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: 0959301
Sex: M
Age: 30
State: IN

Vax Date: 01/17/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: Augmentin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Side effects first notice approx 16hours after injection. It started with fatigue and a pressure feeling in the chest. Around the 24hour mark I began to feel the fatigue worsen as well as chills, headache, and some nausea. It's now 38hours after injection and I'm still experiencing chest pressure and fatigue with slight chills.

Other Meds: Ibuprofen Acetaminophen One-a-day multivitamin

Current Illness: N/A

ID: 0959302
Sex: F
Age: 60
State: CA

Vax Date: 01/08/2021
Onset Date: 01/16/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: This last weekend, 01/16/2021 I woke to a sore arm below the injection site in my left arm. As the day went on, the area started getting hot and itchy, and has lasted through today. It is not as red, or sore, but still is itchy. I have been applying Cortizone-10 to the area and has helped, and also took an allergy pill. The area affected is the muscle and skin in the bicep area.

Other Meds: None

Current Illness: A cold with a productive cough, no fever one week prior to the vaccine.

ID: 0959303
Sex: F
Age: 31
State: MT

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Sinus infection since vaccine

Other Meds:

Current Illness:

ID: 0959305
Sex: F
Age: 41
State: NY

Vax Date: 01/06/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: On Thursday, January 14th at approximately 7PM at night, noticed left arm was red, swollen, and hot to touch at the injection site. Called doctor January 15, and was seen in doctors office at 11AM. Doctor stated that it was cellulitis and prescribed Cephalexin 500 mg/ 3 times per day until finished. Still taking the antibiotic. Spoke to another woman at employment who had the vaccine the same day , 15 minutes before me.

Other Meds: 88 mcg levothyroxin 40 mg omeprazole

Current Illness: None

ID: 0959306
Sex: F
Age: 81
State: FL

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

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

Lab Data:

Allergies: Erythromycin Adhesive tape

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

Symptoms: Within a few hours after the injection, there was mild to moderate pain and tenderness that lasted about 24 hours. On day 9 post injection, I noticed a reddened skin area about 3"x2.5" at the injection site with some mild swelling.

Other Meds: Levothyroxine Multivitamin Atorvostatin Clopidogrel Alendronate

Current Illness:

ID: 0959307
Sex: F
Age: 47
State: GA

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/20/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: sulfa, reglan, compazine

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

Symptoms: At the time of the first injection on Dec 28th I noticed I began itching a few days later. I did not put the itching together with the injection due to the dry weather. As time went on I noticed the itching mainly on head and upper torso. I had pain by the injection site but lasted only 2 days and was not that bad. The itching improved over the past week but noticed after my second injection that the itching has started back full force. I wake up scratching during the night. The pain in the arm was worse this time and did interrupt my sleep. Today at work I noticed my arm being sore and increased itching and decided to check the site. I found the site to be sightly swollen, red and warm to the touch. Was advised by provider that I work with to take Benadryl which I cannot do at this time until I am off shift as it makes me drowsy.

Other Meds: Citalopram, Mirapex, Clonopin (prn) Zolpidem ER

Current Illness: none

ID: 0959308
Sex: M
Age: 74
State: NJ

Vax Date: 01/05/2021
Onset Date: 01/09/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt reports a pruritc rash that is getting better. Suspect an allergic reaction to to the Moderna COVID-19 vaccine. The reaction is Urticaria.

Other Meds: Allopurinol, Amlodipine-benazepril, Gabapentin, Simvastatin

Current Illness: No

ID: 0959309
Sex: F
Age: 35
State: RI

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

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

Lab Data:

Allergies: TB Vaccine

Symptom List: Pharyngeal swelling

Symptoms: Entered observation @ 1501. Pt c/o itching to throat and face @ 1523. Patient walked over to stretcher in the clinic. Benadryl 25mg was given po. V/S @ 1526 139/53, P-100, R-18. O2-93%. V/S @ 1530 BP-137/77, P-103, R-18, O2-98%. 1537 pt talking, alert, and oriented. BP-125/75, R-18, P-101, O2-99%. Remained in observation. Alert and responsive. V/S @ 1544 BP-131/77, P-85, O2-100% R-18. Continued to voice no s/s of itching to throat nor face. V/S checked again @ 1553, BP-101/81, P-81, R-18, O2-100%. Pt states that she feels fine. Walked short distance in clinic after sitting up and on side of the bed for a couple of minutes. Left observation @ 1605.

Other Meds: Baclofen, Metroplol

Current Illness:

ID: 0959310
Sex: F
Age: 69
State: RI

Vax Date: 01/06/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: none that I know of

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I started with itchiness at the injection site. Prior to this I had a lump and soreness to the touch but no redness or itchiness. When I got home from work on 1.19.2021 I noticed a large red patch which was hot to the touch. During the day my arm where I received the injection became very itchy. During the day I also was extremely tired and had developed a headache and felt like I may be getting a cold. I also had a neckache. I still have those symptoms. I received my vaccine on 1.06.2021.

Other Meds: aspirin 81 mg 3 x a week, Atenolol 25mg twice a day, Lisinopril 10mg x1 per day, Premarin .03mg x 1 per day, Omeprazole 20mg x I per day, Montelukast 10mg x I per day, multi vitamin daily, vitamin D daily

Current Illness: none

ID: 0959311
Sex: F
Age: 41
State: TX

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On 1/15/2021 awoke to 11x11cm area of painful erythema at injection site, and feverish to touch. Erythema and pain starting to resolve on 1/20/2021, but still visible redness around the injection site.

Other Meds: Spironolactone 100mg Womens OneDaily Multi Vitamin Fluoxetine 40mg Ferrous Sulfate 650mg Zinc 50mg

Current Illness: no previous illness

ID: 0959312
Sex: F
Age: 36
State: MO

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

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

Lab Data:

Allergies: NA

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

Symptoms: Red, swollen, painful, injection site beginning the evening after the second dose. Fatigue a few hours after the second dose. The fatigue continued through the second day after the dose. Headache the day after the second dose. All symptoms were treated with ibuprofen.

Other Meds: Celexa, MVI, oral contraceptive, Zyrtec

Current Illness: NA

ID: 0959313
Sex: M
Age: 58
State: OR

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

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

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: sore arm, headache, whole arm intense itching, hives and swelling (had to remove all rings)

Other Meds: None

Current Illness: none

ID: 0959314
Sex: F
Age: 43
State: NM

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

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

Lab Data:

Allergies: no known allergies

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

Symptoms: Patient started feeling numbness of left hand and fingers after 10 minutes. Pain on forearm (Pressure feeling) Patient was monitor for 15 more minutes, no other interventions

Other Meds: unknown

Current Illness: unknown

ID: 0959315
Sex: F
Age: 60
State: IA

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

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

Lab Data:

Allergies: none

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

Symptoms: severe joint pain

Other Meds: Atorvastatin, venlafaxine

Current Illness: none

ID: 0959316
Sex: F
Age: 22
State: MT

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

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

Lab Data:

Allergies:

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

Symptoms: Headache, Fatigue, Injection Site Pain

Other Meds:

Current Illness:

ID: 0959317
Sex: F
Age: 34
State: MA

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

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

Lab Data:

Allergies: Sesame Seed, Sesame Oil

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

Symptoms: Headaches, Arm Pain, Armpit Glands Sore/Swollen, Injection Site Red/Painful/Raised

Other Meds: Epi-Pen as needed

Current Illness: None

ID: 0959318
Sex: F
Age: 58
State: WA

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Had small red area initially after vaccine was given. 12 days later it increased to baseball size and is itchy. States she had similiar rxn with pneumonia vaccine in past.

Other Meds:

Current Illness:

ID: 0959319
Sex: F
Age: 41
State: CT

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

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

Lab Data:

Allergies: N.K.A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Body aches, head aches, chills, nausea, vomiting, 103+ fever ( comes and go) for 4 days

Other Meds: None

Current Illness: None

ID: 0959320
Sex: M
Age: 74
State: WA

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

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Moderna COVID-19 Vaccine EUA Slight dizziness and fatigue one hour after shot, lasting 30 minutes Very mild soreness around site of vaccine, starting several hours after shot and still noticeable two days later

Other Meds: diclofenac losartan baby aspirin Prevacid

Current Illness: none

ID: 0959321
Sex: M
Age: 75
State: AL

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

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

Lab Data:

Allergies: None listed

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

Symptoms: Patient was given his vaccine from a full vial prior to reconstituted with Normal Saline. Treatment: Patient was observed at the clinic for one hour after vaccination. Patient had no complaints prior to leaving the clinic. Dr placed a Follow up call to patient two hours after he was released from the clinic. Pfizer was consulted. Pfizer reported the patient may experience increased arm pain. Pfizer approved patient to receive second vaccine on his due date. Follow up instructions given to the pt per Dr. Pt advised of date for second vaccine. Patient contacted again 1/20/21 per Dr. Patient doing well and voiced no complains

Other Meds: Unknown

Current Illness: None Listed

ID: 0959322
Sex: F
Age: 49
State:

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

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

Lab Data:

Allergies:

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

Symptoms: chills, low-grade fever (99.6 F), injection site pain

Other Meds:

Current Illness:

ID: 0959323
Sex: F
Age: 48
State: IA

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

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

Lab Data:

Allergies: codeine, sulfa

Symptom List: Unevaluable event

Symptoms: Lump, red, warm to the touch

Other Meds:

Current Illness: none

ID: 0959324
Sex: F
Age: 58
State: KS

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

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

Lab Data:

Allergies: bactrim

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

Symptoms: developed redness, swelling,,,soreness, in arm where the vaccine was given a week later. Warm to touch

Other Meds: Synthroid, Premarin, Celexa

Current Illness:

ID: 0959325
Sex: F
Age: 30
State: OR

Vax Date: 12/28/2020
Onset Date: 01/07/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sulfa Hayfever Melons Avacodo

Symptom List: Injection site pain, Pain

Symptoms: Left Arm pain and redness, extending to neck and sternum, Treated with antibiotics.

Other Meds:

Current Illness:

ID: 0959326
Sex: F
Age: 56
State: NJ

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports tingling in hands, nausea, and sweating with the first dose.

Other Meds:

Current Illness:

ID: 0959327
Sex: M
Age: 53
State:

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

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

Lab Data:

Allergies: none

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

Symptoms: Shingles. Open weeping sores on L side of head. Received prescription for 7 day course of Valtrex (anti viral). Sores scabbed over by end of 7 day prescription. Shingles vaccine had been received 2 years prior.

Other Meds: none

Current Illness: none

ID: 0959328
Sex: F
Age: 59
State: PA

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

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

Lab Data:

Allergies: Unknown

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Person receiving the vaccine developed a tingling in her mouth. Not short of breath or itchy, no hives. Vital signs 156/90, Pulse 72, SPO2 97. Gave her water and candy, sat her in recliner with feet up. She remained with us for over 30 minutes. Felt better after water. Vital signs before leaving were 147/90, pulse 73, SPO2 97

Other Meds: Unknown

Current Illness: unknown

ID: 0959329
Sex: F
Age: 55
State: MO

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

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

Lab Data:

Allergies: Shrimp

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Per patient she began experiencing shortness of breath and tightness in her chest a few minutes after vaccine administration. Pt reports using her inhaler and nebulizer treatments with relief in symptoms. Symptoms have persisted for 24 hours.

Other Meds: Amlodipine, atorvastatin, Breo Ellipta, Ergocalciferol, HCTZ, Ibuprofen, Metformin, Quetiapine, Terbinafine, Topiramate

Current Illness: N/A

ID: 0959330
Sex: F
Age: 61
State: CA

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

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

Lab Data:

Allergies: demerol, fentanyl, penicillin

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

Symptoms: Received first dose of Moderna vaccine in left deltoid. went to car with family and began vomiting. No SOB with chest issues. Called 911. Gave one aspirin per 911 call. Pulse in normal limits. Patient did not get transported to ED via ambulance.

Other Meds:

Current Illness:

ID: 0959331
Sex: F
Age: 45
State: IN

Vax Date: 01/08/2021
Onset Date: 01/10/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Nausea

Symptoms: I developed a red rash on my torso area that I call a viral rash 48 hours after administration of first vaccine. The rash was not painful or itchy and resolved within 48 hours.

Other Meds: Miralax , Linzess, Ibuprofen, melatonin, Benadryl

Current Illness: No

ID: 0959332
Sex: F
Age: 94
State: SC

Vax Date: 01/08/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: SULFA ANTIBIOTICS

Symptom List: Injection site pain

Symptoms: Bruise/knot/warmth at the injection site. Cool compress/massage.

Other Meds: Ensure afterment; HydrOXYzine HCl Tablet 25 MG Give 1 tablet by mouth every 6 hours as needed for Itching; Lasix Tablet 20 MG (Furosemide) Give 1 tablet by mouth one time a day for edema; Sotalol HCl Tablet 120 MG Give 1 tablet by mouth two

Current Illness: INFECTION TO RLE/TREATED WITH AUGMENTIN X 5 DAYS/PROBIOTIC X 7 DAYS

ID: 0959333
Sex: M
Age: 12
State: CA

Vax Date: 05/01/2019
Onset Date: 05/01/2019
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Acute onset fever up to 103 degrees - difficult to control with antipyretics x several days Body aches mild abdominal pain slight cough No other concomitant illness to explain the fever; influenza negative

Other Meds:

Current Illness: none recorded

ID: 0959334
Sex: F
Age: 31
State: CA

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

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

Lab Data:

Allergies: None

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

Symptoms: Day 2-4 soreness, tired, chills, severe fatigue. Day 7 Swelling and pain in arm pit area. Felt like I had a golf ball in under my arm pit. Felt like a pinch nerve by my neck , resolved nu day 14.

Other Meds: None

Current Illness: None

ID: 0959335
Sex: F
Age: 37
State: MT

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

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Rash on chest and arms-started a week after vaccine

Other Meds:

Current Illness:

ID: 0959336
Sex: F
Age: 42
State:

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: severe arm pain later that night and half of next day

Other Meds:

Current Illness:

ID: 0959337
Sex: F
Age: 46
State: NJ

Vax Date: 01/08/2021
Onset Date: 01/15/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: Latex

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

Symptoms: Vaccine recipient received vaccine on 1/8/2021. She reported that on 1/15/2021 around 3-4 pm noticed that she had left eye weakness. Over the weekend 1/16/2021 ? 1/17/2021, she noticed that the left eye weakness/droop was more pronounced when she was tired. On 1/18/2021 she went to see a neurology specialist and had an MRI done. Vaccine recipient reported that the MRI findings were normal. On 1/18/2021 she developed a migraine and took propranolol and Aleve. She is waiting on pending blood work and results.

Other Meds: Calcium/Vitamin D, Vitamin C, Echinacea, Synthroid, Prilosec, Tums, Botox (cosmetic) injection on 12/5/2020

Current Illness: None

ID: 0959338
Sex: M
Age: 63
State: CO

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

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

Lab Data:

Allergies: Furinol

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

Symptoms: Within 45 minutes, started feeling flushed, lightheaded and a little dizzy.

Other Meds:

Current Illness: Sinus Infection

ID: 0959339
Sex: F
Age: 85
State: IL

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

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

Lab Data:

Allergies: penicillin, sulfa, miacalcin, Vitamin B 12, levoxyl, codiene, elocon cream, phosamax, estrogen patch, clindamycin, fulforyl-loop-, cephelosprins, meloxicam, voltaren.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient had an immediate reaction following the 1st Moderna COVID-19 Vaccine administration on 01/18/2021. S/S began immediately following the injection, and were scratchy, dry throat, dry cough, slight wheezing in upper bilateral lobes. Treated with 50 mg Benadryl, monitored for 30 minutes which included vital signs. Patient recovered- home with husband. Advised patient to follow up immediately with urgent care or primary care physician.

Other Meds: Synthroid Aleve prn

Current Illness: None

ID: 0959340
Sex: F
Age: 56
State: NJ

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

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

Lab Data:

Allergies: PENICILLIN, SULFA - RASH

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

Symptoms: PATIENT REPORTS TINGLING IN HANDS, NAUSEA, AND SWEATING WITH THE FIRST DOSE

Other Meds:

Current Illness:

ID: 0959341
Sex: F
Age: 52
State:

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: None known

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

Symptoms: Swelling of lymph nodes in right neck and axilla within one week of vaccine, rash on right arm and neck 2-3 weeks after vaccine

Other Meds: vitamin C, Airborne

Current Illness: Dental work 12/31.

ID: 0959342
Sex: F
Age: 57
State: MA

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

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

Lab Data:

Allergies: Seasonal

Symptom List: Pain in extremity

Symptoms: Soreness/Pain in the injection site and not able to lift the arm for almost 75 hours.

Other Meds: None

Current Illness: None

ID: 0959343
Sex: F
Age: 63
State: TX

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

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

Lab Data:

Allergies: N/A

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

Symptoms: 12 hrs after vaccine headache,nausea,achy,sore arm 24 hrs after vaccine fever 100.2, bad chills,headache,body aches,very sore arm 36 hrs after vaccine swollen lymph nodes under rt arm, temp 99.8

Other Meds: metoprolol, calcium, vitamin D, biotin, coQ10

Current Illness: N/A

ID: 0959344
Sex: F
Age: 34
State: CA

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

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

Lab Data:

Allergies:

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

Symptoms: After vaccination, complained of tingling on lips and tongue. Legs felt heavy; fatigued. Treated with PO Benadryl and observed by onsite RN and paramedic- much improved. Follow-up call to patient 24 hours later and she is feeling much better.

Other Meds:

Current Illness:

ID: 0959345
Sex: M
Age: 23
State: KS

Vax Date: 01/03/2021
Onset Date: 01/04/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: HEADACHE, SHORTNESS OF BREATH

Other Meds:

Current Illness:

ID: 0959347
Sex: F
Age: 26
State: WI

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKA

Symptom List: Vomiting

Symptoms: Hives noted the following morning that were described as red, hot and itchy. Located on chest, head, hands and arms, side of right hip. Used Claritin and ice packs with some relief. Also experienced numbness on her left shoulder and left chest to navel which subsided by mid day. No breathing issues or any additional signs or symptoms.

Other Meds: None

Current Illness: Planning pregnancy

ID: 0959348
Sex: F
Age: 48
State: IL

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Left arm moderate pain, mild swelling, severe headache, fever 101.6, chills, fatigue, muscle aches and joint pain. Treatment- alternate acetaminophen and ibuprofen - reduce chills, fever and severe headache. Muscle aches, fatigue and joint pain remain

Other Meds: Birth Control, multi vitamin

Current Illness: None

ID: 0959349
Sex: F
Age: 56
State: OK

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Severe, painful abdominal cramping, sweating, and pooping. Felt like childbirth. So painful it was difficult to hold back tears or regulated my breathing. A lot like a severe "spastic colon attack". 2 1/2 hrs later, a dozen or so toilet flushed and it's not over with yet!

Other Meds: Did not take meds this morning. Omeprazole 20g 1daily Oxybutin (bladder) 5mg 2x daily A________ (blood pressure) 5mg 1x daily

Current Illness: Prior bladder infection couple of weeks before.

ID: 0959350
Sex: F
Age: 25
State: MT

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Fever

Other Meds:

Current Illness:

ID: 0959351
Sex: M
Age: 55
State: WA

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

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

Lab Data:

Allergies: N/A

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

Symptoms: Within 24 hours, patient reported uncontrolled blood glucose levels above 200. Patient previously had blood glucose within normal limits and was well controlled for some time. These elevated blood glucose levels lasted approximately one week. He had no other dietary/medication changes during this timeframe. The only change was that he received the vaccine. He also experienced headache, fatigue and severe injection site pain, peaking at 24 hours post injection.

Other Meds: Long-acting and short-acting insulins

Current Illness: None

ID: 0959352
Sex: F
Age: 27
State: MO

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: 1410 Client became light headed and reported to obs desk. Unassisted descent to floor upon turning to go to a 30 min obs seat. Did not strike head, sat on buttocks and propped self with left arm; No medical Hx. BP 140/100 P 96 R 12 SpO2 100%; LOC A&O x3, did not lose consciousness; skin warm pink and sweaty; hot at back of neck; HR regular; Resps unlabored; Lungs clear; assisted to a supine on floor and legs elevated; ice pack for comfort; EMS notified 1420 BP 152/104 P 70 R 12 SpO2 99% Resps continued unlabored; EMS arrived; Handoff report given; EMS assessed; client sitting; ; client offered transport to local ED and declined 1430 Client moved back into chair; BP 136/94 P 94 R 12 SpO2 99% 1440 Client stated she was starting to feel light headed again. Moved to floor and legs elevated again. BP 140/90 P 87 R10; Resps unlabored; A&O x3; skin cool pink dry; 1445 BP 136/108 P 85 R 10 ; continues supine with legs elevated; requested that client find someone to drive her home rather than drive self; client contacting boyfriend 1450 BP 140/108 Client states she feels fine but would like to remain on the floor sitting up. 1500 Client moved to chair for further observation; VS assessment discontinued 1530 Client remains in obs and waiting for ride

Other Meds: None

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm