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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1337006
Sex: F
Age: 25
State: WA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/21/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: Shakiness-Mild, Additional Details: She passed out for a brief moment a few minutes after the vaccine. We called 911. Fire Dept checked her and all vital signs are normal. The paramedic think that she had a brief panic and her blood pressure went down. She was with her mom and mom said this kind of event happened before and she was not concerned.

Other Meds:

Current Illness:

ID: 1337007
Sex: F
Age: 41
State: MI

Vax Date: 05/12/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Erythromycin Codeine Decadron Inapsine

Symptom List: Anxiety, Dyspnoea

Symptoms: 2 DAYS POST 2ND DOSE, LYMPHADENOPATHY OF LEFT AXILLARY AND HEAVINESS IN LEFT MAMMORY TISSUE. 7 DAYS POST 2ND DOSE, BEGAN EXPERIENCING PAIN IN THE PERI-AURICULAR AREA OF RIGHT EAR. DAY 8 LYMPHADENOPATHY OF RIGHT CERVICAL AND RIGHT MAXILLARY NODES

Other Meds: None

Current Illness: None

ID: 1337008
Sex: F
Age: 42
State: MD

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: Fever 101.5, body aches, chills, sweats, pain at injection site.

Other Meds:

Current Illness:

ID: 1337009
Sex: M
Age: 13
State: MO

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: Systemic: Fainting / Unresponsive-Mild

Other Meds:

Current Illness:

ID: 1337010
Sex: F
Age:
State: FL

Vax Date: 02/01/2021
Onset Date: 04/01/2021
Rec V Date: 05/21/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient started to feel a lump under her collar bone in mid April. She was diagnosed yesterday with a ductal carcinoma in her left side, near where the vaccine was, just below the collar bone. She is meeting with a surgeon to discuss plan and prognosis

Other Meds:

Current Illness:

ID: 1337011
Sex: F
Age: 54
State:

Vax Date: 05/13/2021
Onset Date: 05/15/2021
Rec V Date: 05/21/2021
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: full body rash; Benadryl not effective. Prednisone seemed to help with reaction for first vaccine dose, - treating with that again.

Other Meds:

Current Illness:

ID: 1337012
Sex: M
Age: 62
State: CT

Vax Date: 02/09/2021
Onset Date: 04/27/2021
Rec V Date: 05/21/2021
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: Allergy to Venom-Honey Bee

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Diagnosed with Peracarditis on May 5, 2021 with no prior history of heart illness.

Other Meds:

Current Illness:

ID: 1337013
Sex: F
Age: 15
State: MA

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 05/21/2021
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: Pharyngeal swelling

Symptoms: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1337014
Sex: F
Age: 20
State: MO

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: After receiving the vaccine the pt walked over to the Recovery area and Pt verbalized becoming lightheaded, dizzy, and having spotty vision. Pt says she has a history of lightheaded and dizziness , so she knows to lay down when that occurs and that's what she did.

Other Meds: Spironolactone

Current Illness: None

ID: 1337015
Sex: F
Age: 32
State:

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: PenicilinE, NSAID

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Swollen tongue, lips and rash

Other Meds: None

Current Illness: None

ID: 1337016
Sex: M
Age: 51
State:

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 05/21/2021
Hospital: Y

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: Patient has a syncopal episode and was found to be in new-onset A Fib with RVR

Other Meds:

Current Illness:

ID: 1337017
Sex: F
Age: 42
State: TX

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 05/21/2021
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: naratriptan

Symptom List: Rash, Urticaria

Symptoms: Started that day chills and three four hours hot and shaky. I could not work a couple days feeling like very very sick, nauseous. three or four days and went away slow. Missed work last week, diarrhea, getting sick off and on since the covid shot feeling like the flu. But tests negative. Sometimes I am perfectly fine, sometimes very sick and very down. Happens randomly. Could not even get up from the bed. Still taking nausea pills and pills for pain, body aches.

Other Meds: none

Current Illness: none

ID: 1337018
Sex: F
Age: 26
State:

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 05/21/2021
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: Pt c/o feeling tingling and swelling in her tongue and her face after receiving her vaccine. Pt was moved to the Triage room for closer observation. Pt was given oral benadryl and monitored for further symptoms. Pt symptoms continued to progress including itching in her throat and over her face. Pt stated she had reacted to the first dose and was treated with benadryl which successfully managed her symptoms at that time. For this dose, the benadryl did not seem to be effective and d/t progressing symptoms, pt was given IM epinephrine and transported to the ED for further evaluation and treatment.

Other Meds:

Current Illness:

Date Died: 05/17/2021

ID: 1337019
Sex: F
Age: 73
State: IA

Vax Date: 04/02/2021
Onset Date: 05/17/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: none reported

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

Symptoms: unknown

Other Meds: unknown

Current Illness: unknown, none reported on pre checklist

ID: 1337020
Sex: M
Age: 70
State: TX

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 05/21/2021
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: rash from penicillin

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

Symptoms: Lethargy, headache, chill, lack of appetite

Other Meds: Protonix Warfarin Terazosin Triamterene Lovazo

Current Illness: None

Date Died: 04/01/2021

ID: 1337021
Sex: F
Age: 57
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient was a patient with long time diabetes and hypertension. She received the Moderna vaccine last Thursday. She had some nausea and vomiting and later some diarrhea. Unfortunately, she continued to take her diabetic meds and antihypertensives. Her CT abdomen showed duodenitis. She presented with multisystem organ failure and severe lactic acidosis. Despite aggressive treatment, she died less than 24 hours after admission. She was a complex patient and the renal failure and metformin toxicity seemed to be the terminal event, the vaccine may have started the process with some dehydration from nausea and vomiting.

Other Meds:

Current Illness:

ID: 1337022
Sex: F
Age: 50
State: PA

Vax Date: 04/16/2021
Onset Date: 05/03/2021
Rec V Date: 05/21/2021
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: MorphineItching Cat DanderOther (document details in comments) MethylphenidateHeadaches TerconazoleNausea Only

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

Symptoms: COUGH Contact with and (suspected) exposure to covid-19 Encounter for laboratory testing for COVID-19 virus

Other Meds: albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler alclomethasone (ACLOVATE) 0.05 % cream butalbital-acetaminophen-caff (FIORICET) 50-325-40 mg per tablet cloNIDine (CATAPRES) 0.1 mg tablet fexofenadine (ALLEGRA) 180 mg tablet multiple vit

Current Illness:

ID: 1337023
Sex: M
Age: 38
State: CA

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

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

Lab Data:

Allergies: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Nurse injected an empty syringe (no vaccine) to pt's right arm. When she realized that she could not push the plunger as it is empty, the needle was already intramuscular. She withdrawn the empty syringe/needle from the right deltoid muscle and proceeded to reinject with a prefilled vaccine syringe in the left deltoid.

Other Meds: N/A

Current Illness: N/A

ID: 1337024
Sex: M
Age: 26
State: CA

Vax Date: 03/25/2021
Onset Date: 03/01/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pulmonary embolism.

Other Meds:

Current Illness:

ID: 1337026
Sex: M
Age: 50
State: GA

Vax Date: 05/07/2021
Onset Date: 05/13/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Burning on the both feet

Other Meds: None

Current Illness: None

ID: 1337028
Sex: M
Age: 18
State:

Vax Date: 04/14/2021
Onset Date: 04/17/2021
Rec V Date: 05/21/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: The patient presented to the emergency department with chest pain. Admitted the hospital and diagnosed with myopericarditis.

Other Meds:

Current Illness:

ID: 1337029
Sex: F
Age: 56
State: NC

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: I do not have any allergies.

Symptom List: Unevaluable event

Symptoms: Immediately after the shot my arm started hurting. The next day I started getting a headache and nausea, chills and muscle ache. My bottom lip was swollen by the third day and I was not feeling right. I had numbness going up to my right eye and I could not speak clearly.

Other Meds: I was not taking any prescriptions or over the counter medications.

Current Illness: I have no illnesses.

ID: 1337030
Sex: M
Age: 44
State:

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

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

Lab Data:

Allergies:

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

Symptoms: The patient presented to the emergency department with chest and back pain. Admitted the hospital and diagnosed with myopericarditis.

Other Meds:

Current Illness:

ID: 1337031
Sex: F
Age: 60
State: VA

Vax Date: 04/24/2021
Onset Date: 04/30/2021
Rec V Date: 05/21/2021
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: cats,

Symptom List: Injection site pain, Pain

Symptoms: bilateral pulmonary embolus; left leg DVT diagnosed on May 17, 2021

Other Meds: no active medication

Current Illness: none

ID: 1337032
Sex: M
Age: 67
State:

Vax Date: 03/05/2021
Onset Date: 03/12/2021
Rec V Date: 05/21/2021
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: Significant left axillary lymphadenopathy, not resolving after 6+ weeks. Patient presented to family practice physician with large axillary swelling and lymphadenopathy. Patient had several follow ups with providers and was eventually diagnosed with B-cell lymphoma.

Other Meds:

Current Illness:

ID: 1337033
Sex: F
Age: 16
State: CA

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: PT RECD FIRST DOSE OF MODERNA 4/23/21 AS A MINOR. PT CAME BACK TODAY FOR SECOND DOSE. PARENT WAS EDUCATED AND INFOR PROVIDED REGARDING MODERNA FOR MINORS. CONSENT SIGNED. PT RECD SECOND DOSE TO LEFT ARM.

Other Meds:

Current Illness:

ID: 1337034
Sex: F
Age: 55
State: LA

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

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Numbness at injection site down the arm to the elbow and down to the fingertips but not the hand. Injection site not red or swollen just sore. Pins and needles at wrist and fingertips.

Other Meds:

Current Illness:

ID: 1337035
Sex: F
Age: 48
State: VA

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to Penicillin and Cloves

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: On 4/10/2021 i was vomiting, 4/11/2021 i had hives on my face

Other Meds: I was taking Lithium, Gabapentin, Dulera, Flonase, Contras, Prednisone, Ativan

Current Illness: No other illnesses

ID: 1337036
Sex: M
Age: 57
State: PA

Vax Date: 04/16/2021
Onset Date: 05/03/2021
Rec V Date: 05/21/2021
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: NKA

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

Symptoms: Close exposure to COVID-19 virus

Other Meds: atorvastatin (LIPITOR) 10 mg tablet fluocinonide (LIDEX) 0.05 % cream glimepiride (AMARYL) 2 mg tablet turmeric-herbal complex no.278 150 mg capsule VITAMIN D2 50,000 unit capsule

Current Illness:

ID: 1337037
Sex: M
Age: 46
State: NY

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List: Nausea

Symptoms: Moderna COVID-19 Vaccine EUA Per first aid provider at vaccine POD: Chief Complaint: lips tingling, no swelling or rash noted, patient monitored for 30 minutes, medical options of Benadryl discussed, patient refused, symptoms resolved, patient instructed if symptoms reoccur to take Benadryl per package directions, seek medical help if symptoms persist or other symptoms develop.

Other Meds: Allergy medication daily

Current Illness:

ID: 1337038
Sex: F
Age: 53
State: SC

Vax Date: 05/01/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: Covid 19 infection

Other Meds: Tylenol

Current Illness: None

ID: 1337039
Sex: F
Age: 59
State: WI

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

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

Lab Data:

Allergies: Methylprednisolone Latex Sumatriptan Codeine Diphenhydramine Fentanyl

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

Symptoms: 2nd dose given 14 days from 1st dose in error

Other Meds: Buprenorphine HCl-Naloxone HCl 8-2 MG SL FILM Calcium Carbonate 1500 (600 Ca) MG OR TABS Cholecalciferol 25 MCG (1000 UT) OR tablet citalopram (CELEXA) 40 MG OR tablet Diclofenac Sodium 1 % TD GEL docusate sodium (COLACE) 100 MG OR capsule

Current Illness: None noted

ID: 1337040
Sex: F
Age: 58
State: CA

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: NKDA

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

Symptoms: Patient received the 2nd COVID vaccine (Pfizer, lot #EW0182, use by 05/22/21 at 10:20am, expiration date 08/2021) at 1532. Client reported a tingling sensation in the L arm to employee at 1545. Employee immediately assessed client. The patient was A&O to person, time, place, and situation. No loss of consciousness or dizziness occurred. Vital signs were taken by EMT at 1545 with BP 155/45 in R arm sitting upright, HR of 78, RR of 18, and O2 saturation level of 100%. At 1550 the patient denied numbness, tingling, or shortness of breathe. Vital signs at 1550 were BP 155/75 in R arm sitting upright, HR of 75, RR of 16, and O2 saturation level of 100%. At 1600 patient was talking in full sentences and sitting upright in zero gravity chair. Client reported medical history of hypertension. Client is taking BP medication but was not able recall name of medication. Vitals at 1600 were BP 150/80 in R arm sitting upright, HR of 70, RR of 16, and O2 saturation level of 99%. At 1605, patient was stable and employee educated about V-Safe information and advised patient to follow up with her PCP at Hospital. Educated about ER precautions. Patient left the site at 1615.

Other Meds: BP Medication (name unknown)

Current Illness: N/A

ID: 1337041
Sex: F
Age: 48
State: CA

Vax Date: 04/11/2021
Onset Date: 04/20/2021
Rec V Date: 05/21/2021
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: Severe dry and chapped lips - duration ~7days; minor swelling

Other Meds: Wellbutrin (150mg); Multi-vitamin; Cinnamon extract; Milk Thistle; Vitamin C; Flaxseed oil Collagen

Current Illness: None

ID: 1337042
Sex: F
Age: 64
State: OR

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: A sudden drop in Blood Glucose immediately after the shot. Started feeling clammy after about 15 minutes. BG before shot was 160; after about 20 minutes BG was 120.

Other Meds: Lantus Solostar Humalog Metformin Glimepiride Jardiance

Current Illness:

ID: 1337043
Sex: M
Age: 18
State:

Vax Date: 05/08/2021
Onset Date: 05/12/2021
Rec V Date: 05/21/2021
Hospital: Y

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: Patient received dose 1 of Moderna vaccine on 5/8/2021 and had witnessed seizure 5/12/2021- (first time ever). He was admitted to ICU on 5/12/2021 and discharged 5/15/2021. He states he had one seizure while in the ICU and another seizure 5/16/2021- at home after discharge. He has since been placed on anti-seizure medications and is scheduled for follow up with neurology on 6/2/2021. Patient's mother states ICU doctors told her they found a blood clot in the brain picked up by MRI.

Other Meds:

Current Illness:

ID: 1337044
Sex: F
Age: 22
State: NY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 05/21/2021
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: Sore throat and pressure on throat but able to swallow and breathe with no issues

Other Meds:

Current Illness:

ID: 1337045
Sex: M
Age: 71
State: FL

Vax Date: 02/17/2021
Onset Date: 02/17/2021
Rec V Date: 05/21/2021
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 Known

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Began having nausea / upset stomach or stomach ache, and often pain behind and/or below sternum . The symptoms would come and go daily for about 8 weeks and last for about one to three hours each time, sometimes before mealtimes. Would often be gone after a meal. As of today, 5/21 I still have the stomach ache once in a while. The morning after the first shot, I awoke with a severe stiff neck all the way around. I've had the stiff neck every day so far. After 7 weeks I went to a chiropractor for 6 treatments over about 6 weeks with little relief. As of today the stiff neck is about 60 % better.

Other Meds: Flecainide 50 mg Twice a day Diltiazem 120 mg Once a day Eliquis 5 mg Twice a day

Current Illness:

ID: 1337046
Sex: F
Age: 39
State: CO

Vax Date: 04/16/2021
Onset Date: 04/26/2021
Rec V Date: 05/21/2021
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: About a week after I had the shot, I started experiencing joint pain on my left hand. Around 4/5 am in the morning, the fingers on my left hand felt stiff and painful. I had to apply ice and heat to help with the pain and stiffness. This lasted for about a week. On May 2nd, I asked for prayer at church. The day after this, I felt no more stiffness and no more pain. I still have tenderness in my fingers in my left hand, but praise God, no more morning stiffness or pain. I went to the doctor and he diagnosed me with reactive arthritis.

Other Meds:

Current Illness:

ID: 1337047
Sex: M
Age: 31
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: at 9:12am pt c/o nausea dizziness with feeling of about to faint. patient placed in gurney in supine position with HOB elevated. Vitals monitored vitals BP 121/72 P-69 RR-18 o2- SAT 98% RA t- 98.2 pt. recovered well from symptoms. vitals BP- 135/86 RR-18 P-75 o2-98% #21 pt stable and sent home #23 nausea with other vaccine pt cannot remember specific name

Other Meds:

Current Illness:

ID: 1337048
Sex: F
Age: 16
State: PA

Vax Date: 04/17/2021
Onset Date: 05/03/2021
Rec V Date: 05/21/2021
Hospital:

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

Lab Data:

Allergies: AmoxicillinHives / Urticaria PenicillinsHives / Urticaria Zantac [Ranitidine Hcl]Rash

Symptom List: Pain in extremity

Symptoms: SORE THROAT HEADACHE FATIGUE

Other Meds: albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler amitriptyline (ELAVIL) 50 mg tablet busPIRone (BUSPAR) 10 mg tablet FLUoxetine (PROzac) 20 mg capsule MICROGESTIN FE 1.5/30, 28, 1.5 mg-30 mcg (21)/75 mg (7) per tablet montelukast (SINGUL

Current Illness:

ID: 1337049
Sex: M
Age: 20
State: NJ

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

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

Lab Data:

Allergies: NKDA; NKA

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

Symptoms: Patient fainted. Had patient site down and elevated legs

Other Meds: No

Current Illness: None

ID: 1337050
Sex: F
Age: 60
State: NY

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: 10 minutes after receiving the covid vaccination patient began to feel very overheated and started to sweat profusely. Emergency services were called and took her to the nearby hospital. Around 4:30pm the same day she came back into the pharmacy to tell us they released her from the hospital but while there she experienced uncontrollable vomiting.

Other Meds: none

Current Illness: none

ID: 1337051
Sex: F
Age: 51
State: TX

Vax Date: 03/19/2021
Onset Date: 04/13/2021
Rec V Date: 05/21/2021
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: Penicillins: anaphylaxis Influenza Vaccine, Recombinant: anaphylaxis Lipitor: Myalgias (Adverse Reaction)

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

Symptoms: Patient has had chronic intermittent pain on her left lower leg for the past 5 years. However, she has noticed more pain on the left lower leg since having the COVID-19 Janssen vaccine on 3/19/2021. She is a chronic smoker. Thus, a left lower extremity arterial doppler was done on 5/20/2021 which incidentally revealed a DVT in the gastronemius vein of the left lower extremity. A subsequent bilateral US venous doppler of both lower extremities was done which revealed no DVT. Therefore, a repeat venous doppler of the left lower extremity was ordered for today, 5/21/2021, and remains pending at this time. Of note, patient was started on eliquis on 5/20/2021 (10 mg BID for the first 7 days with subsequent decrease to 5 mg BID thereafter). She will be referred to a hematologist for continued management.

Other Meds: Zantac 150 mg oral tablet [1 tab PO BID prn for GERD] Lexapro 20 mg oral tablet [Take 1 tablet(s) by mouth daily] Pravastatin 40 mg oral tablet [Take 1 tablet(s) by mouth at bedtime] traZODone 50 mg oral tablet [TAKE 1 TABLET BY MOUTH AT BE

Current Illness: none

ID: 1337052
Sex: F
Age: 33
State: WA

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: mushroom, sulfa drugs, some other medications

Symptom List: Vomiting

Symptoms: Before receiving the vaccine, patient stated that she had a history of fainting and lightheaded after receiving a vaccine. Patient received vaccine at 12:30pm then at 12:40pm, patient said she had an adverse drug reaction after receiving vaccine. She felt lightheaded and fatigue. She was dozing off and on afterwards. We had her sit in a chair with her legs propped on another chair. We gave her water and juice to help hydrate her. We also checked her blood pressure and it was normal. Pharmacist called 911 and EMT arrived to check her out. They took her vitals: blood pressure 162/90, pulse 94 and 106, and O2 stat 98-99. EMT determined this was a panic attack and patient agreed to be transported to Hospital at 1:25pm but changed her mind to not go.

Other Meds:

Current Illness:

ID: 1337053
Sex: F
Age: 21
State: IN

Vax Date: 05/07/2021
Onset Date: 05/21/2021
Rec V Date: 05/21/2021
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: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: after getting the shot it only took a few min after to start having really bad mood swings that didnt stop till the 4th day sore arm by the end of the day . the next 2 days i started to have diarrhea and felt nauseous arm was very sore. 4th day i puked and had diarrhea also very gassy arm was still sore not as bad. the 5th day diarrhea and gas, 6th-8th days i was vary gassy woke up nauseous. 9th day felt normal again and all the symptoms went away.

Other Meds: no

Current Illness: no

ID: 1337054
Sex: F
Age: 48
State: CA

Vax Date: 05/03/2021
Onset Date: 05/11/2021
Rec V Date: 05/21/2021
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: Severe chapped and cracked lips, particularly around the outline of the lips. Some puffiness of lips (especially the outline of lips).

Other Meds: Wellbutrin (150mg) Multi-vitamin Cinnamon extract Milk Thistle Vitamin C Flaxseed oil Collagen

Current Illness: Had severe dry lips ~7days after my first covid vaccine

ID: 1337055
Sex: M
Age: 76
State: IN

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
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: High fever of 106.3, chills, headache, aches, unable to stand, weak, dizzy

Other Meds: Multi-vitamin, Metforman, Gavapintin, magnesium, potassium, Repatha

Current Illness:

ID: 1337056
Sex: M
Age: 16
State: TX

Vax Date: 05/01/2021
Onset Date: 05/19/2021
Rec V Date: 05/21/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: Patient is a 16yo girl admitted on 5/19 with sepsis secondary to myocarditis and pneumonia, s/p IVIG, after presenting with fever, myalgia, sore throat, hypotension, elevated troponin, elevated CRP, and leukocytosis with left shift. Sore throat has been present for about a week and fevers began on 5/17 with a Tmax of 103. On 5/18, she began developing shortness of breath and upon evaluation by the PCP on 5/19, she was admitted. During initial workup on 5/19 upon admission, hospitalist was high concerned as she developed hypotension of 91/48 on 5/20 at 08:35am. CT of chest on 5/20 showed patchy consolidation of the posterior lower lobes bilaterally. At that point, I was contacted and recommended broadening regimen to clindamycin , ceftriaxone, and azithromycin. Upon transfer to Hospital, further serologies were collected which showed leukocytosis with left shift, highly elevated CRP, elevated troponin, elevated IL-6, elevated ferritin, negative Covid abs test, negative RVP, and negative Covid PCR. IVIG (2grams/kg) started on 5/20 at 22:57. Cardio and ID on board and all regular myocarditis infectious workup has been collected. ID consulted for workup and management. Of note, patient received the Covid vaccine on 5/1/21

Other Meds: n/a

Current Illness:

ID: 1337057
Sex: F
Age: 57
State: PA

Vax Date: 04/21/2021
Onset Date: 05/08/2021
Rec V Date: 05/21/2021
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: NabumetoneOther (document details in comments)

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

Symptoms: UNKNOWN

Other Meds: escitalopram (LEXAPRO) 10 mg tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm