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: 0959607
Sex: F
Age: 60
State: NJ

Vax Date: 01/11/2021
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: Sulfa

Symptom List: Dysphagia, Epiglottitis

Symptoms: Moderna-Covid-19 Vaccine EUA I had no symptoms for the first 7 days. Not even soreness at the injection site. Then on day 7 the injection site became itchy under the skin, slight soreness. Day 8 more itchy under the skin, warm to touch, redness an soreness in the area not just at the injection site. Day 9 hive like rash, itchy under the skin, red and soreness, warm to touch. I took a benadryl 25mg it took out the swelling in the hive like rash. Thats my story. Now I'm very concern do I get my Second Vaccine on February 9,2021. Please advise me on what I should do. I'm having a Tela-Med appointment with my primary on Friday Jan.22

Other Meds: multi-vitamin calcium with D3 vitamin B complex vitamin C Levothyroxine 75mg 1xdaily

Current Illness: none

ID: 0959608
Sex: F
Age: 18
State: IL

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

Lab Data:

Allergies: no allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: about 15 minutes after getting vaccine, she felt lie head is spinning and about to faint. She reports not having eaten much today. Also says she does not remember having any other vaccinations before. She sat down and rested, ate some food and drank some water and felt slightly better.

Other Meds: sertraline

Current Illness: no other illnesses

ID: 0959609
Sex: F
Age: 50
State: VA

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: After 30 minutes of evaluation, client began to cough and feel her throat swelling. She then retrieved her own supply of Benadryl and took it. After 15 minutes, the patient was still coughing but used her own inhaler which immediately had a positive response. Patient was observed an additional 30 minutes until symptoms resolved. Client agreed to follow up with PCP and follow recommendations. Client stable when departed.

Other Meds:

Current Illness:

ID: 0959610
Sex: F
Age: 30
State: CA

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever, chills, body aches, headache, fatigue. Improving.

Other Meds:

Current Illness:

ID: 0959611
Sex: F
Age: 26
State: MI

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: LA

Lab Data:

Allergies:

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

Symptoms: Dizziness, vomiting, fever, chills

Other Meds: Birth control Hair skin and nails vitamin

Current Illness:

ID: 0959612
Sex: F
Age: 48
State: WV

Vax Date: 01/14/2021
Onset Date: 01/15/2021
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: None known

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

Symptoms: Right arm was hot to the touch, red and swollen 3 to 4 inches above and below where shot was given. Arm, shoulder, back and neck pain for hours and chills.

Other Meds: Fluoxetine 20mg Fluoxetine 10mg Savella Amitiza Levothyroxine Vitamin D2 Omerprazole

Current Illness: none known

ID: 0959614
Sex: F
Age: 38
State: WI

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: grapes, blueberries, dust

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient describes a tingling in her tongue, this is the same reaction she gets with exposure to her other allergens including: grapes, blueberries, and dust. The patient was given 50mg Benadryl and monitored for 1.5 hours. The patient did not report a gradual lessening of symptoms. Patient will be released with instructions for self monitoring and emergency planning if the symptoms get worse. She has had no history of EPI usage for an allergic reaction. She has gone for the

Other Meds: No medications

Current Illness: no past medical history

ID: 0959615
Sex: M
Age: 53
State: RI

Vax Date: 01/14/2021
Onset Date: 01/16/2021
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: MUCINEX

Symptom List: Pharyngeal swelling

Symptoms: STARTING 48 hrs LATER PAIN RT HIP. THEN WEAKNESS RT LEG ONLY. LED TO 9 FALLS OVER THREE DAY PERIOD. IMPROVED AS OF 1/20/21 HEADACHE ON NIGHT ON VACCINE ONLY.

Other Meds: XARELTO, CLONIDINE, LOSARTAN

Current Illness: FEVER, CHILLS, DIARRHEA, SHAKES X 48hrs DEC 29TH-3 or 4

ID: 0959616
Sex: F
Age: 41
State: CO

Vax Date: 01/14/2021
Onset Date: 01/09/2021
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: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: developed tender lymph nodes in neck and above (L) clavicle 1/9/2021 - palpable on exam as shotty Lymphadenopathy anterior cervical with slight rash at injection site

Other Meds: Topical retin A, Kyleena IUD

Current Illness: N/A

ID: 0959617
Sex: M
Age: 75
State: CA

Vax Date: 01/11/2021
Onset Date: 01/14/2021
Rec V Date: 01/20/2021
Hospital: Y

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: On 01/14/2021 patient developed fever and chills and had right leg pain similiar to previous episodes of leg infection, right lower extremity showed mild soft tissue swelling. Chest X-ray showed bilateral perihilar vascular congestion which was new since prior study. Patient's temperature was 40.12 C and blood pressure 193/85. Patient was admitted to Hospital at that time.

Other Meds:

Current Illness:

ID: 0959618
Sex: F
Age: 27
State: NY

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: sulfa antibiotics

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

Symptoms: Patient reports numbness & tingling with a heavy arm 10 minutes post vaccination. V/S taken WNL. BP-126/92, HR 80, SPO2 98%, RR-18. Patient given electrolytes for rehydration. Patient reports suffering from medical PTSD of 15 years ago. Pt observed for additional 15 minutes. Pt discharged at 1705. BP 126/92 HR 80 O2 Sat -98% Pt reports tingling & numb in (R) fingertips, arms heavy 5lb.

Other Meds: xanax Effexor Lorena Remeron Gralisse

Current Illness: Neck & back pain

ID: 0959619
Sex: F
Age: 44
State: WA

Vax Date: 01/08/2021
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: SYR
Vax Site: RA

Lab Data:

Allergies: no

Symptom List: Rash, Urticaria

Symptoms: Day 10 large lump appeared / not painful red, hot to touch, & itchy

Other Meds: Irbesartan, pantoprazole, nitrofurantoin

Current Illness: no

ID: 0959620
Sex: F
Age: 79
State: OK

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

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

Lab Data:

Allergies: tamsulosin - unknown, ciprofloxacin PO and fluoroquinolones - throat closure, povidone - iodine -

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

Symptoms: Eleven hours after receiving COVID vaccine, client started experiencing stroke-like symptoms legs/arm weakness, couldn't speak, shortness of breath, and throat swelling. Hospital ruled out acute stroke but could not entirely exclude a cerebellar stroke due to her dizziness with vertigo and nystagmus (per hospital report). Client was in hospital 2.5 days, per hospitalist. note-all work up including MRI and tte were negative for acute findings- symptoms have resolved. Hospitalist noted symptoms may be worse following second shot. Spoke with client 1/19/21 and she reported feeling weak and tired only.

Other Meds: Atorvastatin 40MG PO DAILY, calcium 1200 MG PO BID, Vitamin D3 400 UNITS PO HS, Metoprolol SUCCINATE 37.5MG ORAL BID

Current Illness: none

ID: 0959621
Sex: F
Age: 34
State: MO

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Stated had adverse reaction to Influenza vaccination

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

Symptoms: Patient stated begin 24 hours after initial vaccination experienced fatigue and headache which continued to worsen resulting in inability to function and sleep continuously. Developed Diarrhea 4 days after vaccination. Begin vomiting on Monday 1-18-21. Went to Urgent Care and had a COVID test which came back Negative on 1-20-21 Will see primary care physician this Friday 1-22-21. Still experience Diarrhea, fatigue, headaches and nausea as of 1-20-21. Patient been instructed to rest, drink plenty of fluids and treat symptoms until to be seen by primary care provider

Other Meds: None known

Current Illness: None known

ID: 0959622
Sex: F
Age: 34
State: MT

Vax Date: 12/28/2020
Onset Date: 12/29/2020
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: 0

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

Symptoms: sore arm 1st day felt like a bruise 3rd day - welt size of band aid 4th day - ballsized hard/red/hot lump ?afraid about infection 8th as it resolved she became fatigued/"body drawing! body aches no fever

Other Meds: steroid inhaler & rescue inhaler

Current Illness: menstrating at the same time

ID: 0959623
Sex: M
Age: 17
State: IN

Vax Date: 01/05/2021
Onset Date: 01/05/2021
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: UNKNOWN

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

Symptoms: Vaccine was administered outside the FDA approved age range. There were no adverse events/reactions.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 0959624
Sex: F
Age: 17
State: IN

Vax Date: 01/05/2021
Onset Date: 01/05/2021
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: UNKNOWN

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

Symptoms: Vaccine was administered outside the FDA approved age range. There were no adverse events/reactions.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 0959625
Sex: M
Age: 13
State: GA

Vax Date: 08/11/2020
Onset Date: 08/12/2020
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: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Mom reported on 8-13-20 via phone that child had rash on rash on right arm starting 8-12-20. Mom stated she gave oral benadryl. Mom stated 8-13-20 child's face swollen & c/o entire body itcjing. Stated she continued with benadryl. Referred child to MD or ER immed. mom stated child had improvement 8-13-20.

Other Meds: No

Current Illness: No

ID: 0959626
Sex: F
Age: 39
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Fatigue, body aches, injection site pain, headache

Other Meds:

Current Illness:

ID: 0959627
Sex: F
Age: 39
State: NY

Vax Date: 01/08/2021
Onset Date: 01/18/2021
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: Latex sensitivity

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

Symptoms: Typical mild symptoms 24-36 hours after injection (arm soreness, redness and minor swelling at injection site, myalgia, arthralgia, fatigue), all resolved within 73 hours. Day 11 post-injection, re-emergence of urticaria at injection site, red, warm, swollen, about 2 inches in diameter. Day 12/13 post-injection, increased diameter.

Other Meds: Escitalopram, lamotrigine

Current Illness: None

ID: 0959628
Sex: F
Age: 54
State: CA

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: Penicillin

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

Symptoms: Only had right arm soreness until around 10pm. Around 10pm had a headache, upset stomach and neck was achy. Woke up around 3am with chills off and on for about an hour, achy all on right side of my body, and had a bad headache.

Other Meds: Lisinopril 2.5mg/day

Current Illness:

ID: 0959629
Sex: F
Age: 74
State: MN

Vax Date: 01/16/2021
Onset Date: 01/16/2021
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: Ambien Lisinopril Eggs-causes diarrhea when taken with Metformin

Symptom List: Unevaluable event

Symptoms: Diarrhea x 2 episodes

Other Meds: Aspirin 81mg take 1 tab po QD Calcium + Vit D 600mg/800units take 1 tab po BID Miralax 17gm mix 17gm in 8oz of H20 QD Vit D3 1000IU take 1 cap po QD

Current Illness: N/A

ID: 0959630
Sex: M
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: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Medication Administration Error being reported per EUA Fact Sheet for Providers: Patient received Moderna COVID Vaccine as 2nd dose in series in error - First dose was Pfizer. Vaccinator inadvertently used incorrect vaccine and did not realize error until administered. Observation was carried out as per standard practice. No harm to patient. No further action taken or subsequent doses scheduled based on CDC guidance RE: errors with interchangeability (https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html)

Other Meds:

Current Illness:

ID: 0959631
Sex: F
Age: 49
State: GA

Vax Date: 10/21/2020
Onset Date: 10/21/2020
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: Chickens

Symptom List: Injection site pain, Pain

Symptoms: Within 5 minutes of influenza vaccination, Pt came in itching + had facial Flushing. Pt has an allergy to chickens but stated she has never had any trouble with Flu vaccinations.

Other Meds: Benadryl every night

Current Illness:

ID: 0959632
Sex: F
Age: 39
State: CA

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: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fatigue, body aches, injection site pain, headache

Other Meds:

Current Illness:

ID: 0959633
Sex: F
Age: 29
State: ND

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

Lab Data:

Allergies: Sulfa, amoxicillin, penicillin

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

Symptoms: Fever of 103.7, severe body aches, chills, vomiting

Other Meds:

Current Illness:

ID: 0959634
Sex: F
Age: 49
State: RI

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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pt entered observation @ 1645. @ 1704 states prickles felt on back and arm. States s/s had been going on about 10 mins before she said anything. Benadryl 25mg given @ 1705. Does have allergies to Flu Vaccine, MRI Dye, Vicodin, Buspar, Lisinopril, Suchycin. Celexa, Prev Pack, Lexapro, Penicillin, Hydrocodone, and Fluoxetine. Remains to voice s/s @ 1729. Red Blotchy areas noted to face and neck. Pt states this is normal for her when her anixety level is high. V/S were taken @ 1733 BP-193/105, P-74, R-18, 02-100% on L arm. V/S obtained on R arm @ 1731 BP-193/111, P-76, R-18, O2-100%. States that takes BP meds daily @ night, in which she hasn't taken her meds all day. Takes Amlodipine 5mg, Klonopin 0.5mg, Vit D 1000, MVI, Clartin 5mg, and Zantac 150mg. Stil continues to voice s/s @ 1739. BP remains elevated. Patient sent to ER @ 1740. Pt entered registration @ ER @ 1745. Pt continue to voice s/s of prickling noted to body. Denies SOB nor trouble w/ breathing.

Other Meds: Amlodipine, Klonopin, Vit D, MVI, Claritin, Zantac

Current Illness:

ID: 0959635
Sex: F
Age: 37
State: CO

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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: extreme immune? reaction, starting around 11 pm the same day of reaction, including high subjective fever, delirium, repeated episodes of syncope, extreme weakness lasting 2-3 hours. overall - flu like symptoms that lasted 36 hours post injection.

Other Meds: Amoxicillin 875 mg bid

Current Illness: tooth pain

ID: 0959636
Sex: M
Age: 29
State: CA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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: Amoxicillin- rash

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

Symptoms: Constant/On and off headache since second vaccine was given (over a week now). Headache more in the frontal section of the head and in between eyes; however, it migrates and intensifies around my head. The headache depresses my mood and had to call off work. Been in bed due to headache since second dose was given.

Other Meds: Celexa - general anxiety

Current Illness: None

ID: 0959637
Sex: F
Age: 46
State: TX

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: none

Symptom List: Nausea

Symptoms: 1/12/2021 fever 101.2 body aches chills fatigue still continue yesterday diarrhea symptoms lasted x2 days 11/20/2021 noted left arm with inches all around with bright red patches redness lt arm around injection site. Denies pain Taking Tylenol

Other Meds: none

Current Illness: none

ID: 0959638
Sex: F
Age: 40
State: NE

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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: DEVELOPED NECK PAIN (ALL AROUND), NOT COMPLETELY RESOLVED AT THIS TIME.

Other Meds:

Current Illness:

ID: 0959639
Sex: F
Age: 52
State: MI

Vax Date: 01/16/2021
Onset Date: 01/17/2021
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: Shrimp Unknown wool

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

Symptoms: Fever, chills, myalgias, arthralgias, fatigue, dizziness, headache, nausea, injection site pain -started about 8 hrs after vaccination and lasted for about 2 days. About 40 hours after vaccination developed decreased sensation, numbness over left side of the scalp and in next few hours had numbness of left side of face, arm and fingers with some weakness in grip and fine motor movements. Has been the same since then. Fe hours later started having

Other Meds: Lisinopril/Hydrochlorothiazide Paroxetine

Current Illness:

ID: 0959640
Sex: F
Age: 52
State: GA

Vax Date: 01/12/2021
Onset Date: 01/14/2021
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: Sulfur

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

Symptoms: Pain at the injection site started in the evening of 1/12/2021. It went away after 2-3 days. Redness and itchiness started on 1/14/2021. Applied hydrocortisone cream for 3 days then resolved. However, the redness and itchiness returned on 1/20/2021. Possibly caused by irritation form blood pressure monitor cuff or slept on the left side of body in the previous night.

Other Meds: Vitamin A, B, D

Current Illness: none

ID: 0959641
Sex: F
Age: 75
State:

Vax Date: 01/14/2021
Onset Date: 01/15/2021
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: unk

Symptom List: Tremor

Symptoms: pt reported getting the moderna vaccine lot number 025L20A on Jan 14th 2021 and then on the 15th she had diarrhea during the day, then chills later in the evening, then a horrible burning pain from stomach to throat that night til about 4am. Pt stated she has not had the symptoms again since but she did also delay her copaxone shot by about 3 days because of that. pt stated md is aware and ok with getting 2nd dose of series.

Other Meds: unk

Current Illness: unk

ID: 0959642
Sex: F
Age: 27
State: NY

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient was administered potentially undiluted vaccine- stayed for observation period of 15 minutes, no adverse reactions. Pt notified of administration later in the day via phone call.

Other Meds:

Current Illness:

ID: 0959643
Sex: F
Age: 75
State: CA

Vax Date: 01/17/2021
Onset Date: 01/18/2021
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: None

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

Symptoms: Pain of injection site, fatigue, headache for about 36 hours, after all systems but injection site gone. After 48 hours injection site was not painful. Mild signs as expected.

Other Meds: Premarin 0.3, Losartan 50, Simvastatin 40, vitamins D & E, Biotin 3000, Nexium 24 hour

Current Illness: None

ID: 0959644
Sex: F
Age: 49
State: FL

Vax Date: 01/11/2021
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: Pineapple allergy, environmental allergies

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

Symptoms: 2? raised, hard, warm welt at site of injection

Other Meds: Triamcinalone ointment, Motrin, Benedryl

Current Illness: N/A

ID: 0959645
Sex: F
Age: 25
State: MN

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I started having cramps Friday night and Saturday morning I started bleeding, by Saturday evening I was passing clots and tissue. ER doctor and nurses did tests and found I was having a miscarriage.

Other Meds:

Current Illness: I was unaware I was pregnant at time of vaccine. Turns out I was, I had a miscarriage a week later at about 4-5 weeks.

ID: 0959646
Sex: F
Age: 69
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient describes Soreness at injection site, later experienced body aches, headache, fever that is rising and hoarseness in voice

Other Meds:

Current Illness:

ID: 0959647
Sex: F
Age: 16
State: MD

Vax Date: 08/13/2020
Onset Date: 08/14/2020
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: 0N 8/14/2020 PATIENT'S MOM CALLED OUR OFFICE CONCERNED ABOUT POSSIBLE SHOT REACTION. LARGE RED AREA AROUND SITE AND HOT TO TOUCH. AN APPOINTMENT FOR EVALUATION WAS SCHEDULED. PT CAME IN 8/14/2020 AND WAS DIAGNOSED WITH ADVERSE EFFECT OF OTHER BACTERIAL VACCINES (BEXSERO LOCAL REACTION, WITH ERYTHEMA, SWELLING, AND PAIN) AFTER THIS APPOINTMENT THERE WERE NO CALLS BACK FROM PATIENT WITH WORSENING CONDITIONS. PATIENT RECIEVED HER SECOND BEXSERO VACCINE ON 10/14/2020.

Other Meds: NONE

Current Illness: NONE

ID: 0959648
Sex: F
Age: 30
State: CA

Vax Date: 01/16/2021
Onset Date: 01/16/2021
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:

Symptom List: Pain in extremity

Symptoms: Patient with h/o hives from first dose (12/26/20) became lightheaded and dizzy 20-30 minutes after second dose. Received 25 mg Benadryl and Epi-Pen before being sent to the ED.

Other Meds:

Current Illness:

ID: 0959649
Sex: F
Age: 32
State: TX

Vax Date: 11/24/2020
Onset Date: 11/27/2020
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:

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

Symptoms: Three days post vaccination, patient complained of numbness to entire arm. She states this only occurs when she is laying down. It used to wake her up at night. Now, she gets minimal numbness and tingling sensation every 2 or 3 days.

Other Meds:

Current Illness:

ID: 0959650
Sex: F
Age: 40
State: CA

Vax Date: 01/12/2021
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:

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

Symptoms: My left arm is welted, really swollen and bruised. In the same exact area the area is really hot, and it itches alot! The symptoms have just recently surfaced, it has been 1 week.

Other Meds:

Current Illness:

ID: 0959651
Sex: F
Age: 93
State: MN

Vax Date: 01/16/2021
Onset Date: 01/17/2021
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: Oxycodone

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

Symptoms: 3 episodes of emesis "a couple" episodes of diarrhea

Other Meds: Tylenol 500mg take 1 tab po TID

Current Illness: N/A

ID: 0959652
Sex: M
Age: 32
State: MI

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

Lab Data:

Allergies: seasonal allergies, Lamictal, Gabapentin, Topomax

Symptom List: Vomiting

Symptoms: Patient complained of "throat thickening" at 0931. Patient with history of "reaction to some infusion" done at clinic requiring IV Benadryl/steroid/?epi. Treated with 0.3 mg Epi IM at 0937, reported symptoms resolved by 0838. Patient transported to local hospital via EMS at 0950.

Other Meds: Albuterol, Diclofenac, omeprazole, Flexeril, Zyrtec prn

Current Illness: none

ID: 0959653
Sex: M
Age: 90
State: TX

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: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient reported fever, dizziness and lightheadedness, as well as low blood pressure to this nurse by phone. This nurse requested patient to be seen by provider as soon as possible. Patient agreed and came to clinic soon after phone call. Dr notified this nurse that patient was advised to be seen by provider in ER for possible IV fluids and lab work due to symptoms. Pt refused and went home.

Other Meds: amlodipine 5 mg tablet Take 1 tablet by mouth once a day as directed. Aspir-81 (aspirin) 81 mg tablet,delayed release (DR/EC) Take 1 tablet by mouth once a day as directed. carvedilol 25 mg tablet Take 1 tablet by mouth twice a day a

Current Illness: None reported by patient

ID: 0959654
Sex: M
Age: 28
State: OH

Vax Date: 12/23/2020
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Local injection site warmth edema, pruritis, blanching erythema progressing from 3x3 cm to 10x8 cm maximum extent over the course of 24 hours on injection day #8. Resolved spontaneously over 3 days. Worse with muscle manipulation. No weakness. No fevers, chills, constitutional symptoms. No other symptoms.

Other Meds: Pantoprazole

Current Illness: None

ID: 0959655
Sex: F
Age: 33
State: GA

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Soy

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Left arm joint pain 4 hours after shot. Chills. Nausea. Muscle aches. Headache. Fatigue. Stomach ache. Remaining started that night continuing now.

Other Meds: Prenatal Multi DHA vitamins

Current Illness: No

ID: 0959656
Sex: F
Age: 73
State: NH

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: IM
Vax Site: RA

Lab Data:

Allergies: non known

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

Symptoms: fever, aches, tired

Other Meds: metrolol, atorvastatin, clopidogrel, losartan potassium, trazadone, claritan,

Current Illness:

ID: 0959657
Sex: M
Age: 29
State: VA

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: none listed

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

Symptoms: Patient had seizure like activity- Has seizure disorder meds were stopped 1-6-2021

Other Meds: Strattera 25mg 2 twice daily/Lipitor 10mg 1 in the evening/Advil 200mg 3 twice daily/Remeron 15mg in the morning and Remeron 45mg in the evening. Tegretol was stopped 1-6-21 per inmate request Tegretol was restarted today at 200mg twice da

Current Illness: Cyst removal

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm