2hr after receiving vaccine - reporting of difficulty breathing and dizziness (both 7/10). Patient reports unable to work. HR=74, RR=16, SP02=98% on room air. Received liquid benadryl 30mL/75mg PO. Symptoms improved following administration and was able to speak without gasping per clinic staff. Patient was released to home and transported there via the company vehicle following resolution of symptoms at 4:40pm.

Other Meds: Baby aspirin as reported on prescreen

Current Illness: None reported on prescreen.

ID: 1334221
Sex: F
Age: 36
State: MN

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
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 reported feeling very dizzy, nauseous, and was sweating a few minutes after getting the immunization as she was sitting in the waiting area for observation with her husband. I gave her some cold water and had her lie down on a towel and pull down her mask to be able to get more adequate oxygen. After a few minutes she was feeling better but reported that she was breaking out with red spots on both arms that didn't itch but hurt. I gave her 25 mg oral Benadryl. After her observation was up, she decided to head home with her husband as she was feeling much better. I told her to continue to take Benadryl 25-50 mg every 4-6 hours until her spots disappeared.

Other Meds:

Current Illness:

ID: 1334222
Sex: F
Age: 74
State: CT

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: sulfa, sulfates, erythromycin, food dye (red & yellow), contrast dye, iodine, latex, sam-e, bananas, yeast, cranberries,

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: pt got the TDAP vax (manufacturer unknown) at hospital after falling on 3/13/2021. Pts had a headache and her arm became red, swollen, itching, sore, black and blue. These symptoms lasted 2 weeks.

Other Meds:

Current Illness:

ID: 1334223
Sex: M
Age: 26
State: IN

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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:

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

Symptoms: Roughly 15 hours after receiving the vaccine, I started to develop muscle aches. Within 30 minutes of the aches, they became severe. Aches were primarily located in the lower back, shoulders, hips, and calves. 30 minutes following, I started to feel very fatigued and had labored breathing. Another 1.5 later, I developed chills and had flu like symptoms. By the afternoon, I had broken into a fever and had mild nausea. Besides the muscle aches, as one symptom onset, the others seemed to fade away. By 5:00 in the evening, (roughly 25 hours after receipt of vaccine) the symptoms quickly subsided. The only residual side-effects within the rest of a 48 hour period were soreness in the area of the injection, and mild headache.

Other Meds:

Current Illness:

ID: 1334224
Sex: F
Age: 52
State: IN

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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: Headache Body aches Chills Fever Light and sound sensitive

Other Meds: None

Current Illness: None

ID: 1334225
Sex: M
Age: 14
State: CA

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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: Pt experienced headache, blurry vision, "muffled sounds," flushing/sweating & experienced dizziness. Juice was given, mom stated this happens for all shots, crackers given, pt lay down & rested. Provider cleared pt, pt stable & released from vaccination site

Other Meds:

Current Illness:

ID: 1334226
Sex: F
Age: 40
State: WI

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 05/20/2021
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: I have an IUD and haven?t had a menstrual cycle in over a year when it was placed. About 24 hours after receiving this vaccine I had a heavy flow period that tapered off but lasted a few weeks. The same thing happened with my second dose.

Other Meds: None

Current Illness: None

ID: 1334227
Sex: F
Age: 86
State: CT

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 05/20/2021
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: Valsartan (angioedema); Amlodipine (angioedema); Normadyne; metronidazole; Erythromycin (difficulty breathing); Cipro; Flagyl; Besivance eye drops; Achromycin; Keflex; Clindamycin; Amocicillin; Floxin; Tramadol: Codeine

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

Symptoms: Day after the injection the area around the site became reddened, gradually worsening daily until the redness was 3.5" long x 4" wide, L arm was swollen from the shoulder to fingertips, and the arm was painful with limited ROM. Redness began to fade after 3 weeks; L arm remains swollen and painful. Pt was evaluated by the MD on 5/18/21 and was advised to hold off on 2nd vaccine (scheduled for 5/25/21) MD will decide if/when 2nd vaccine will be administered.

Other Meds: Triamterene Metoprolol Meloxicam

Current Illness: None

ID: 1334228
Sex: F
Age: 37
State: MO

Vax Date: 04/30/2021
Onset Date: 05/07/2021
Rec V Date: 05/20/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Tingling and numbness in fingers/hands and toes/feet and abdomen that is constant/lingers.

Other Meds: None

Current Illness:

ID: 1334229
Sex: F
Age: 68
State: VA

Vax Date: 05/04/2021
Onset Date: 05/07/2021
Rec V Date: 05/20/2021
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: Given Moderna injection 0811 lightheadedness, tightness left side of throat and scratchiness at 0822 dizziness at 0823 assisted to stretcher, at 0823 Benadryl 50mg po at 0824 Hospital emergency team called Sent to ED for follow up pulse 110 BP 158/104 resp 22 Discharged from ED 1006 still complaining of palpitations went home for the day family will be with her

Other Meds: Albuterol 0.083 5ml Levothroxine 75MCG ALVESCO 80 MCG

Current Illness:

ID: 1334230
Sex: F
Age: 32
State: NC

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 05/20/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: that evening developed fever and chills, the next day progressive malaise and lymphadenopathy. persisted x 3 days, tmax = 102

Other Meds: none

Current Illness: Raynaud's Syndrome since 2019

ID: 1334231
Sex: F
Age: 43
State: WI

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 05/20/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Very fatigue, sore arm, body aches, body chills, fever, headache, brain fog

Other Meds: Lisiniprol, Lexapro, Lipitor, Metfromin

Current Illness: None

ID: 1334232
Sex: F
Age: 85
State: OH

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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: Instead of a 2nd Moderna dose, patient received a dose of Janssen.

Other Meds:

Current Illness:

ID: 1334233
Sex: F
Age: 42
State: MI

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/20/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Arm is very sore and started running a low grade fever 101F. Took 325mg acetaminophen.

Other Meds: No

Current Illness: No

ID: 1334234
Sex: M
Age: 40
State: IN

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 05/20/2021
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: Seafood

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

Symptoms: Headache, dizziness, fatigue.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm