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: 0962781
Sex: F
Age: 61
State: WI

Vax Date: 01/18/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: no known allergies

Symptoms: rash across mid section and blotchy on face. She called nurse line, they advised her to take benadryl and she reports things are resolving.

Other Meds: unknown

Current Illness: unknown

ID: 0962782
Sex: F
Age: 83
State:

Vax Date: 01/05/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: 01/19/21 Platelet Count: 23 TEST WAS REDONE TO VERIFY: 01/21/21 Platelet Count: 34

Allergies: Iodine Hives (High) High Alcohol Nausea and Vomiting Aricept [Donepezil] Confusion Not Codeine Unknown/Not Verified Other: See Comments Dizziness Patient cant tolerate spinal anesthesia

Symptoms: At this time provider of this patient feels the only reasoning behind patient's low platelet count could be in possible relation to COVID19 vaccine given 01/05/21. Patient is not having any other concerns and health status has not changed (besides platelet result) since before vaccine on 01/05/21. Patient was not given vaccine by our facility but by the pharmacy. At this point provider plans to advise patient does NOT get 2nd dose.

Other Meds: diclofenac (VOLTAREN) 1% gel Apply 2 g topically 4 times a day as needed (finger joint pain) diclofenac (VOLTAREN) 1% gel Apply 4 g topically 4 times a day as needed (knee pain bilateral) triamcinolone acetonide (KENALOG,ARISTOCORT) 0.1 %

Current Illness:

ID: 0962783
Sex: F
Age: 30
State: NV

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital: Y

Lab Data: CBC, CMP 1/20/2021 & 1/21/2021; LACTIC ACID X4 OVER 1/20/2021 & 01/21/2021; COVID-19 SCREENING (NEGATIVE) 1/20/2021 SEE BELOW FOR RESULTS

Allergies: GABAPENTIN, METOPROLOL, IVABRADINE, MORPHINE, PCN

Symptoms: "history of multiple allergic type reactions in the past is presenting for itching and the feeling of hoarse voice after receiving the first Covid vaccine. Here, she is slightly tachycardic, but her oxygen level is good, her lungs are clear. She has no urticaria, she has no stridor or wheezing. She does not wish to receive epinephrine because she has had such bad effects from it in the past, and is agreeable to Solu-Medrol and Benadryl. She took Pepcid prior to having her injection. Her friend who is with her recommends that she has a history of severe events like this in the past, and she usually does better after breathing treatment. However, patient states that she often ends up on BIPAP" PER ED MD NOTE

Other Meds: TOOK PEPCID PRIOR TO VACCINE

Current Illness: NONE KNOWN

Date Died: 01/15/2021

ID: 0962784
Sex: M
Age: 88
State:

Vax Date: 01/09/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: LATEX, NATURAL RUBBER

Symptoms: patient expired 1/15/2021; had been treated as outpatient for pneumonia, likely COVID-19 but no positive test result in December 2020. PMH diabetes

Other Meds:

Current Illness: PNEUMONIA

ID: 0962785
Sex: M
Age: 35
State: VA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: unknown

Symptoms: Patient received vaccine and walked over to the monitoring room to have a seat. After about 15 minutes, he felt lightheaded and passed out. Patient woke up and was still lightheaded. 911 was called and patient was sent to the ER. Patient is now doing well.

Other Meds: n/a

Current Illness: unknown

ID: 0962786
Sex: F
Age: 26
State: MA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient received Covid-19 Moderna Vaccine @ 0930, 2 minutes after receiving vaccine patient c/o "feeling flushed & dizzy" Provided cot for patient to lay down, VSS 119/73, HR 85, O2 sat 100%, patient denied any SOB/difficulty breathing After 30 minutes of monitoring, patient reported symptoms had resolved

Other Meds:

Current Illness:

ID: 0962787
Sex: F
Age: 82
State:

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: Metronidazole

Symptoms: vomitting, diarrhea, hypotension, bradycardia 2 hours after the vaccine was given treatment: placing the patient in trendelenburg position until BP improved after 1 hr

Other Meds: Lisinopril to 10 mg BID, Coreg 25 mg BID, ASA 81mg qd, ASA 81mg qd, ASA 81mg qd, cranberry tabs TID, omeprazole 20mg qd, Florastor 250mg qd, miralax qd, Lorazepam 0.5mg BID, Nuedexta 20/10mg BID, escitalopram 20mg qd, Bupropion Xl 150mg

Current Illness:

ID: 0962788
Sex: F
Age: 55
State: CA

Vax Date: 01/07/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: phone evaluation

Allergies: Lupron IM - hives and swelling Sulfa - hives

Symptoms: seven days after injection, redness/swelling/tenderness at injection site x 48 hours

Other Meds: none

Current Illness: none

ID: 0962789
Sex: F
Age: 45
State: OK

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: Reglan causes worsening anxiety

Symptoms: approx 15 minutes after receiving the vaccine, client started c/o tingling in hands and arms bilaterally, as well as clammy hands and light headedness. She also said her eyes were foggy. Vital signs monitored and o2 given per mask. She c/o frontal area head pain, resolved after being on O2 for 5 minutes. 4:05pm says clamminess in hands and light headedness improved. She was release to drive home and told to report to ER if she has any more problems. client does report today of having daily headaches since she received her shot.

Other Meds: Paxil,clonazepam,pantroprazole, hydroxine, ibuprofen

Current Illness: none

ID: 0962790
Sex: F
Age: 56
State: PA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: Recipient was seen by MD the next day and EKG was normal. Recipient is also ordered an echocardiogram to make sure everything else is normal.

Allergies:

Symptoms: On the evening that the recipient received the vaccine, heart rate increased for two hours, at one point climbing to 140 beats per minute. Her Apple Watch detected atrial fibrillation. The atrial fibrillation resolved after two hours.

Other Meds:

Current Illness:

ID: 0962791
Sex: F
Age: 76
State: NY

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: penicillin and claritin

Symptoms: mild headache for 36 hours; exhaustion for 36 hours; sensitive to cold,unable to get warm for 36 hours, shivering a lot; vomited once after 22 hours after the injection. No fever.

Other Meds: eliquis, atorvastatin, Vit d3, Fish oil, biotin, aspirin

Current Illness: tendonitis left heel

ID: 0962792
Sex: F
Age: 37
State: NY

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: PCN

Symptoms: Within 8 hours (up to 25 hrs post vaccine) experienced somnolence, brain fog, GI upset, chest pressure/tightness, nausea and a migraine (hx of chronic migraines). Chest tightness continued for 3-4 days. Vitals were WNL.

Other Meds: Ajovy, Botox (for migraines), Zofran prn, Allegra qd, Dexilant qd, Pepcid prn, Magnesium Glycinate 400mg, Vitamin D 2000

Current Illness: N/A

ID: 0962793
Sex: M
Age: 60
State: NJ

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Body aches, fatigue, fever, nausea, joint pain , COVID + 1 month ago.

Other Meds:

Current Illness: Covid + in December

ID: 0962794
Sex: F
Age: 23
State: VA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: penicillin

Symptoms: About 1:00 am woke up with chills, bad headache, fever - got up to 99.8 - fatigue - took med_Tylenol - and all day the next day these symptoms continued and I had to stay in bed and not do anything. The day after that it resolved.

Other Meds: Fludrocortisone and a salt tablet; Adderall - didn't take on the day of vaccine

Current Illness: cold - not COVID 19

ID: 0962795
Sex: F
Age: 43
State: ME

Vax Date: 12/26/2020
Onset Date: 12/26/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Immediately after injection metallic taste in mouth by 1 hour after returning home marked urticaria LUE and induration and extended rash L rib cage and flank. Rash persisted 10+ days; pt took photos and reported to V-Safe. Presented for second vaccination - deemed ineligible b/o immediate allergic reaction per CDC criteria.

Other Meds: None

Current Illness: None

ID: 0962796
Sex: F
Age: 41
State: PR

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient reports general malaise, chills and joint pain

Other Meds:

Current Illness:

ID: 0962797
Sex: F
Age: 53
State: NY

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: Albuterol, Latex ,bananas Crestor Cyclobenzaprine, Melon Kiwi

Symptoms: 15 minutes following injection patient c/o of increased heart rate and headache,

Other Meds: gabapentin/methimazole

Current Illness: None

ID: 0962798
Sex: F
Age: 92
State: KS

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Resident tested positive for COVID 01/06/2021. Resident received monoclonal antibody treatment on 01/10/2021.

Other Meds:

Current Illness:

ID: 0962799
Sex: F
Age: 56
State: PA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Chills, fever, headache, fatigue, nausea & body aches- Bed rest and Advil - Relieved some symptoms -

Other Meds: Lexapro Lisinopril

Current Illness: COVID-19

ID: 0962800
Sex: F
Age: 75
State: PA

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: NA

Allergies: none

Symptoms: Patient describes feeling "woozy" immediately following the injection, followed by severe pain in R hand and 3 fingers (index, middle, and ring finger) went numb. All symptoms resolved on their own. She did not receive medical care, nor did she follow-up with her pcp.

Other Meds: unknown

Current Illness: cellulitis of leg

ID: 0962801
Sex: F
Age: 40
State:

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: Patient contacted physican but they felt she did not need to be examined at the time.

Allergies: None, except for seasonal allergies where member takes Allegra or that type of OTC meds

Symptoms: Morning of 1/16/21, patient woke up early because the arm itched. She had swelling in hands, feet and rash on both arms and her torso. Also had tingling in hands and feet. Had these reactions for a couple days. Also had chills and nausea on Sun, Mon, and Tuesday but those symptoms have subsided. Still has some rash, but is taking Benadryl; has generalized itching.

Other Meds: Vitamins (OTC)

Current Illness: No

ID: 0962802
Sex: F
Age: 35
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: None

Allergies: Sensitivity to Vicodin, makes me vomit

Symptoms: 10/10 pain to injection site in left arm, muscle aches all over body, fever, headache

Other Meds: Escitalopram Protonix Pepcid Zyrtec

Current Illness: None

ID: 0962803
Sex: F
Age: 42
State: MI

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: EKG

Allergies: Bactrim

Symptoms: Tachycardia/shortness of breath 160-180?s sustained 20 min

Other Meds: Synthroid

Current Illness: None

ID: 0962804
Sex: F
Age: 81
State: CO

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: NONE

Allergies: None

Symptoms: Nausea, Weakness Second day 99.00 temperature, only lasted one day

Other Meds: metformin 500 mg LevoThyroxine Nexium Vitamin C, Fish Oil,Multi Vitamins, Lung Vitamin Bystolic had not taken for two weeks prior to vaccine

Current Illness: Had covid 19 October 7 and was hospitalized one week. Had all the mediations on trial. Am still on oxygen at night.

ID: 0962805
Sex: F
Age: 37
State: NY

Vax Date: 01/14/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: N/A

Allergies: PCN

Symptoms: Within 6 hours (up to 25 hrs post vaccine) experienced somnolence, brain fog, GI upset, chest pressure/tightness, nausea and a migraine (hx of chronic migraines). Chest tightness persisted for 3-4 days, and intermittently still occurs

Other Meds: Ajovy, Botox (for migraines), Zofran prn, Allegra qd, Pepcid prn, Dexilant qd, Magnesium Glycinate, Vitamin D

Current Illness: N/A

ID: 0962806
Sex: F
Age: 33
State: OH

Vax Date: 01/05/2021
Onset Date: 01/09/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: Ultrasound obtained today

Allergies: None

Symptoms: Right axilla lymphadenopathy and pain, still present but overall improving. Confirmed via ultrasound

Other Meds: None

Current Illness: None

ID: 0962807
Sex: F
Age: 34
State: NY

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: No tests conducted. Observed in ER

Allergies: Latex hives Amoxicillin hives Sulfa hives

Symptoms: Within 30 minutes of receiving vaccine, complained of dry mouth and difficulty in swallowing. Alert, oriented. Color pink; skin warm and dry; VS within normal range. Denies shortness of breath; no overt swelling. After few minutes, c/o burning in chest. Benedryl 25 mg tab x2 given with water. Able to swallow, but stated it was difficult to do so. Interacting and conversing with EMTs.

Other Meds: Asmodafinil 50 mg qday Pantoprzole Delayed Releas Tab qday Cyanocabalamin 1000 qday Poroxetine 12.5 mg qd Levocetirizine 5mg qday Montelukast q day L-Lysine 500 mg qd Prednisone 60 mg x1 in ER Benedryl 50 mg x1 at Clinic Famotidine 40 mg x1

Current Illness: Hypothyroidism Idiopathic Hypersomnia Narcolepsy Anxiety Depression Side effect to Lexapro requiring ER visit

ID: 0962808
Sex: F
Age: 64
State: FL

Vax Date: 01/09/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: penicillin

Symptoms: Site of vaccination is still red and warm.

Other Meds: simvastatin sumatriptan armour thyroid omeprazole

Current Illness: none

ID: 0962809
Sex: M
Age: 60
State: TX

Vax Date: 01/08/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: None

Allergies: None

Symptoms: Got Allergic Reaction in my left arm where vaccine is given

Other Meds: Atorvastatin 10 mg Fish Oil Omega03 1000mg

Current Illness: None

ID: 0962810
Sex: F
Age: 41
State: NY

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: At onset: BP 170/100, pulse 100, O2 sat 100% At release: BP 136/96, pulse 86, O2 sat d100%

Allergies: Bactrim

Symptoms: Employee c/o fullness in throat with difficulty swallowing. No SOB. Given 25 mg of Benadryl IM. Symptoms resolve within a half hour and patient was released to return to work

Other Meds: Vitamin C and B6

Current Illness: None

ID: 0962811
Sex: F
Age: 50
State: SC

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: not at this time, planning on following up with my primary

Allergies: Codeine latex

Symptoms: hours after vaccine I had an episode of sweating/clammy increase HR 128 lasting for a few minutes. The next morning has slight fever 99 but with HA and body aches and continue with increase HR 110-138 at rest. 2-3 days after symptoms continued. On 4thday continue with HA, less intense but HR remain elevated 108-136 at rest and with light activity. HR continues to be elevated 1 week later 100-132 all other symptoms have resolved, no days of work missed

Other Meds: Iburprofen

Current Illness: no

ID: 0962812
Sex: F
Age: 74
State: OH

Vax Date: 01/09/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: Iodine Dye, Pencillin

Symptoms: Bells Palsy

Other Meds: Vit C, Levothyroxine, ASA 81 mg, Atenolol, Atorvastatin, Donepezil, Escitalopram, Humalog Insulin, Lisinopril, Loratadine, Multi-Vit, Murbetriq, Preservision, Toujeo Injections, Vit D3 50000 u per wk.

Current Illness: Upper respiratory infection in Dec 2020. Treated with Levaquin and prednisone

ID: 0962813
Sex: F
Age: 47
State: CA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: No

Allergies: unknown

Symptoms: Within 5 minutes after COVID vaccine was administered staff c/o onset of migraine headache and dizziness. Naprosyn 250 mg was given PO. After 15 minutes staff began to cough for the next 10 minutes and Benadryl 25 mg PO was given. Monitored staff for the next 20 minutes , which cough subsided within that time. No other adverse reaction reported by staff at that time.

Other Meds: unknown

Current Illness: unknown

ID: 0962814
Sex: F
Age: 49
State: NY

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: Erythromycin, Azithromycin, Sesame Seeds

Symptoms: Sore arm day of. Next day: Headache, extreme fatigue, nausea, low grade fever of 99 these symptoms lasted until 1/15/21 at 1300.

Other Meds: Imuran (on hold), Celebrex, Zyrtec, Pantoprazole, BCP, Symbicort, Singulair

Current Illness:

ID: 0962815
Sex: F
Age: 59
State: MT

Vax Date: 01/15/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Dry Mouth, Swollen tongue, Sores in mouth

Other Meds:

Current Illness:

ID: 0962816
Sex: F
Age: 21
State:

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: Vaccination

Allergies: None

Symptoms: Dizziness, malaise

Other Meds: Trazodone, lexapro, apriso, butabital, blesovi, hycoscamine

Current Illness: IBS or Crohns

ID: 0962817
Sex: F
Age: 34
State: CO

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient received COVID vaccine and was sitting in the monitoring area. She was unable to sit still and flagged the RN monitor. She c/o feeling hot, itching, and "scratchy" throat making it "feel funny" to swallow. Strong pulses, patent airway, no hives noted, speaking in full sentences. ED Charge RN contacted and ED RN transported to ED without incident via wheelchair.

Other Meds:

Current Illness:

ID: 0962818
Sex: F
Age: 56
State: ME

Vax Date: 01/19/2020
Onset Date: 01/20/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data: N/a

Allergies: None

Symptoms: Fever, nausea, diarrhea, headache, dizzy, body and bone ache lasting 2 days

Other Meds: Fluoxetine 30mg

Current Illness: None

ID: 0962819
Sex: F
Age: 81
State: CT

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: Vital signs stable per EMS and paramedic

Allergies: None

Symptoms: Vaccinator reported she injected the pt with 0.5 mL of air instead of the vaccine. reports she had prefilled her syringes with 0.5 mL of vaccine ahead of time and inadvertently drew up air in the syringe instead of the vaccine. recognized immediately after administration that it did not feel right and the pt confirmed she did not feel the vaccine administered. further inspected the syringe which visually appeared dry, no left over vaccine, no droplets. EMS and paramedic called to vaccination station (they were on site), they evaluated pt. VSS, pt felt well other than some bruising and soreness at the injection site. Per paramedic 0.5 mL of air into deltoid will not cause an adverse reaction. But pt may experience bruising. Pt and family verbalized understanding. (me) called who recommended calling Moderna and our medical advisor. called Dr. and also Moderna. Dr. states the decision to revaccinate the pt is at (vaccinator) discretion if she feels the syringe truly did not contain vaccine. Dr. confirmed 0.5 mL of air into the deltoid will not hurt the pt. Called Moderna ? they advised management of invalid doses of the vaccine is at the medical advisor and vaccinators discretion. There is no information available on adverse reactions with double dose. Standard 0.5 mL dose contains 100 mcg. In a phase 1 study 250 mcg doses were injected into participants, the only information from the trial that is available is related to efficacy and not adverse reactions per Moderna. vaccinator, pt, and her family consented to receiving re-vaccination as they all strongly felt the original syringe did not contain vaccine. Pt was vaccinated successfully, all questions answered, pt sat in observation and tolerated the vaccination well. Director of Health was present and spoke with the pt and family about results of Modera information, DPH information, and discussion with Dr.

Other Meds: Simvastatin donepezil alopurinol pantoprazel metopelol clonidine

Current Illness: Pt confirmed with vaccinator that she was feeling well today

ID: 0962820
Sex: F
Age: 50
State: WV

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Moderate tingling and pin prink stabbing sensation in the soles of my feet and burning of my feet

Other Meds: Chlorthalidone 25mg daily Pepcid 40 mg bid Aspirin 81 mg daily Vitamin D daily Tylenol 1000mg

Current Illness: None

ID: 0962821
Sex: M
Age: 0
State:

Vax Date: 12/31/2020
Onset Date: 01/03/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient received Rotateq and Prevnar 13 vaccinations 12/31/2020. Developed frank blood in stools 01/03/2021. Presented to office for evaluation of continued bloody stools on 01/05/21. Patient sent for stat KUB which returned as highly suspicious for Intussusception. STAT ultrasound confirmed presence of Intussusception and patient transferred to pediatric ER. Upon arrival in ER, repeat ultrasound revealed Intussusception had resolved on its own. Probable cause of Intussusception was adverse event to Rotateq vaccine. The patient has recovered from the adverse event.

Other Meds:

Current Illness:

ID: 0962822
Sex: F
Age: 47
State: CT

Vax Date: 12/24/2020
Onset Date: 12/30/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data: Covid test; negative 12/30/2020 hartford healthcare

Allergies: penicillin; allergic reaction. extreme as child

Symptoms: 12/24 Vaccine 12/30 malaise, increase temp to 99.7 (usually 96/97), fatigue, nausea, episode of vomiting, massive chills, flu like symptoms. 'life having the flu for 4-6 hours' 1/6/2021 14 days after vaccine; extreme episode of severe chills lasted approximately 2/3rd of the day

Other Meds: detrol LA / daily

Current Illness: n/a

ID: 0962823
Sex: M
Age: 41
State: MA

Vax Date: 12/23/2020
Onset Date: 12/26/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data: Rapid Antigen testing

Allergies: None

Symptoms: Temp of 100.4

Other Meds: None

Current Illness: None

ID: 0962824
Sex: F
Age: 34
State: KS

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data: none

Allergies: penicillin

Symptoms: Rash in inner upper arms and also on top of thighs...occurred over night about 30hrs after initial shot

Other Meds: birth control

Current Illness: none

ID: 0962825
Sex: F
Age: 60
State: ME

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data: None

Allergies: Penicillin, hazelnuts,

Symptoms: Starting at about 8:00 p.m. last night, pain in the arm continuing to get worse as the night went on, by the time I went to bed at 11:00 my whole body hurt. I had severe chills and severe headache. The chills ended sometime in the middle of the night but the headache continues to now. Most of the body aches are gone.

Other Meds: Levothyroxine, daily vitamins, D, B, evening primrose, magnesium

Current Illness: None

ID: 0962826
Sex: F
Age: 40
State: AZ

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: None

Symptoms: Fever, chills, headache, body aches, tired and loss of voice

Other Meds: Claritin, B12 shots, Mirena

Current Illness:

Date Died: 01/14/2021

ID: 0962827
Sex: F
Age: 93
State:

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
Hospital: Y

Lab Data:

Allergies: ATORVASTATIN; CODEINE; DOXY

Symptoms: Admitted 1/14/21: Patient is an elderly 93-year-old female with multiple medical problems including chronic combined CHF, P 80, diabetes mellitus, HTN, hyperlipidemia, CKD stage 3, has been complaining of generalized weakness, fatigue, decreased appetite for the past few days. She had an outpatient COVID-19 vaccine earlier today. Within 2 hr of admitting the patient to the hospital, condition clinically deteriorated. Patient elected to be DNR/DNI while in the ED. Patient was pronounced dead at 10:30 p.m. earlier today. Preliminary cause of death: Hypoglycemia induced lactic acidosis.

Other Meds:

Current Illness:

ID: 0962828
Sex: F
Age: 39
State: MT

Vax Date: 01/15/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Fever, Swollen arm, and Body aches

Other Meds:

Current Illness:

ID: 0962829
Sex: F
Age: 33
State: NM

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies: NA

Symptoms: Extreme pain in mid-back that radiates around torso, creating a constricting feeling when I try to breathe. Hurts to lay down or lift objects. Heart rate is elevated from 50-60s to 80-90s. Some numbness in hands. Some feelings of disorientation. I have not sought healthcare yet, although plan to if the pain worsens.

Other Meds: NA

Current Illness: NA

ID: 0962830
Sex: F
Age: 69
State: MI

Vax Date: 11/03/2020
Onset Date: 11/03/2020
Rec V Date: 01/21/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient experienced a rash that presented on the vaccinated arm. The rash spread to a little above the vaccination site to just below the elbow. The rash was itchy and was described as "hives".

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm