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: 0957480
Sex: U
Age: 0
State: CO

Vax Date: 09/06/1975
Onset Date: 01/13/2021
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: Severe headache, body aches, cold sweats, chills, and muscle spasms. At a week out I continue to have body aches.

Other Meds:

Current Illness:

ID: 0957481
Sex: F
Age: 54
State: PA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Allergic to jodo

Symptom List: Anxiety, Dyspnoea

Symptoms: fever, headache, muscle pain, joint pain, nausea, conjunctivitis, facial edema,

Other Meds:

Current Illness:

ID: 0957482
Sex: F
Age: 32
State: CA

Vax Date: 01/07/2021
Onset Date: 01/08/2021
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: None

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

Symptoms: -fever (up to 103F) x 11 days -chills x 11 days -muscle/body aches x 11 days -fatigue x 11 days -swollen lymph node x 10 days -rash (red, raised, dry/scaly) on bicep area of left arm (same arm as injection site) x 11 days -nausea/diarrhea x 3 days (starting on 1/18/21) -decreased appetite x 2 days (starting on 1/18/21)

Other Meds: None

Current Illness: None

ID: 0957483
Sex: F
Age: 42
State: MN

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: no

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I tested positive for COVID 3 days after taking the vaccine.

Other Meds: none

Current Illness: Tested positive for COVID 4 days after taking the vaccine.

ID: 0957484
Sex: F
Age: 64
State: MN

Vax Date: 01/06/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Left arm, near injection site, was reddened, raised and warm to touch 9 days after the day of injection. approximately 3x3 inches. Was seen in the ER where I work and it was recommended that I start Cephalexin 500mg 1 capsule 4 times per day x 10 days. Diagnosed as a Cellulitis.

Other Meds: Vitamin D, Multivitamin and calcium, Allegra, and Flonase

Current Illness:

ID: 0957485
Sex: F
Age: 34
State:

Vax Date: 01/18/2021
Onset Date: 01/19/2021
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: Fever, chills, aches, muscle pain, joint pain, nausea, feeling unwell

Other Meds:

Current Illness:

ID: 0957486
Sex: M
Age: 32
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Fever of 102F for hours today. I've now taken total of 975 tylenol and 400 Ibuprofen today to combat. Fever is finally decreasing. Currently 99.9F.

Other Meds: Zinc supplement, multi vitamin gummy, Lexapro 10mg

Current Illness: Covid 19 symptoms 2 weeks before (loss of smell and night sweats)

ID: 0957487
Sex: F
Age: 58
State: IN

Vax Date: 01/01/2021
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:

Symptom List: Pharyngeal swelling

Symptoms: T 101.7

Other Meds: Rosuvastatin 5 mg, aspirin 81mg, latanoprost 1 dr.

Current Illness: Coronavirus 12/30

ID: 0957488
Sex: F
Age: 29
State: PA

Vax Date: 01/11/2021
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: Penicillin, amoxicillin, azithromycin,

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: About 1 week after the injection, the injection area began swelling, itching, becoming on to the though, and very red. It a little bit larger than the size of a quarter.

Other Meds: Hormonal Birth control Zoloft

Current Illness: None

ID: 0957489
Sex: M
Age: 27
State: IA

Vax Date: 01/01/2021
Onset Date: 01/01/2021
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: Tingling on the face in the left side. Headache. Fatigue

Other Meds:

Current Illness:

ID: 0957490
Sex: F
Age: 82
State: AK

Vax Date: 12/29/2020
Onset Date: 01/11/2021
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: Codeine, Bactrim

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

Symptoms: Several days after receiving the Covid vaccine in her L arm the patient presented with redness, swelling, heat, and tenderness in same are. The redness was marked and grew past outline, moving all the way down to her hand. She was started on Keflex with no improvement. Doxycycline was started; then discontinued when there was no change. Claritin, Benadryl and Kenalog cream was then started. Redness continues but has not grown.

Other Meds: Liptor, Sinemet, Coreg, Lexapro, gabapentin, Megace, melatonin, Oxycontin, miralax, Seroquel, Exelon patch, senna, centrum silver multivitamin

Current Illness: Osteoarthritis, depression, hallucinations, aortic valve narrowing, vaginal bleeding

ID: 0957491
Sex: M
Age: 27
State: CA

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: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Fever on and off for 1.5 days starting ~14 hours after initial injection, and swollen cervical lymph nodes starting ~72 hours after initial injection (ongoing).

Other Meds: Keppra XR 750 mg QID (3000 mg total daily)

Current Illness: None

ID: 0957492
Sex: F
Age: 47
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:
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: 11:58am- tingling in right chest and neck , felt a high 8:00pm- back pain and neck pain/ shoulder blades stiffness and muscle ache /soreness at right arm place of injection 8:30: sleepy 2:40am - Instense stiffness pain in the neck and shoulder blades with aching pain. 4:00am : Insomnia Pain lesson next day by 50 percent. Still experiencing soreness throughout today 1/19/2021 Took 3 Tylenol every 6 hours

Other Meds: None

Current Illness: None

ID: 0957493
Sex: F
Age: 35
State: TX

Vax Date: 01/01/2021
Onset Date: 01/14/2021
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: Keflex

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

Symptoms: After 2nd shot in series I experienced a very painful, swollen lymph node under my right arm. Reaction occurred 2 days after injection, resolved 5 days after symptom first appeared.

Other Meds: Zoloft, Allegra, multi-vitamin, melatonin

Current Illness: None

ID: 0957494
Sex: M
Age: 15
State: CO

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Vaccine was administered to minor who is 15 years of age. Vaccine not licensed for this age group. Patient was monitored for 15 minutes post vaccination. No S/S of complications Client denied any adverse reaction while in clinic. Reviewed with clients parents expected vaccine reactions and encouraged registration of client in the V-Safe Program.

Other Meds: None

Current Illness: None

ID: 0957495
Sex: F
Age: 65
State: MO

Vax Date: 12/28/2020
Onset Date: 12/29/2020
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: Sensitivity to citrus and ?Collin? family antibiotics

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

Symptoms: At injection site I had an area, about the size of a quarter, that raised up (like a hive). It was red, warm to the touch, and itched occasionally. Within another 24 hours the size spead to about 2? wide. Still red, warm to the touch. Took about 6 days to be totally gone. Arm never hurt or was sore from the shot - seemed to be a local area reaction.

Other Meds: At our thyroid medication Dietary supplements and vitamins

Current Illness: None

ID: 0957496
Sex: F
Age: 70
State: DE

Vax Date: 01/17/2021
Onset Date: 01/18/2021
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: Side effects from Shingles (Pt -1&2) and the newest Flu shot for 65+ Chills, body aches, fatigue, headache

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

Symptoms: Headache, chills, fatigue, body ache Symptoms began on 01/18/21 , 6pm Subsided approximately 12N, 01/19/21

Other Meds: Amlodipine BE, Gabapentin, Duloxetine DR, Meloxicam, Nortriptyline Vitamin Supplements: Daily+ B Complex, Type II Collagen w/ Hyaluronic Acid & Boron, C, Calcium, D3, Glucosamine

Current Illness: None

ID: 0957497
Sex: F
Age: 26
State:

Vax Date: 01/11/2021
Onset Date: 01/18/2021
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: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Moderna COVID-19 Vaccine EUA. One week post injection, site of injection has swelled, become warm, and developed pruritus. Attempted to use OTC topical steroid and ibuprofen with little effect.

Other Meds: acetaminophen 1000 mg

Current Illness:

ID: 0957498
Sex: F
Age: 53
State: ID

Vax Date: 01/11/2021
Onset Date: 01/12/2021
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: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: headache, body aches, fever, nausea, fatigue, injection site pain and redness, joint pain, not feeling well

Other Meds: Lisinopril, venlafaxin, HCTZ, ibuprofen, Vitamin B 12

Current Illness: none

ID: 0957499
Sex: F
Age: 33
State: CA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
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: Peanuts.

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

Symptoms: Chills, body aches, fevers, headaches, migraine diarrhea Started a bit after the vaccine was administered. Body aches, chills head aches and migraines. Have been on going since Monday January 11, 2021

Other Meds: At the time of getting vaccinated i wasn't taking any medications.

Current Illness:

ID: 0957500
Sex: F
Age: 50
State: VA

Vax Date: 01/08/2021
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Benadryl, Phenergan

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

Symptoms: Initial local pain in upper arm that is typical for shots which lasted 3 days. Then asymptomatic for 4 days and then with pain again in same region, tender to touch and movement. The next day developed headache for about 18 hours and also itchy hives over area of shot that then got bigger and became a large red welt with warmth for 3 days and then resolved on its own. Surprised that symptoms did not occur till 1 week after the shot

Other Meds: Ambien

Current Illness: None

ID: 0957501
Sex: F
Age: 38
State: AZ

Vax Date: 01/05/2021
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: Nsaids, bell peppers

Symptom List: Unevaluable event

Symptoms: I started to experiencing itchiness at the site of the injection on Friday January 15th along with firmness around the site of the injections. On January 19th my arm now has a rash around the injection area that is approximately 6inches in diameter.

Other Meds:

Current Illness:

ID: 0957822
Sex: F
Age: 60
State: TX

Vax Date: 01/18/2021
Onset Date: 01/18/2021
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: nka

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

Symptoms: began having tingling to face & tongue @ approx 0915 progressed to tongue and mouth swelling and rash to face

Other Meds:

Current Illness:

ID: 0957835
Sex: F
Age: 52
State: TX

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Severe Headaches, Dizziness & facial tingling 10 minutes after recieving 2nd Covid Vaccine. Transported to ER for further evaluation / treatment

Other Meds:

Current Illness:

ID: 0957855
Sex: F
Age: 62
State: CA

Vax Date: 12/30/2020
Onset Date: 01/08/2020
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: Erythromycin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Redness, swelling, itching at injection site.

Other Meds: levothyroxine & Atorvastatin

Current Illness: None

ID: 0957871
Sex: F
Age: 42
State: KY

Vax Date: 12/24/2020
Onset Date: 01/18/2021
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: NONE

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

Symptoms: LEFT SIDED FACIAL PARALYSIS THAT BEGAN ON 1/18/2021 WHEN SHE WOKE UP. SHE WORKED THAT DAY AND THE LEFT SIDED FACIAL PARALYSIS WAS PROMINANT. NO OTHER NEUROLOGICAL SYMTOMS WERE PRESENT. SHE SAW A PROVIDER AFTER WORK AND WAS DIAGNOSED WITH BELLS PALSY AND TREATED WITH A PREDNISONE DOSE PAK. FOLLOW UP WITH HER THIS MORNING 1/19/2021 ABD THE SYMPTOMS ARE THE SAME, NO WORSE OR NO BETTER. THE FIRST DOSE OF THE MODERN VACCINE WAS ADMINSTERED ON 12/24/2020.

Other Meds: NONE

Current Illness: NONE

ID: 0957881
Sex: F
Age: 49
State: WV

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: NKDA/other

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Began having headache morning of 12/30/2020 Arm pain at injection site with multiple nodules under skin surrounding area. Headache continued through 01/02/2021 - no improvement with Tylenol, Motrin. Joints locked up in hands and feet 12/31/2020 Severe hip pain, reduced by 01/02/2021. Arm pain continued for one week after vaccine administration, along with intermittent headache of varying intensities and durations. Joint discomfort remains as of 01/12/2021.

Other Meds: Voltaren

Current Illness: None

ID: 0957887
Sex: F
Age: 32
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
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: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 1135 - (L) ear ringing it migrate to (L) neck. V/S BP-116/70, HR-76, O2Sat-97% on RA, R-18 1142 - Diziness and middle back pain start hurting. V/S BP-110/68, HR-75, O2Sat-96%, R-15 1150 - pt. continue to have symptoms, escort to ER.

Other Meds:

Current Illness: None

ID: 0957888
Sex: F
Age: 41
State: WV

Vax Date: 12/29/2020
Onset Date:
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: no adverse reaction to much vaccine given felt tired next day.

Other Meds: None

Current Illness: None

ID: 0958065
Sex: F
Age: 37
State: WV

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: none

Symptom List: Nausea

Symptoms: - Severe pain, swelling & redness at the injection site (RA) - Chills, headaches, dizziness, tiredness, hunger.

Other Meds: none

Current Illness: none

ID: 0958102
Sex: F
Age: 70
State: WV

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PCN/Sulfa

Symptom List: Injection site pain

Symptoms: Headache Sore Arm received 1ml instead of 0.5ml

Other Meds: Synthroid

Current Illness: N/A

ID: 0958124
Sex: F
Age: 45
State: WV

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: LA

Lab Data:

Allergies: IV Contrast Dye

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

Symptoms: I was given 1ml,Correct Dose is 0.5ml.Headache, Tiredness, cough and slight nasal Discharge. Symptoms lasted 24 hours.

Other Meds: N/A

Current Illness: N/A

ID: 0958150
Sex: F
Age: 53
State: WV

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Aspirin

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

Symptoms: Patient no adverse symptoms Patient was given too much vaccine 1mL instead of 0.5 mL

Other Meds: 0

Current Illness: 0

ID: 0958154
Sex: F
Age: 35
State: WV

Vax Date: 12/29/2020
Onset Date: 01/03/2021
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: NKDA or NKA

Symptom List: Tremor

Symptoms: headache sore axillary nodes pressure in chest

Other Meds: birth control pill - orthomicronor

Current Illness: none

ID: 0958163
Sex: M
Age: 70
State: WV

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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 NKDA

Symptom List: Erythema, Pruritus

Symptoms: Mild soreness injection site Slight swelling of 3-4 cm diameter at injection site with little or no redness. Lasted 48-72 hour as it tapered off

Other Meds: Preservision - Areds 2, Osteo Biflex, Centrum Silver

Current Illness: None

ID: 0958183
Sex: F
Age: 49
State: WV

Vax Date: 12/29/2020
Onset Date: 12/29/2020
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: Statol Oxycodone

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

Symptoms: I was given 1mL of the vaccine instead of the 0.5mL. No adverse reactioNs.

Other Meds:

Current Illness:

ID: 0958197
Sex: F
Age: 48
State: TX

Vax Date: 01/13/2021
Onset Date: 01/13/2021
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:

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

Symptoms: ear congestion Bilateral hand swelling, redness BP 132/92 HR 107 P 70 99% RA

Other Meds:

Current Illness:

ID: 0958203
Sex: F
Age: 52
State: WV

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Pineapple

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pain at the site of the injection and fatigue. Tylenol 1g taken on 12/29/2020 at night *** Given 1ml of the vaccine instead of the recommended 0.5ml

Other Meds: OTC multivitamins

Current Illness: N/A

ID: 0958210
Sex: F
Age: 48
State: WV

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Cipro, Levaquin, Cleocin, Bactrim

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

Symptoms: Was given a double dose of vaccine by accident. Severe headache Asthma flare up pain, redness, swelling @ injection site. Earache/infection but don't know if its related.

Other Meds: Zoloft, Wellbutrin, Abilify, Protonix, Famotidine, Trazodone, Xyzal, Pro-Air

Current Illness:

ID: 0958215
Sex: M
Age: 58
State: TX

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: feeling light headed & legs feels heavy which makes it difficult to walk. dizziness

Other Meds:

Current Illness: none

ID: 0958222
Sex: F
Age: 48
State: WV

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: LA

Lab Data:

Allergies: pineapple, peicillins

Symptom List: Pain in extremity

Symptoms: Woke at 4:30 AM on 12/30/21 with headache, fever, body aches, sore arm, redness and swelling at site, vomiting. Took tylenol for fever and stayed in bed. The next morning I felt fine just tired. I was given full dose on 12/29/20.

Other Meds: Atorvastatin vit D3, vit B12, ezetimibe, lamotrigine, losartan, metoprolol, venlfaxine

Current Illness:

ID: 0958231
Sex: M
Age: 58
State: TX

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:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: none

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

Symptoms: feeling light headed & legs feels heavy which makes it difficult to walk. dizziness

Other Meds:

Current Illness: none

ID: 0958240
Sex: F
Age: 51
State: TX

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 10 min after recieving vaccine: - increased HR - itchy over entire body - Benadryl given - ER for further eveluas

Other Meds:

Current Illness:

ID: 0958244
Sex: F
Age: 49
State: TX

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: 10 mins after first dose - Flushed, heart racing and head pressure. BP 139/89 - HR 115 Took Benedryl 25 mg P.O. Denied ER visit Released home.

Other Meds:

Current Illness:

ID: 0958257
Sex: F
Age: 56
State: CA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: received covid vaccine at 1100. Informed writer of flushed Feeling and heart pounding at 1105. Manual pulse done. 95bpm. O2 sat monitor to be delivered. 11:10 vital signs done. BP 122/80 P-72 O2 sat 97%. By 11:15 symptoms passed. Patient stayed by cart. No further feeling of flushing or increased heart rate. Left clinic at 11:35, vital signs stable feeling well

Other Meds: Metformin, HCTZ, Losartan, Rosuvastatin, Vitamin D

Current Illness:

ID: 0958799
Sex: F
Age: 47
State: OH

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: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client stated she had participated in a trial for Regeneron, last therapy was 12/31/2020 (received 3 of 6 injections). Stated she had a negative COVID-19 antibody test the week before holiday. She assumed that she was a placebo recipient. She contacted the study and asked about getting the COVID-19 vaccine. She stated that she was not advised either way to get vaccine or not. She will no longer participate in the Regeneron study, but will do follow up appointment. Discussed CDC guidance "Person who previously received passive antibody therapy or COVID-19" and client to try to find out if she was receiving a placebo, if so, she will schedule 2nd immunization at recommended time. No adverse reaction at at this time.

Other Meds: Vit. D3, Multivitamin.

Current Illness: None

ID: 0958801
Sex: F
Age: 55
State: CA

Vax Date: 01/06/2021
Onset Date:
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: NKA

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

Symptoms: I received the vaccine and approx 1min I developed chest pressure, head pressure, Dizzy + lightheaded - Had a hard time waking to gurney due to dizzy. BP +180s Back burning pain traveling mid back to lower back, joint pain, general weakness, throat scratchy, itichess on legs + Think I was monitored for 2 1/2 hrs and sent home after Benadry + Tylenol given. I have continued to have extreme fatigue. general weakness, lightheaded, dizzy and burning back pain lasted 11 days. Today is 12th day and still have lightheaded, dizzy intermittent and general weakness, fatigue, "no energy."

Other Meds: Losartan, Clonidine, multivitamin, folic acid, vit B 12

Current Illness: Newly Dx Diabetic 10/2020, HTN, Obese,

ID: 0959927
Sex: M
Age: 77
State:

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

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: short of breath Narrative: patient complained of shortness of breath prior to getting covid vaccine, patient and wife stating it was his norm. After vaccine he complained of increasing shortness of breath, and hypoxic with bluish nail beds, lips, and greyish in color. Applied O2 via mask, and nail beds, lips, and facial color returned, sent patient to local ER for treatment and evaluation.

Other Meds:

Current Illness:

ID: 1279627
Sex: F
Age: 65
State: CA

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: IM
Vax Site: RA

Lab Data:

Allergies: sulfa, doxycycline, codeine

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

Symptoms: 1/15/21 severe sore lt deltoid x 3 days. PM of 1/15, nausea and fatigue. AM 1/16 awoke with severe chills and nausea. Thru 1/16 & 1/17 severe fatigue, dizziness, GI sx, w/ severe diarrhea. No fever, but chills and hot flashes persisted. I kept falling asleep. My typical activity was severely affected. Family had to care for me. I am a registered nurse, which helped prevent an ER visit. Benadryl and Advil were minimal help. These symptoms were not mild. Moderate to severe

Other Meds: norvasc. lipitor, ketotifen, ceclor, metformin, epi-pen

Current Illness: none

ID: 1279628
Sex: F
Age: 63
State: ME

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: EE reports she received the Covid 19 Modera vaccine lot number 039K20A on 01/08/2021 at 0600 in her left deltoid. EE reports she noted a rash the next day but then it resolved the next day. EE reports she noted redness and itching on her left upper arm on 1/16/21. EE reports the rash and itching has mostly resolved today 1/19/2021.

Other Meds: Magnesium, Ginko supplement

Current Illness: denies

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm