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: 0957081
Sex: F
Age: 49
State: WA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
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: Pfizer C19 vaccine given, Patient was a staff member at facility, felt unwell, blood pressure was taken by observer, pt ultimately felt well enough to go back to her office. At some point she contacted her doctor by phone and came back to observation reporting numb tingly lips and cheeks (covered by mask). Requested a diphenhydramine 50mg, which was given at 1400. rated reaction feel as level 5. After 25 minutes asked again and rated level 1. Contacted doctor. He cleared her to go home and would follow up in 2 hours to see how she was doing.

Other Meds:

Current Illness:

ID: 0957082
Sex: F
Age: 48
State: OH

Vax Date: 01/09/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
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: codeine claritin

Symptom List: Anxiety, Dyspnoea

Symptoms: On January 16, one week after my injection (on January 9) my upper arm formed a quarter size reddened area in the injection area. It was slightly warm, hard to touch, itchy, and looked similar to a hive. It stayed this way until the morning of Tuesday January 19. The area is only slightly red at the moment, it is now 730pm. I tried to submit an update to my V-Safe profile but it said I had updated all my health questions. I did fill out my form on Saturday the 16th prior to my symptoms presenting.

Other Meds: Coumadin, Advair Once a Day Vitamin, Citracal, Glucosamine Chondritin, Probiotic

Current Illness: na

ID: 0957083
Sex: F
Age: 43
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
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: PCN, milk, crabs, Bezzoyo paroxide

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

Symptoms: About 2 minutes after injection patient reported redness showing on both hands and feeling a little bit dizziness. At the time she was on the W/C to ED, she reported her throat feeling tight.

Other Meds: Claritine, Olapatadine

Current Illness: unknown

ID: 0957084
Sex: F
Age: 26
State: NY

Vax Date: 01/11/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: A week after the shot I have a rash below my injection site. It is blotchy and about an inch long and an inch wide. It is a bit itchy

Other Meds: Lo loestrin

Current Illness: None

ID: 0957085
Sex: F
Age: 29
State:

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: Codeine

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

Symptoms: AE's : Injection tenderness, fever, chills, headache, malaise, severe myalgia, lymphadenopathy, mild sore throat, occasional nausea and lightheadedness when standing for longer than 5-10 minutes at a time. Tx: none Outcome: All AE's except injection tenderness and right axial lymphadenopathy fully resolved within 48 hours.

Other Meds: Amphetamine Salts ER (PO); Etonogestrel (implant)

Current Illness: N/A

ID: 0957086
Sex: F
Age: 58
State: CA

Vax Date: 08/31/2020
Onset Date: 08/31/2020
Rec V Date: 01/19/2021
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: Persistent pain in shoulder diagnosed as SIRVA by Primary care physician on 1/19/2021 prescribed Etodolac 400mg twice daily

Other Meds:

Current Illness:

ID: 0957087
Sex: F
Age: 37
State: WA

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/19/2021
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: Swelling, pain, hardness, redness spreading. Treated with Cephalexin 500 MG. Infection is going away.

Other Meds: Airborne, tums

Current Illness: None

ID: 0957088
Sex: F
Age: 41
State: PA

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/19/2021
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: At about 4:30am on 12/24/20 she woke up with an itchy throat and hives all over body. Took 50mg Benadryl and symptoms cleared up in 3 hours. Developed hives again that evening. Took Benadryl 25mg and resolved. This has continued to occur approximately once daily with relief of Benadryl 25mg. Was advised by Dr. that this could be from an allergy to the filler.

Other Meds:

Current Illness:

ID: 0957089
Sex: F
Age: 53
State: PR

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: Aspirin Skelaxin Shrimps Almonds

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: One and a half hour after the vaccine, the headaches began. They lasted during the next day. I treated them with acetaminophen. The next day of the vaccine, my left arm turned red around the vaccination area (about a lemon in size), it got swollen, and itching. I put ice on the area and it improved, but the redness continue. Then, eight days later it got worse, the redness area increase in size, it got swollen again (more than previously) and the itching was back. Also, the area seems to have a fever (when touch). I took Benadryl for two consecutives days and applied ice to the area. The swollen and the itching improved; but it has been 11 days and I still have the redness in my arm (bigger than a lemon in size).

Other Meds: Nexium 40 mg (1 daily/morning) Pepcid 20 mg (1 daily/night) Actonel 150 mg (1 per month) Symbicort Albuterol HFA Multivitamin for women Fish Oil 500mg Calcium 500 mg Biotin

Current Illness: Asthma Gastritis - Reflux Sinusitis

ID: 0957090
Sex: F
Age: 43
State: NC

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/19/2021
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: Site red and itchy on day after vaccine 1/8/2021. Patient reported left arm and hand tingling as of 1/19/2021. Spoke with her primary care provider who instructed her it would most likely resolve on its own. No treatment provided.

Other Meds:

Current Illness:

ID: 0957091
Sex: M
Age: 72
State: NC

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
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: Serentil

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

Symptoms: COVID-19 Vaccine

Other Meds: Lantis, Novolog, ferrous sulfate, metformin, juardance, eloquis,tamulosin, vitamin D3, Metropolol, lisinopril, atorvastatin,omeprazole, finesteride, potassium , centrum 50+

Current Illness: Removal of sebaceous cyst,

ID: 0957092
Sex: F
Age: 56
State: CA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/19/2021
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: sulfa, walnuts and pecans

Symptom List: Rash, Urticaria

Symptoms: Headache, fatigue, chills x 4 days. Headaches and fatigue continue on day 12 post vaccination.

Other Meds: Advair, xopenex, claritin, vit c, vit d, zinc

Current Illness: none

ID: 0957093
Sex: M
Age: 29
State: CA

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Body ache, headache, and fever Tylenol lowered the temperature of fever.

Other Meds: none

Current Illness: none

ID: 0957094
Sex: M
Age: 58
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/19/2021
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: ASPIRIN ATROPINE DONNATAL FLAGYL: Rash HALDOL: Rash HALOPERIDOL HYOSYCYAMINE METRONIDAZOLE NSAIDS (NON-STEROIDAL ANIT-INFLAMMATORY DRUG): Rash - Reaction: CAUTION with hx ulcers; PENICILLINS: Rash PHENOBARBITAL PNEUMOVAX-23: OTHER (Moderate to Severe) SOB/redness/High BP and HR SCOPOLAMINE

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

Symptoms: elevated blood pressure, labored breathing, hives on body.

Other Meds: amLODIPine 10 mg tablet ammonium lactate 12% lotion atenolol 100 mg tablet atorvastatin 20 mg tablet azelastine 137 mcg nasal spray aerosol calcium carbonate 600 mg calcium tablet Centrum Silver cephALEXin 750 mg capsule ciprofloxacin 500 m

Current Illness:

ID: 0957095
Sex: F
Age: 57
State: CA

Vax Date: 01/08/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
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: Latex

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

Symptoms: After 1/8 injection, arm painful for about 72hrs, then I did not notice it any longer. on 1/16 -site started to be sore again. on 1/18 - discomfort increased and I noticed it was warm to the touch, slightly swollen and light red. on 1/19 - no change really - maybe slightly less painful. no fever so far

Other Meds: Provigil, Prevastatin, Multi-Vit, Fish oil, Vit D, Ubiquital, Vit. C

Current Illness: none

ID: 0957096
Sex: F
Age: 40
State: WI

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/19/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient reported slight facial swelling but also has sinus issues

Other Meds:

Current Illness:

ID: 0957097
Sex: F
Age: 44
State:

Vax Date: 01/05/2021
Onset Date: 01/13/2021
Rec V Date: 01/19/2021
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 known

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

Symptoms: Itching and redness at injection site developed 8 days after vaccination. 9 days after injection the itching subsided but red area grew substantially and area was slightly swollen. By that night injection site was hot to the touch. No pain or discomfort. No fever or body aches. By day 10 reduced redness but spread to a larger area on arm. Redness gradually subsided a little each day and was completely gone by day 14.

Other Meds: Vitamin D3 One A Day Multivitamin

Current Illness: None

ID: 0957098
Sex: M
Age: 48
State: CA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/19/2021
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: 6 hours after receiving vaccine I developed frequent loose stools. This continued for two days, on the 3rd day I developed cramping with loose stools. This continues today. I am using pedialyte to keep my hydration, immodium AD and probiotics for the diarrhea. No fever; mild chills

Other Meds: tumeric, fish oil, vitamin D, terazosin, tolteradine

Current Illness: none

ID: 0957099
Sex: F
Age: 28
State: CA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: Cipro Clincaymyacin Macrobid Flagyl

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fast heart rate- intermittent

Other Meds: Mini pill Sertraline

Current Illness: Common cold week prior

ID: 0957100
Sex: F
Age: 52
State: IN

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: After having the vaccination, felt woozy, headache. Went to bed, up Sunday morning, about 1:30, 1:45 had sever headache, feverish, no energy, sick to her stomach. Monday morning, excessive heart rate. Did not go to work. Was pale looking. By Monday evening, felt better. Today, wasn't feeling 100% but did go back to work.

Other Meds: Metoprolol , Amlodipine, Levothyroxine, Lisinopril, Bupropin

Current Illness: no

ID: 0957101
Sex: F
Age: 48
State: OH

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/19/2021
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: none

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

Symptoms: 12 hours after vaccination, had fever, chills, headache, muscle aches. 24 hours after vaccination, still had headache and muscle aches. Experienced nausea and vomiting 24 hours after vaccination. Missed work as a result of these side effects.

Other Meds: Mycophenolate 1500 mg bid Prednisone 5 mg daily

Current Illness: none

ID: 0957102
Sex: F
Age: 38
State: NY

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 01/19/2021
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 known

Symptom List: Unevaluable event

Symptoms: Fever and body aches/joint pain began while sleeping, around 12:00am on 1/17/21 and persisted through late morning (around 10:00am) on 1/18/21. Also had chills and extreme fatigue. Slept almost all day on 1/17/21 and went to sleep early. Took 700 mg of Tylenol on 1/17/21 at 7:30am, 2:30pm, 7:30pm, and the morning of the 18th but fever continued to register between 100.2 and 100.8. Was unable to record temperature at highest fever the night of the 17th while sleeping. All symptoms have resolved as of today, 1/19/21.

Other Meds: Levothyroxine 25 MCG Tablet, Sertraline 100 MG

Current Illness: No illness

ID: 0957103
Sex: F
Age: 46
State: VA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
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: 1/15/21 sore injection site arm and fever 100.5F. Treated with acetaminophen. 1/16/21 soreness improved but not gone. Fever resolved. 1/17/21 to present stomach ache with diarrhea. Eating bland diet, taking zyrtec 10 mg daily, taking lomotil per label direction, taking probiotic.

Other Meds: 225ug levothyroxine daily

Current Illness: None

ID: 0957104
Sex: F
Age: 31
State: WI

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Patient started getting electrical zingers across her shoulder, clavicle and neck later in the afternoon, occurring every 15 minutes.

Other Meds:

Current Illness:

ID: 0957105
Sex: F
Age: 22
State: IL

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: 1/14/21- 10:30am Noticed some fullness/swelling in throat. Was still able to breath fine, but definitely noticed a difference. This lasted a few hours. 1/15/21- 3:45am I got up to use bathroom and noticed I was very lightheaded. I thought maybe I just stood up too fast. I got back in bed and my arm was 8/10 pain so I also thought faintness could possibly due to pain. 7:15am I got up to go to work and quickly felt very warm and my vision started to go black. I laid back down for a few minutes until this resolved. I took my temperature and it was 99.0. I got up again and started to get ready but began feeling light headed again. I ended up getting ready while sitting down because I kept feeling too much like I was going to pass out. I ate breakfast and felt fine. 8:00am I left for work and after driving for about 5 minutes I felt myself getting very warm again and light-headed. I ended up pulling over and calling for someone to come pick me up. 9:00am My temperature was 99.5. My blood pressure laying down was 110/74 and HR was 74. After standing for 5 minutes my BP was 90/70 and my HR was 92. During this 5 minutes of standing I felt myself getting warm again but my vision did not start to go black and I was able to stand for the full 5 minutes. At various times throughout the day I would feel faint if I was standing or sitting upright for too long. The last time I felt this was was probably 11:30pm on 1/15/21. 1/16/21 - No light-headedness or warmth. Did feel some slight chest pressure, but nothing crazy and it only lasted maybe half of the day.

Other Meds: Sertaline 50mg daily Iron 65mg daily Vitamin D3 5000iu daily Multi-Vitamin (biotin, keratin, vitamin c, vitamin e)

Current Illness: None

ID: 0957106
Sex: F
Age: 0
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
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: unknown

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

Symptoms: Within 5 minutes of giving patient her vaccination patient broke out into a macule rash mainly on her forehead and upper R cheek. oxygen sat level at 100% room air, 158 for pulse. Slightly lethargic & sleepy but no acute distress noted, no difficulty breathing or SOB noted.

Other Meds: none

Current Illness: none

ID: 0957107
Sex: F
Age: 35
State: DE

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
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: Latex Codine Diclofenac Wasps Hornets Zoloft

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Immediately > Sore to touch and felt swollen Within 1 hr > very tired 10pm: Body aches, temperature of 99.9F, arm so sore I could not touch it, sweating, stomach muscle pain Saturday 1/16/21 @ 1am > 103F temperature, every part of body hurt (even my cheeks could not be touched), joints very sore, difficult to walk, very tired, sweating, dizziness Remainder of day until 10pm > Very tired, lethargic, fever not below 100 with medication, very sore muscles and joints throughout entire body, slight cough, difficult to sit or walk due to pain, sweating, muscle weakness, dizziness 10pm> temperature 99.9 without medication, muscle and joint pain not as severe, sweating, feet still very sore, tired, muscle weakness Sunday 1/17/21 @ 9am > temperature 98.8F without medication, a little tired, moderate joint pain in hips feet, slight cough, dizziness, sweating (symptoms continued) 9pm> temperature 98.3F, mild joint stiffness in hips, mild pain in feet, moderate nausea Monday 1/18/21 8am > temperature 97.9F Mild pain where toes and foot connect, mild nausea, slightly tired 5pm> temperature 98.3F, very painful stomach muscle spasm while leaned over for approximately 30 seconds to 1 minute on both sides 1/19/21 8am > temperature 97.6F, mildly tired, mild stomach muscle spasms while sitting and standing 7:40pm temperature 98.3, mild stomach muscle spasms while sitting and standing

Other Meds: Meloxicam Mobic Lexapro Zyrtec Flexaril

Current Illness: None

ID: 0957108
Sex: F
Age: 83
State: MA

Vax Date: 10/09/2020
Onset Date: 10/10/2020
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: Carafate, Lovastatin, Zoloft, Codeine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received high dose flu vaccine 10/9/2020. No problem day of vaccination. The next two days (10/10 and 10/11/2020) "the pain was so awful I could not lift my arm." Continues to feel light throbbing pain at site of injection. At night she has to hang arm down on side of bed and it helps. Once in a while can feel throbbing down the right arm into fingers. Patient first reported above on 1-19-2021

Other Meds: Aspirin, Calcium, topical CBD oil, chlorthalidone, Klor-con, Losartan, Magnesium, Multivitamin, Pravastatin, Stool softener, Vitamin D

Current Illness: None known

ID: 0957109
Sex: M
Age: 73
State: AZ

Vax Date: 02/24/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: CORVOD19 VACCINE FEB 24, 2021 5:48 AM

Other Meds: LISINOPHIL HCTZ, ATENOLOL, HYGROXYZINE HCL, SIMVASTAIN, LEVOCETIRIZINE, EZETLMIBE, BYDUREON PEN, AZELASTINE HCL NASAL, VITIAM D3, BAYER BABYBASPIN 81MG, GLUCOSAMINE CHONDROLTIN, OMEGGA 3, NIACIN, VIAMIN C, MUTI-VITAMIN, CO-Q10

Current Illness: NONE

ID: 0957110
Sex: F
Age: 18
State: CA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Nausea

Symptoms: 2 minutes loss of sight after having COVID-19 injection. Patient has no history of allergic reactions in the past no history of loss of vision in the past. Patient states that she is somewhat clammy and may have low blood sugar. No fever chills sweats no nausea vomiting diarrhea. Symptoms have completely resolved.

Other Meds:

Current Illness:

ID: 0957111
Sex: F
Age: 82
State: IN

Vax Date: 01/09/2021
Onset Date: 01/17/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: Sporanox

Symptom List: Injection site pain

Symptoms: Eight days after the first injection, I noticed for the first time a reddish blotch near the site of the injection. The day after it had spread downward, the next day the redness seems to have diminished some, but it still covers the same area. The redness was warm to the touch, and hard, but not painful. The area felt like the size of the palm of my hand. I did not run a fever. I realize that redness is one of the side effects, but my concern is that it didn't occur immediately; rather, one week later.

Other Meds: Escitalopram, B12, B6, Move Free Advanced plus MSM, Citracal, Centrum Silver, Theratears, Travatan, Rhopressa, Timolol, Pilocarpine

Current Illness: none

ID: 0957112
Sex: F
Age: 52
State: NV

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: pt had horrible headache, felt horrible for at least 3 days

Other Meds: ibu 800, alpraz 0.25, pregab 150, estradiol 0.5, buprop xl 300, levo 25, omep 20, combivent, pravastat 10

Current Illness:

ID: 0957113
Sex: F
Age: 38
State: VA

Vax Date: 01/12/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: On day 2 there was soreness. The soreness returned on day 7, approx 2-3 inches around the injection site is hard to the touch, warm, and there is some redness. The soreness was first noticed when I woke up and had continued and gotten worse through the day.

Other Meds: None

Current Illness: None

ID: 0957114
Sex: F
Age: 41
State: PA

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Decided to get second vaccine 1/11/21 even though she was still getting hives from 1st dose. Developed swelling on inner canthus L eye. Saw Dr. 1/14/21 and famotidine was ordered. This reduced hives. In 1/16/21 developed swelling of R inner canthus. Took Benadryl and famotidine hs on 1/17/21. Took famotidine 1/18/21 before work, but developed hives under arms and tongue began to swell that evening. Took another dose of famotidine. Tongue improved within 40 minutes but L side of face began to swell. Took Benadryl 50mg. Facial swelling improved but did not go away. Called Dr. this am and was ordered a Medrol dose pack. If this is not effective then she will be referred to Dr., allergist.

Other Meds:

Current Illness:

ID: 0957115
Sex: M
Age: 81
State: FL

Vax Date: 01/14/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
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: n/a

Symptom List: Erythema, Pruritus

Symptoms: tired and fatigue, soreness in arm on first day, diarrhea,sore knee, magnified any type of pain he initially had:shoulder pain as well

Other Meds: Fiber Blend, Barley Life Extra

Current Illness: n/a

Date Died: 01/18/2021

ID: 0957116
Sex: M
Age: 75
State: HI

Vax Date: 01/14/2021
Onset Date: 01/18/2021
Rec V Date: 01/19/2021
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: Cipro caused nausea, Coreg caused bradycardia, Hydrocodone, calcium acetate

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

Symptoms: Sudden death without warning symptoms 4 days after vaccine. Many medical problems which most likely explain the outcome but spouse feels it is related and it is a new vaccine. Monitor for pattern?

Other Meds: Atovastatin, Ferrous sulfate, Finasteride, Flomax, Humulin N, Pantoprazole, ProAir, Reglan, Spiriva, Turmeric

Current Illness: Diabetes, Chronic renal failure on hemodialysis, Atrial fibrillation, Quadriplegia, Thrombocytopenia, Gastroparesis, Vitamin D deficiency, BPH, Neurogenic bladder, distant history of small intestine carcinoid tumor, right cerebral artery aneurysm, Barrett's esophagus, MGUS, Hypertension, obstructive sleep apnea, Pulmonary hypertension, Junctional tachycardia.

ID: 0957117
Sex: F
Age: 32
State: CA

Vax Date: 01/17/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
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: Shellfish

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

Symptoms: Low grade fever started 1/18 around 1400: 100.4 F, accompanied by body aches, chills, fatigue and headache. Fever spiked 1/19 around 1445: 103.2

Other Meds: Vitamin D Prenatal vitamin Nexplanon implant

Current Illness: None

ID: 0957118
Sex: F
Age: 46
State: FL

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Headache, Left hand(vaccine) in severe pain

Other Meds: Tylenol taken after vaccination

Current Illness: No

ID: 0957119
Sex: F
Age: 61
State: WI

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/19/2021
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: Patient reported fever, aches, headache, bilateral foot pain, jaw and facial pain

Other Meds:

Current Illness:

ID: 0957120
Sex: F
Age: 90
State: CA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
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: Patient vomited after the first vaccine dose - fruit juice was given and nausea resolved.

Other Meds:

Current Illness:

ID: 0957121
Sex: F
Age: 55
State: GA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
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: Pain in extremity

Symptoms: Patient complained of dizziness, felt "flushed". O2 sat was 99% no DIB, asked patient to lie down, no hives noted, face and neck became flushed. Blood pressure was 180/92, c/o facial "tingling" 50mg IM Benadryl given. Vital signs returned to normal after 8 minutes, PCP and family notified. All redness and "tingling" gone-released to family and instructed to f/u with PCP.

Other Meds: No medications

Current Illness: None

ID: 0957122
Sex: F
Age: 63
State: AZ

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Arm hurt so bad several hours after shot, I could not use it. Went to bed early not feeling well. Woke up the next day. Awful headache, muscles hurt so bad I could hardly get out of bed, shivers, stomach up set , couldn't eat, extremely tired. Lasted all day , all night and half the next day until I felt right.

Other Meds: Iron, magnesium, B 12, calcium, baby aspirin, B complex, multi vitaman, levothyroxine, D3

Current Illness: None

ID: 0957123
Sex: F
Age: 55
State: PA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/19/2021
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, Augmentin, Bactrim, barium sulfate, bromocriptine, clindamycin, egg, hydrochlorothiazide, Latex, Levaquin, lisinopril, milk, Norvasc, Sulfa (Sulfonamide Antibiotics)

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

Symptoms: chest pain. resolved after arrival to the ER.

Other Meds: BuSpar Spiriva with HandiHaler Symbicort Hydralazide atorvastatin albuterol sulfate omeprazole naproxen PROzac triamcinolone acetonide prednisone hydrOXYzine HCl Pepcid AC

Current Illness: eczema hypertension GERD COPD

ID: 0957124
Sex: F
Age: 39
State: CA

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
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: Fever and body aches starting approximately 11 hours after injection, lasting about 48 hours.

Other Meds: Venlafaxine, generic for Effexor

Current Illness: I had COVID 19. First symptoms started December 7th, tested positive on December 12. Last fever was recorded December 22, but chest tightness and fatigue didn't end for another 2 weeks. I also had strange mouth soreness from Jan. 4-9, which I realize may have been COVID 19 related.

ID: 0957125
Sex: F
Age: 58
State: LA

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/19/2021
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: Sulfa

Symptom List: Vomiting

Symptoms: Fever 101.5, chills, headache, muscle aches and diarrhea-1/13/21. Fever 100.7 headache, muscle aches 1/14/21. Abd pain 1/16, 1/17 ER admission- abdominal pain 1/18. Discharge home. Rash and abd pain 1/19

Other Meds: Furosemide 20mg twice weekly

Current Illness: None

ID: 0957126
Sex: F
Age: 48
State: NY

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
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: Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fatigue for 24 hours, soreness in left arm

Other Meds:

Current Illness:

ID: 0957127
Sex: F
Age: 28
State: WI

Vax Date: 01/05/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: ten days after receiving her Covid vaccine Pt noticed a bumpy rash on her hands and fingers and toes which are itchy and sore. She saw her Dr. She said if it didn't improve she should see a dermatologist.

Other Meds:

Current Illness:

ID: 0957128
Sex: F
Age: 57
State: CT

Vax Date: 12/26/2020
Onset Date: 01/03/2021
Rec V Date: 01/19/2021
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: Augmentin, Reglan, Compazine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Little itching when sleeping. Woke up to 9 cm round area of redness, warm to the touch, firm and swollen. It lasted 2 1/2 days then she was fine.

Other Meds:

Current Illness: no

ID: 0957129
Sex: F
Age: 52
State: NY

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/19/2021
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 red and swollen down to the elbow for four days. Very itchy and hot to the touch.

Other Meds: Tylenol

Current Illness: COVID 19 body aches, joint pain, left armpit swollen

ID: 0957130
Sex: M
Age: 41
State:

Vax Date: 01/11/2021
Onset Date: 01/15/2021
Rec V Date: 01/19/2021
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: NKDA

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

Symptoms: Right sided body rash consistent with varicella zoster

Other Meds: Meloxicam Cyclobenzaprine Ketoconozole

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm