VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 0958737
Sex: F
Age: 37
State: PA

Vax Date: 01/05/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: Cat dander and dust mites

Symptoms: Moderna Vaccine. No immediate reaction. 1/13/21 I noticed there was still a sizable lump at the injection site. Called our Employee Health hotline and they advised to apply heat and massage the area. 1/14/21, I applied heat and massaged the area and within a few hours the injection site started to get red and increase in size, and my eyes began to itch and swell. Took a Benadryl and in the morning there was more swelling in my face. Went to the dr, they couldn't confirm if was or wasn't vaccine related, and advised to continue taking Benadryl and apply cool compress if arm was painful. Swelling continued on 1/15 and 1/16. Arm still has a large spot, it is less red in color now, there is still slight heat at the injection site. I have been taking at least 1 Benadryl for the last 7 days now.

Other Meds:

Current Illness:

ID: 0958738
Sex: F
Age: 77
State: NV

Vax Date: 01/17/2021
Onset Date: 01/17/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: None

Allergies: adhesive tape. Bug spray

Symptoms: Lightheaded nausea swelling headache chills itching. Swelling continues spreading around injection site and is hard as a tick. Sensation of stinging

Other Meds: Prilosec Effexor Losartan Restoril tizanadine vitamins c d-3 salmon oil culturally colostrum coQ10 pomegranate cranberry lute in zeaxanthin magnesium Zyrtec aspirin gabapentin

Current Illness: None

ID: 0958740
Sex: F
Age: 67
State: PR

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: NO

Allergies: NO

Symptoms: ENROJECIMIENTO, PICOR,ARDOR, AREA CALIENTE Y RONCHAS CON BURBUJAS CON LIQUIDO QUE SE EXTENDIERON HASTA EL CUELLO

Other Meds: NO

Current Illness: NO

ID: 0958741
Sex: F
Age: 47
State: MA

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient had her vaccination and went back to work for about 15 min. When she was at work, she felt her legs shaking and tingling on her top lip. She came back to the vaccine clinic and asked to be monitored. Vital signs taken 138/90, HR 109 POX 100 RA. Continued to have tingling upper lip and brought to ED for further observation. Warm hand off to ED RN

Other Meds:

Current Illness:

ID: 0958742
Sex: F
Age: 71
State: AZ

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Sore upper arm for first 24 hrs and dull headache starting 1/13/21, 2pm) ; Took acetaminophen Sudden onset severe chills/shivering, nausea, worse headache approx 24 hrs later (1/14/21, noon). Chills and nausea gone by 2am 1/15/21. Very sore arm persisting until 1/18/21, mid-day.

Other Meds: Creon, famotidine, calcitriol, losartan potassium

Current Illness: None

ID: 0958743
Sex: F
Age: 69
State: NC

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

Lab Data: EKG, Vital signs, aspirin 81mg x 4,

Allergies: Codeine Cortisone Iodine Nut - Unspecified pinenut Clinoril [Sulindac] Ginger R Iodinated Contrast Media Rash Low 5/28/2016 Past Updates... Other reaction(s): Headache Walnut Itching Low Allergy 10/27/2016 Past Updates... Sesame seeds, Pecans Demerol [Meperidine] Indocin [Indomethacin Sodium] Morphine

Symptoms: Patient is a 69 y.o. female with history of multiple medical problems as indicated below including rheumatoid arthritis. She is a non-smoker. She tells me she has "a heart condition" and is followed by a cardiologist. She tells me she was in her usual state of health and took her COVID-19 first vaccine today. Approximately 30 seconds later she noted chest tightness/burning that has been constant. It is rated 9/10 at maximum and improved to 5/10 after about 10 to 15 minutes. She also states, "my eyes feel funny. I feel cold. I am dizzy." She endorses palpitations and dyspnea. She denies any abdominal pain, nausea, vomiting, fevers, diaphoresis, headache, cough, rash, or syncope. She does have a history of seafood allergies and had similar reactions after eating seafood. She tells me 3 years ago after a flu shot she fainted. She tells me the past 2 years after her flu shot she had nausea or vomiting. She tells me she fell yesterday and hurt her hip but she did not hit her head. No LOC. She tells me she takes baby aspirin nightly. Family history: Mom and dad both died at age 82 from lung cancer. They both had heart disease. She was sent back from the vaccination area to urgent care to be evaluated after her reaction to the COVID-19 vaccine.

Other Meds: ACETAMINOPHEN (TYLENOL EXTRA STRENGTH ORAL) Take 1 tablet by mouth continuously as needed. ? albuterol (PROAIR HFA) 90 mcg/actuation inhaler Inhale 2 inhalations into the lungs every 4 (four) hours as needed for Wheezing or Shortness of

Current Illness:

Date Died: 01/16/2021

ID: 0958745
Sex: M
Age: 73
State: CO

Vax Date: 01/12/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: None

Allergies: No Known Allergies

Symptoms: Resident was noted to have increase weakness on 1/15/2021. Resident was warm to touch with low grade fever of 99.3 F. Resident was up propelling self in w/c on 1/16/2021 he was pleasant, accepted medications and ate lunch. He was found slumped over in his w/c not responding and vital signs absent.

Other Meds: Divalproex Sodium Tab DR 250mg and 500mg, Lexapro 20mg, Quetiapine Fumarate 200mg tab, Senna 8.6 mg, Latanoprost drops,

Current Illness: Hx of TBI and schizophrenia with worsening behaviors over the past few months including refusing care including meals and medications and striking out with care. Resident had a fall on 1/14/2021. Resident received treatment for a UTI with Keflex for 7 days starting 12/6/2020.

ID: 0958746
Sex: F
Age: 54
State: CA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient describes this is her 2nd dose and she is experiencing Joint pain, Arm numbness, range of motion in lifting her arm, very fatigued and also reports headache and her blood suger shot up to the 300 range, patient is an insulin dependent diabetic and this is her main concern.

Other Meds:

Current Illness:

ID: 0958748
Sex: M
Age: 66
State: FL

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: IODO

Symptoms: A reddened swelling with pain

Other Meds:

Current Illness:

ID: 0958749
Sex: F
Age: 25
State: MA

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: woke w/ arm pain the following day which resolved, 12/28 arm pain, swollen, gland axillary/post neck, eval PCP; inc redness by 1/1/21, seen in ED, RX for cellulitis

Other Meds:

Current Illness:

ID: 0958750
Sex: F
Age: 54
State: NJ

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: CODEINE

Symptoms: LOW GRADE FEVER, BODY ACHES, HEADACHE, RESTLESSNESS, TIREDNESS. TOOK TYLENOL EVERY 6 HRS AND REST.

Other Meds: VALSARTAN; JANUVIA; DILTIAZEM; PRAVASTATIN; JARDIANCE

Current Illness: NONE

ID: 0958751
Sex: F
Age: 39
State: HI

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data: COVID test - neg Flu test -neg

Allergies: Medication allergy list is massive! Only remember Codeine - makes me dizzy and nauseaus; can't even walk and Sulphur drugs - gives me hives and that's all I remember at the top of my head - Allergy- strawberries, dogs, cats, rabbits, dust mites, sensitivity to Wheat and lactose intolerant.

Symptoms: Time I got shot - within 2 hours; arm sore; body aches - by five hour mark I knew something wrong. Extremely fatigued. 7:00 Pm had a fever. Slept a long time - so much pain in body aches that I was crying into the 24th. "Like I want to die" body aches. I took Tylenol for pain and fever. Had these symptoms until I went to Dec 27 went to URGENT CARE. Had to take a COVID test and Flu test - negative. Continued to have symptoms until New Year's Eve. Urgent care just said to keep taking Tylenol. Fatigue and weak still for 14 days. Was also getting Vertigo - 7 days into it and it lasted a week - off and on.

Other Meds: Gummy Multi-Vitamins - Womens; Vit D; Bioastin; generic Zyrtec

Current Illness: no

ID: 0958752
Sex: M
Age: 49
State: WA

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: N/A

Allergies: none

Symptoms: Lethargy and an extreme migraine

Other Meds: Melatonin 3mg, Zyrtec and Multivitamin

Current Illness: none

ID: 0958753
Sex: M
Age: 53
State: FL

Vax Date: 01/06/2021
Onset Date: 01/11/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Swelling, redness and itching but symptoms subsided after a few days.

Other Meds:

Current Illness:

ID: 0958754
Sex: F
Age: 46
State: NJ

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

Lab Data: Days after the shot I woke up with a quarter size red bump at the injection site it was very itchy but not warm to touch. Treated topically with Benadryl spray for hours later extremely itchy treated topically with Cortizone cream red and area has increased in size to about 6? x 4?

Allergies: Sulfa drugs

Symptoms: 7 Days after the shot I woke up with a quarter size red bump at the injection site it was very itchy but not warm to touch. Treated topically with Benadryl spray for hours later extremely itchy treated topically with Cortizone cream red and area has increased in size to about 6? x 4?

Other Meds: Lisinopril norvasc lexapro zyrtec

Current Illness: None

ID: 0958755
Sex: F
Age: 40
State: CA

Vax Date: 01/12/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital: Y

Lab Data:

Allergies: none

Symptoms: Pt was 18 weeks pregnant at the time of the vaccine. Second pregnancy. Pt is a physician. Pregnancy was entirely normal up to that time. On 1/18/2021, she began to have heavy vaginal bleeding probably due to a placental abruption and subsequently delivered at 18 weeks. Baby was stillborn. Ultrasound done 1/15/2021 normal. Lethal event for the fetus. The patient did well.

Other Meds: prenatal vitamins

Current Illness: none

ID: 0958757
Sex: F
Age: 40
State: ID

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

Lab Data: N/A

Allergies: Codeine, Morphine, Effexor

Symptoms: mild swelling of the left hand initially, then mild swelling of the right hand,

Other Meds: unknown

Current Illness: none

ID: 0958760
Sex: F
Age: 34
State: MA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: TINGLING ARM ; RESOLVED

Other Meds:

Current Illness:

ID: 0958761
Sex: M
Age: 51
State: AR

Vax Date: 12/29/2020
Onset Date: 01/02/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: Normal CBC and sed rate. brain and C spine MRI unremarkable. Lumbar puncture revealed abnormal high CSF proteins and no WBC present. EMG. Indicative of acute Gillian Barre Syndrome.

Allergies: Penicillin

Symptoms: 2 days after 1st dose: severe headache and body aches. Severe tinnitus. Insomnia, constipation. After 3 days tingling numbness and weekends in extremities. Loss of appetite. Weight loss. Symptoms persisting for 3 weeks.

Other Meds: Synthroid 125ug Lexapro 10mg

Current Illness: None

ID: 0958762
Sex: F
Age: 33
State: NY

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: 33M with pmh GERD, no known hx allergies, p/w sob after receiving IM epi at clinic. Pt received covid vaccine and was having anxiety - told the provider she was SOB so she was given epi and started having more anxiety so she was brought to the ED. Upon arrival, patient agitated tachy to 120s, screaming, flailing her arms,

Other Meds: None

Current Illness: None

ID: 0958764
Sex: F
Age: 51
State: CA

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

Lab Data: None

Allergies: Latex, Tylenol, PNC class, Imatrex, Benzocaine, other caines,

Symptoms: 1/13/21: Via email, client stated on 01/13/2021 @ 5:45 AM she noticed the injection site on left upper arm was red and hot aprox. 3" x 2" in size, and was very itchy with some soreness. 01/20/21 @ 10:30 AM spoke with client who stated the redness faded but there was a red streak running down the upper arm with warmness to site. Client stated she had a phone appointment on 1/15/21 with PCP who told her to monitor the site. Client stated on 1/16/21 the redness or warmth to site was resolved. RN

Other Meds: Topomax, Zoloft, Advair, Alvesco, spiriva, stool softener,

Current Illness: None

ID: 0958765
Sex: F
Age: 65
State: FL

Vax Date: 01/08/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: None

Allergies: No known medication or food allergies Inhalant allergies/cat dander

Symptoms: Diffuse maculopapular rash- minimal itching on torso- ? started after 2nd vaccine? Noticed worsening on 1/19/21

Other Meds: Famotidine Fish oil Vitamin D3 Losartan Intermittent Citracal +D Intermittent Centrum silver- woman>50

Current Illness: None

ID: 0958766
Sex: F
Age: 47
State: IN

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: None

Allergies: Sulfa; pollens; dust ; wheat

Symptoms: Chills, lethargy, body aches

Other Meds: Citalopram; lamictal; Adderall Xr; Zyrtec; Wellbutrin

Current Illness: None

ID: 0958767
Sex: F
Age: 49
State: CA

Vax Date: 01/12/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: None yet

Allergies: Sulfa, certain vegetables, turkey

Symptoms: One week after receiving the vaccine, I awoke at 4am to severe pain, swelling, and stiffness at the injection site. By 7am I was feeling nauseous, lightheaded and my arm was very stiff, itchy and swollen at the injection site. I took Zyrtec D thinking that this was a delayed allergic response to the vaccine. By 10am the symptoms were worsening and my lymph nodes in my left underarm and in my neck were swollen. I called my physician who had me add another dose of Zyrtec and Motrin. These symptoms worsened over the course of the day including tingling in my left arm and hand, numbness in my arm and hand until approximately 730pm when I was finally able to eat something and keep it down. I went to bed exhausted, still with stiff upper arm and feeling general malaise. I awoke this morning (1/20/21) at 6:45am and my arm is still stiff and swollen. Other symptoms are resolving and I have been able to eat.

Other Meds: Advair, Flonase, Zyrtec-D

Current Illness: None

ID: 0958768
Sex: F
Age: 33
State: CA

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

Lab Data:

Allergies: None

Symptoms: Dizziness, Feeling Hot, flushed. Treatment ice pack.

Other Meds: Daily vitamin

Current Illness: No

ID: 0958769
Sex: F
Age: 85
State: IN

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

Lab Data: taken to ER.

Allergies: shell fish, sulfa, penicillin

Symptoms: patient was complaining of 'hoarseness of throat'. This was approximately 20 minutes after the administration of vaccine. Patient taken to ER when she arrived to ER patient stating her throat was itchy.

Other Meds:

Current Illness:

ID: 0958770
Sex: M
Age: 43
State: MD

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Soon after the injection he noted a slight fever, body pain, migraine, slight nausea. These symptoms lasted for 2 days

Other Meds:

Current Illness:

ID: 0958771
Sex: F
Age: 39
State: CO

Vax Date: 01/18/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Rash on body, treated with Benadryl

Other Meds:

Current Illness:

ID: 0958772
Sex: M
Age: 78
State: NY

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: day after injection noticed approx 1/2 inch diameter hard lump at site oozing clear liquid. Has since almost disappeared but leaving small longitudinal scab.

Other Meds: Rosuvastatin Ccalcium Amlodipine Benazepril Tamsulosin HCL Various vitamins

Current Illness: none

ID: 0958773
Sex: M
Age: 49
State: IN

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: None

Allergies: Codeine

Symptoms: Exhausted and cold then hot.

Other Meds: Medium & melatonin

Current Illness: No

ID: 0958774
Sex: F
Age: 56
State: NM

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data: Patient applied aquaphor to the site, due to it looking like "a burn."

Allergies: Sulfa drug, maybe. Latex

Symptoms: Patient reports that the day after receiving the vaccine, she had a reddened area around the site. The following day, she began having blisters and redness, near where the vaccine had been given. She reports she had taken Benadryl and Aleve, and the next day the the redness was half the size. Today, that area is intact, but shows white scaring.

Other Meds: Bencar/HCTZ, Metoprolol, Progesterone, Estridol, Claritin, CO Q10, Lexapro. Botox injection 12/29/20

Current Illness: None. Only HTN

ID: 0958775
Sex: F
Age: 53
State: GA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: unknown

Symptoms: Individual was given vaccine at 10:00am. At 10:40 am after receiving the vaccine individual developed itchy and reddened left forearm and stomach individual vitals were stable. Individual went home after waiting 45 mins. with no noted distress.

Other Meds: unknown

Current Illness: unknown

ID: 0958776
Sex: F
Age: 59
State: FL

Vax Date: 01/01/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: COVID test was negative

Allergies: Sulfa Iodine Clyndamycin Penicillin Levaquin

Symptoms: Chills muscle pain Headache Nausea Sore throat Tylenol protonix

Other Meds: Aspirin day before Lipitor day before vaccination

Current Illness: RA ? Mild

ID: 0958777
Sex: F
Age: 54
State: TN

Vax Date: 01/11/2021
Onset Date: 01/17/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: My PCP ran lab tests on 1/18/2021 which were all normal.

Allergies: Codeine, Demerol, and Prednisone

Symptoms: On Sunday, January 17, 2021 I started having severe joint pain in my wrists, elbows, knees, hips and shoulders. Along with aching all over. Over the course of the day, I started to feel bad. Then on Monday January 18, 2021, in addition, to the joint pain, I started feeling disoriented, dizzy like spells of vertigo. I went to my PCP who did lab work and all was normal. He said it muse be delayed reaction to the vaccine. Later in the day, I was having difficulty putting words together and more dizzy and very lethargic. I laid down and slept until the next morning. (Tuesday 1/19/21) On Tuesday 1/19/21, they symptoms were improved but still had some dizziness. On Wednesday 1/20/21, the symptoms have improved except for an occasional dizzy spell.

Other Meds: Metoclopramide 5mg, Gabapentin 300mg, Ondansetron 8mg (PRN), Estrogen-Methyltestos 1.25-2.5MG TB, Metamucil, Atorvastatin

Current Illness: None

ID: 0958778
Sex: F
Age: 44
State: IL

Vax Date: 01/11/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: Penicillin Sulfa

Symptoms: About 8 days after receiving the vaccine the injection site is red, swollen and tender. It was not at all for the first week when I would have expected it. Going on day 3 of the discomfort.

Other Meds: Zoloft Multivitamin

Current Illness: None

ID: 0958779
Sex: F
Age: 45
State: OR

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data: Chest Xray 1/11/2021 - negative; Covid 19 test 1/11/2021- negative.

Allergies: Aspirin, morphine, oxycodone, lisinopril, topiramate, Wellbutrin, shellfish, losartan.

Symptoms: 12/29/20 , left arm soreness, sinus issue, throat issue, which by 12/30/20 sinus/chest congestion with cough. HD tested for Covid 19 (negative on 1/1/21) Started aka seltzer cold and flu medicine, seen in respiratory clinic on 12/31 - started new meds codeine with guaifanesin cough syrup, Flovent inhaler, and Mucinex Max strength cold and flu. 1/8/21, felt more fatigued and cough felt more violent. Seen again in respiratory clinic 1/11/21 negative chest X-ray and Covid 19 test, continue same regimen - rest, OTC, inhalers. 1/20/21, first day of feeling overall improvement, still ongoing cough.

Other Meds: Maxzide, Irbesartan, Omeprazole, Lomaira, Double X Supplement, Hair Skin, Nails Supplement

Current Illness: 1 day prior 12/27 cried all day due to recent death in the family, only symptom I noticed were plugged sinuses. Also never felt fully recovered with mild case of Covid 19 in April 2020.

ID: 0958780
Sex: F
Age: 31
State:

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: I have a subjective fever, and fatigue and severe headache and body pain

Other Meds:

Current Illness:

ID: 0958781
Sex: F
Age: 49
State: CA

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: Sulfa drugs; wheat

Symptoms: Chronic headache

Other Meds: Vitamin D3, 5000 IU; flonase spray

Current Illness: None

ID: 0958782
Sex: M
Age: 36
State: NM

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Large R axillary adenopathy . Present approximately 24 hours. Currently stable. Outcome to be determined.

Other Meds:

Current Illness:

ID: 0958783
Sex: F
Age: 36
State: FL

Vax Date: 01/11/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: penacylin

Symptoms: arm after 9 days started getting red spots, next day was one big red swollen site

Other Meds:

Current Illness:

ID: 0958784
Sex: F
Age: 41
State: NC

Vax Date: 01/13/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies: Gluten intolerance

Symptoms: Received vaccine 1/13/21. 1/19/21 discovered bright red, hot to touch, slightly raised, itchy rash below the injection site. The site is approximately the size of a post it note. Reported rash to nurse the morning of 1/20/21. Per my employer I was sent to urgent care for further evaluation and treatment. Given a 5 day course of prednisone.

Other Meds: Wellbutrin, Prozac, magnesium, B2, fenofebrate, Zyrtec, emgality, Flonase

Current Illness: None

ID: 0958785
Sex: F
Age: 80
State: AZ

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

Lab Data:

Allergies:

Symptoms: none

Other Meds:

Current Illness:

ID: 0958838
Sex: F
Age:
State: PR

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: Test Date: 20210107; Test Name: Heart rate; Result Unstructured Data: Test Result:Low

Allergies:

Symptoms: sinus arrhythmia; Night sweats; Heart rate low; Dyskinesia; This is a spontaneous report from a contactable nurse (patient). This 36-year-old female patient the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), intramuscular at single dose in the left arm on 07Jan2021 10:00 for covid-19 immunisation. Medical history included hypotension, rheumatoid arthritis, asthma. Concomitant medication included clonazepam, methylprednisolone. On 07Jan2021 21:00, the patient experienced sinus arrhythmia, night sweats, heart rate low, dyskinesia, all with outcome of recovered with sequelae. Therapeutic measures were taken as a result of the events included Inderal 10mg. The events were assessed as congenital anomaly. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination. The patient had not been tested for COVID-19 since the vaccination. The patient was not pregnant at the time of vaccination. Information on the lot/batch number has been requested.; Sender's Comments: A possible contributory effect of suspect BNT162B2 on reported events cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.

Other Meds: CLONAZEPAN;

Current Illness:

ID: 0958839
Sex: U
Age:
State: PA

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Administered a vaccine that has been refrozen; Vaccine vial punctured for more than 6 hours; A spontaneous report was received from a healthcare facility administrator concerning a patient who received Moderna's COVID-19 (mRNA-1273) Vaccine and experienced expired product administered. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 30 Dec 2020, a vial containing Moderna's COVID-19 Vaccine was thawed, and the vial was punctured. Afterwards, the vial was placed back into refrigeration overnight. On 31 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection from the same vial. The dose given was outside of the six-hour timeframe from the first puncture of the vial, and the patient experienced expired product administered. Treatment information was not provided. Action taken with mRNA-1273 in response to the event, expired product administered, was not provided. The event, expired product administered, was considered recovered/resolved.; Reporter's Comments: This report refers to a case of product storage error and out of specification product use for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of product storage error and out of specification product use.

Other Meds:

Current Illness:

ID: 0958840
Sex: M
Age:
State: CA

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: postural dizziness; dyspnea; paresthesia; This is a spontaneous report from a contactable Physician. This Physician reported for a 28-year-old male patient received 2nd dose of BNT162B2 Intramuscular on 10Jan2021 07:30 on Left arm for covid-19 immunization. Medical history and concomitant drug were not reported. No other-vaccine-in-four weeks. No other-medications-in-two weeks. Historical Vaccine was first dose of BNT162B2 on an unspecific date. Patient experienced Moderate reaction: postural dizziness, dyspnea, and paresthesia on 10Jan2021 09:00 AM that resolved with H1 and H2 antagonists and IV hydration. AE-resulted-in Emergency room/department or urgent care. Outcome of the event was recovered. No covid-prior-vaccination. No covid-tested-post-vaccination. Information on the lot/batch number has been requested.; Sender's Comments: A causal association between BNT162B2 and the reported events cannot be excluded based on a compatible temporal relation between vaccination and onset of events. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.

Other Meds:

Current Illness:

ID: 0958841
Sex: F
Age:
State: PA

Vax Date: 01/07/2021
Onset Date: 01/09/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: Test Name: fever was low at 99.6; Result Unstructured Data: Test Result:99.6 Fahrenheit; Comments: fever was low at 99.6

Allergies:

Symptoms: passed out; dizzy; hit the ground; nausea; pain at injection site; fever; chills; tired; severe headache; vomiting x 2; cold; experienced orthostatic hypotension; This is a spontaneous report from a contactable other HCP. A 65-years-old female patient started to receive bnt162b2 (BNT162B2; Lot # EK9231) vaccine , intramuscular in the left arm on 07Jan2021 11:00 at single dose for Covid-19 immunisation . Medical history included rubber sensitivity (Latex). The patient's concomitant medications were not reported. On 09Jan2021 12:00 the patient experienced orthostatic hypotension , passed out with outcome of recovered , dizzy with outcome of recovered , hit the ground with outcome of recovered. These events were considered serious because medically significant. On 09Jan2021 12:00 the patient also experienced the following non serious events: nausea with outcome of recovered , pain at injection site with outcome of recovered , fever with outcome of recovered , chills with outcome of recovered , tired with outcome of recovered , severe headache on with outcome of recovered , vomiting twice with outcome of recovered , cold with outcome of recovered. The reporter stated the patient attempted to get out of bed and she passed and hit the floor. Caller states she think she may have experienced orthostatic hypotension. Caller stated if she had stayed in bed she probably would not have fallen. Her husband found her laying in vomit The patient underwent lab tests and procedures which included body temperature: 99.6 fahrenheit on unknown date.; Sender's Comments: Based on a chronological temporal association a causal relationship between events orthostatic hypotension , passed out dizzy and falling down and BNT162B2 vaccine cannot be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds:

Current Illness:

ID: 0958842
Sex: F
Age:
State: AZ

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

Lab Data:

Allergies:

Symptoms: Several back operations of stimulator in the back and in pain management; This is a spontaneous report from a contactable Consumer. This adult female Consumer(patient) reported that: An adult female patient received bnt162b2 (BNT162B2) at single dose on an unspecified date for Covid-19 immunisation. Medical history was none. No known allergies. The patient's concomitant medications were not reported. Patient was not pregnant a time of vaccination. The patient had not received any other vaccines within 4 weeks prior to the BNT162B2 vaccine. The patient had not experienced Covid-19 prior to vaccination. The patient experienced several back operations of stimulator in the back and in pain management on an unspecified date, resulted in disability or permanent damage. Post the vaccination, the patient has not been tested for COVID-19. The outcome of events was unknown. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 0958843
Sex: F
Age:
State: WA

Vax Date: 01/09/2021
Onset Date: 01/10/2021
Rec V Date: 01/20/2021
Hospital:

Lab Data: Test Date: 20210110; Test Name: Body temperature; Result Unstructured Data: Test Result:99.7 Fahrenheit; Test Date: 20210111; Test Name: Body temperature; Result Unstructured Data: Test Result:99.5 Fahrenheit; Test Date: 202101; Test Name: Body temperature; Result Unstructured Data: Test Result:back to normal Fahrenheit

Allergies:

Symptoms: I began to pass out and yelled for my husband, he said when he came in I was sitting on the toilet with my head back, eyes rolling back not responsive.; I had my 2nd vaccine at work early Sat the 9th and felt increasingly worse all day; I woke up at midnight and felt extreme malaise; I was covered in sweat; vomited; I checked my temp and it was 99.7?F; sore; I think I had either a seizure or a vasovagal response.; This is a spontaneous report from a contactable nurse (patient). This 58-year-old female patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (Lot EJ1685 or FJ1685), intramuscular at single dose in the left arm on 09Jan2021 06:00 for Covid-19 immunisation. Medical history included atrial fibrillation on unknown date (1 episode), allergic to Keflex. There were no concomitant medications. The patient previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (Lot EJ1685 or FJ1685), intramuscular in the left arm on 22Dec2020 for Covid-19 immunisation. On 10Jan2021 01:00 AM, the patient experienced: I began to pass out and yelled for my husband, he said when he came in i was sitting on the toilet with my head back, eyes rolling back not responsive (loss of consciousness) (medically significant), I had my 2nd vaccine at work early sat the 9th and felt increasingly worse all day (feeling abnormal), Iwoke up at midnight and felt extreme malaise (malaise), I was covered in sweat (hyperhidrosis), vomited (vomiting), I checked my temp and it was 99.7?F (pyrexia), sore (pain), I think I had either a seizure or a vasovagal response (seizure). No treatment required. The outcome of the events was recovered. The events were described as follows: I am healthy RN with no active medical problems. I had my 2nd vaccine at work early Sat the 9th and felt increasingly worse all day, I expected this so was not alarmed and went to bed around 10pm. I woke up at midnight and felt extreme malaise and went to the bathroom in case I might vomit, etc. and I tried to have a BM. I began to pass out and yelled for my husband, he said when he came in I was sitting on the toilet with my head back, eyes rolling back not responsive. He yelled at me for about 10 seconds and I came to, I was covered in sweat. I asked him to walk me back to the bedroom where I again passed out, fell to the floor and hit the bed, then was unresponsive again for about 10 seconds then came to again and vomited. After this I felt completely relieved of my malaise. I checked my temp and it was 99.7?F. After this I was sore but otherwise completely okay, the next day I had a temp of 99.5?F. Today I am back to normal. I think I had either a seizure or a vasovagal response. The vaccine was administered at Hospital Facility. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination. The patient had not been tested for COVID-19 since the vaccination. The patient was not pregnant at the time of vaccination.; Sender's Comments: Based on the close temporal relationship, the association between the event "began to pass out" with BNT162b2 can not be fully excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.

Other Meds:

Current Illness:

ID: 0958844
Sex: F
Age:
State: MT

Vax Date: 12/16/2020
Onset Date: 12/23/2020
Rec V Date: 01/20/2021
Hospital: Y

Lab Data: Test Date: 20201223; Test Name: CT of brain X3; Result Unstructured Data: Test Result:Unknown result; Test Date: 20201223; Test Name: MRI of C-spine and Brachioplexus; Result Unstructured Data: Test Result:Unknown result; Test Date: 20201223; Test Name: MRI of brain X2; Result Unstructured Data: Test Result:Unknown result

Allergies:

Symptoms: suddenly lost mobility of left arm; Continue paresthesia and proprioreceptive deficits of left arm; Continue paresthesia and proprioreceptive deficits of left arm; This is a spontaneous report from a contactable nurse (patient). This 46-year-old female patient received the first single dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot EK5730) intramuscular, in right arm, on 16Dec2020 at 14:00, for COVID-19 immunization. No other vaccine was given in 4 weeks. Medical history included hypothyroidism, migraine headaches, IBS and COVID-19 (on an unspecified date prior to vaccination). Past drug history included allergy to morphine. Concomitant medication included levothyroxine sodium (SYNTHROID). On 23Dec2020 at 09:30 the patient experienced suddenly lost mobility of left arm, continue paresthesia and proprioreceptive deficits of left arm. She was transported to the ER and was admitted to hospital for 2 days. CT of brain X3, MRI of brain X2, MRI of C-spine and Brachioplexus were performed with unknown results. The patient was not tested for COVID19 after vaccination. The events resulted in: Doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care, hospitalization, disability or permanent damage. No treatment was administered. The events had not yet resolved.; Sender's Comments: Based on the temporal relationship, the association between the events " lost mobility of left arm, continue paresthesia and proprioceptive deficits of left arm" with BNT162b2 can not be fully excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.

Other Meds: SYNTHROID

Current Illness:

ID: 0958852
Sex: F
Age:
State: PA

Vax Date: 10/18/2020
Onset Date: 10/18/2020
Rec V Date: 01/20/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Large left arm discoloration; Bruising from vaccines in same arm shingles/Flu; Hot to touch; Fluad Quadrivalent and Shingrix administered in the same arm; This spontaneous case was retrieved on 24-Dec-2020 from Vaccine Adverse Event Reporting System (reference number: 892542-1), reported by other health professional and concerned a 70-year-old, female patient. The patient's medical history was not reported. The patient's concomitant medications included just prescribed medications (Rx's), used for an unreported indication. The patient had no known allergies. On 18-Oct-2020, the patient was vaccinated with Fluad Quadrivalent (influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; dose: reported as one, route of administration: intramuscular, anatomical location: left arm, dose and indication: not reported) in same arm as Shingrix (explicitly coded as 'Product administration error'). The batch number reported was 279813. On the same day, the patient was vaccinated with non-company, co-suspect Shingrix (varicella zoster vaccine rge (cho); dose: reported as second, route of administration: intramuscular, anatomical location: left arm and indication: not reported). The batch number reported was H552G. On the same day, after receiving Fluad Quadrivalent and co-suspect Shingrix, the patient developed large left arm discoloration and bruising from vaccines received in the same arm. Caused very red large hand sized bruise on arm and still not right after one week. It was hot to touch, still after five days. It was reported that the area was mapped and watched for spreading. This was the second shot and the patient had no issues at the first shot. On an unspecified date in Oct-2020, the patient visited physician's office, however further details were not provided. At the time of initial reporting on 24-Dec-2020, the patient had not recovered from the events. The reporter did not provide causality assessment. The case was assessed as non-serious. Company comment:The patient developed all events on the same day after vaccination with the suspect product, Fluad Quadrivalent. Chronology is suggestive. Reportedly, Fluad Quadrivalent and Shingrix were administered in the same arm. Causality may have been confounded by treatment with co-suspect vaccine Shingrix. Considering all above mentioned, causal relationship for all events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes). Product administration error is assessed as not related based on company's conventions.; Sender's Comments: The patient developed all events on the same day after vaccination with the suspect product, Fluad Quadrivalent. Chronology is suggestive. Reportedly, Fluad Quadrivalent and Shingrix were administered in the same arm. Causality may have been confounded by treatment with co-suspect vaccine Shingrix. Considering all above mentioned, causal relationship for all events is assessed as possibly related (defaults to ''related'' in the safety database for reporting purposes). Product administration error is assessed as not related based on company's conventions.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm