VAERS 2021 Database www.vaers.hhs.gov

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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: 0963155
Sex: F
Age: 51
State: CA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
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: She can eat Aloe vera juice. When she rubs Aloe vera skin products on her skin, she gets an itchy rash a day later.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Symptoms were first noted 12/24/2020. She had the Pfizer Covid vaccine at about 6pm. At about 10 pm she had mild chest tightness. It persisted for >24. hours. She also had injection site soreness. She was tired for a day. If she talked a lot or got angry, she found it a little difficult to breathe. (Her mother was in the hospital and she had been talking a lot.) She did not have any other symptoms. She reports she was not stressed when she had the vaccine: her mother?s stressful problem started in January. The patient?s symptom severity is rated as: ?mild,? ?not very severe.? If she did not talk, she did not feel anything. The SECOND DOSE was given at my office. The Covid vaccine was administered and the patient was observed for two hours. This was from Pfizer-Biontech Lot EL3246, expiring 4/2021. She had some chest tightness and was given an albuterol nebulizer treatment. Her symptoms resolved and she was discharged to home. I phoned her the next day. She had mild dyspnea the day after the vaccination that resolved that night. She did not have a fever, but did have local soreness, fatigue, body ache, and a headache, for which she took Tylenol. She did see her primary care physician and they discussed the patient?s anxiety due to her mother?s poor health. An EKG will be done.

Other Meds: Atorvastatin 10mg Spironolactone 100mg Estardiol Norethindrone 1-0.5mg Eye gel lubricant Vitamin D 5,000 IU Vitamin B complex

Current Illness: she has been seen by an ophthalmologist for sleeping with her eyes open and dry eyes. hypercholesterolemia. hair loss. Low Vitamin D level. benign positional vertigo. migraine.

ID: 0963156
Sex: F
Age: 38
State: KS

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

Symptom List: Anxiety, Dyspnoea

Symptoms: Right arm was sensitive to touch/warm, hard and sollen like a giant bug bite and red, itchy. Very sore for 3 days and had to ice and keep moving. A week later, still have a reddish/purple bruise that is the size of a quarter and itchy.

Other Meds: Citalopram, women's daily vitamins

Current Illness:

ID: 0963157
Sex: F
Age: 44
State: SC

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
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: hydrocodone, milk penicillin, sulfur, latex, melon, ace inhibitors, codeine, nuts, Paxil

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

Symptoms: Itching was given Benadryl 25mg oral and Pepcid 40mg oral monitored for 30 minutes and sent home.

Other Meds: unknown

Current Illness: Sumatriptan, aspirin 325mg, Montelukast, fexofenadine, albuterol 90mcg QID PRN

ID: 0963158
Sex: F
Age: 50
State: ME

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

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

Lab Data:

Allergies: Egg sensativity

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Immedicately nauseated. Hypertensive event, reddness on neck and upper chest and hands, moment of visual disturbance. Initial BP 157/100 . Diphendhydramine 50mg IM administered and symptoms resolved within 15 min. BP 144/79 which is patients normal reading O2 sat 100 throughout episode. Patient had no further symptoms over the next 24 hours

Other Meds: None

Current Illness: None

ID: 0963159
Sex: F
Age: 46
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Left arm redness below injection site. No fever headaches or body aches.

Other Meds:

Current Illness:

ID: 0963160
Sex: F
Age: 72
State: TX

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

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

Symptoms: No adverse events noted in the immediate observation period after vaccination. Concern is that she may have had undiagnosed and undisclosed COVID illness when she was vaccinated. Scheduled for COVID test on 1/23/21. Results pending.

Other Meds: Unknown

Current Illness: Cough. When screened, the client downplayed the symptoms she was experiencing. Received Moderna Covid vaccine, observed for 15 minutes. Was taken by wheelchair to the exit at the end of the observation period. upon which a family member asked if the COVID vaccine would interfere with a COVID test. The client is scheduled for COVID test on 1/23/21. Family member reported that she was unable to walk to the exit because she was short of breath. Medical Director on site provided guidance regarding COVID exposure and testing. Requested a call back when COVID test results are obtained. Instructed family to quarantine per CDC guidelines.

ID: 0963161
Sex: F
Age: 44
State: MT

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Injection Site Pain, Body Aches

Other Meds:

Current Illness:

ID: 0963162
Sex: F
Age: 58
State: CA

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

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

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: 10 minutes in Heart Rate elevate 125 and 99 oxygen 201/90 blood pressure

Other Meds: Crestor 20 mg and Atenolol 12.5 mg

Current Illness: No

ID: 0963169
Sex: M
Age: 83
State: IL

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

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

Lab Data:

Allergies: Baclofen, dust mite extract, praednisone, tramadol, and venlafaxine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore arm, 2nd day tongue swelled huge went to ER got shot of Benadryl and steroid tired and some dizzy

Other Meds: Carbidopa-levodopa 25-100mg, carbidopa-Levo ER 25-100mg, sertraline HCL 25mg, clopidogrel, 75mg, beazepril-hydrochlorothiazide 20-12.5mg, montelukast sodium, 10mg, aspirin 81mg, zyrtec 10mg, melatonin 10mg, vitamin D flutiasone nasal 50mg

Current Illness: Parkinsons, and radiation to top of head for skin cancer

ID: 0963170
Sex: F
Age: 36
State: AK

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/21/2021
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: Anaphylactic to latex and NSAID'S, Allergic to pork, kiwi, and oral allergy syndrome.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: About an hour after the vaccine, a migraine started that has been unrelieved day and night with max doses of Tylenol. Bilateral eye twitching and freezing mid-twitch has worsened to every few mins with a peak 6 days post-vaccine. 7th day post-vaccine intermittent eye twitching throughout the day with less frequency, however continued migraines without relief. 14 hrs post-vaccine awoke from sleep with excruciating 10/10 pain in my already bothersome hips. Felt like I was in labor, awoke crying in my sleep and screaming out in pain. Hip pain returned to baseline the following day with no return of increased pain.

Other Meds: Tylenol

Current Illness: Strept throat in the middle of December, negative to COVID ?3.

ID: 0963171
Sex: F
Age: 36
State: NY

Vax Date: 01/07/2021
Onset Date: 01/16/2021
Rec V Date: 01/21/2021
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

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

Symptoms: No reaction was serious enough to receive medical care. On day 9 and 10 after receiving my first dose of moderna I had a very itchy large warm red raised rash at the injection site. I tried using Benadryl cream which didn?t help and switched to Cortisone cream which did help with the itch. After 2 days the rash got less red and itchy and mostly disappeared. Right after the injection I had a small red blotch that went away after 5 days and was not itchy. Then this big itchy rash appeared days later.

Other Meds: Allegra D Women?s daily multi vitamin Flonase Montelukast Vitamin C

Current Illness: None

ID: 0963172
Sex: F
Age: 76
State: AZ

Vax Date: 01/06/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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: codeine, latex

Symptom List: Rash, Urticaria

Symptoms: 8.5cm round area of macular erythema, 1cm slightly raised satellite lesion at immunization site. mildly tender

Other Meds: Levetiracetam, cyanocobalamin, MGoxide, Omeprazole. Aspirin, atorvastatin, levothyroxine

Current Illness:

ID: 0963173
Sex: U
Age: 45
State: WI

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient had redness and warmness. She started Itching and felt a little off. She took diphenhydramine 50mg. Her blood pressure was 161/107 and Heart rate was 100. Her temperature was fine. She had water and food and waited about an hour. The itching and rash went away. Her blood pressure came back down to 125/89 and heart rate 93. She left to continue working and has reported no other events since at 4PM.

Other Meds:

Current Illness:

ID: 0963174
Sex: F
Age: 52
State: NV

Vax Date: 12/27/2020
Onset Date: 12/28/2020
Rec V Date: 01/21/2021
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: Chlorohexidine

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

Symptoms: Had nausea; diarrhea; aches, pains, chills, constant low grade fever; headache and a slight cough - for over a week. Stand up /got dizzy. Over and over. Taking anti-nausea meds to stay okay. I did a telehealth with Dr and she told me to stay hydrated and get rest. I only worked 12 hours for that week. Sometimes I still wake up coughing at night.

Other Meds: Tizanidine 4 mg - as needed for migraines and was taking them; trazadone - sleep; Pantapozal; Lovasamtatin; Maxalt; B12 and Vit D - daily

Current Illness: Sinus infection about 3 weeks prior - finished up antibiotics up to 2 weeks prior to injection

ID: 0963175
Sex: M
Age: 29
State: NY

Vax Date: 01/12/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: On the sixth day I started noticing an inflamation on my lymph nodes that is lasting still on my 9th day after my vaccine, then on the 8th day I started having big headaches with weakness and numbness on my body, I didn't develop fever but I had nausea and tiredness that are still present today 01/21/2021

Other Meds: none

Current Illness: none

ID: 0963176
Sex: F
Age: 42
State: WA

Vax Date: 01/08/2021
Onset Date: 01/12/2021
Rec V Date: 01/21/2021
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: Dilaudid, Codeine, Morphine, Oxybutynin

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

Symptoms: I did not have an office visit, I SHOULD have went to the walk-in clinic Wednesday. I did notify my provider through our patient portal. Tuesday night my stomach was a bit itchy and my back. I didn't think anything of it. Wednesday morning I woke up with a rash on my chest, back and stomach. I came to work (not listed on the symptom checker) called health clinic; spoke with an employee; he said that is too far out after the vaccination to have had a reaction to it. He told me to watch the rash and then call my PCP if it gets worse. I know 2 other people who also got a rash; however, 1 was just at the injection site and the other 1 was down the same arm as the injection site (all not my family). I'm not sure I want to receive the 2nd vaccine. An itchy rash over my body; if associated with the vaccine, seems fairly mild/moderate. I continue to hear that patients have increased symptoms after their 2nd dose. I'm not sure, at this point, what is related to Chronic Fatigue Syndrome or if the vaccine just heightened some of my CFS symptoms (Dizziness, nausea and eye focus). I did have some increased dizziness and nausea about 20 minutes after the vaccine but they didn't bother me too much at the time. I have not changed soap, ate anything out of the ordinary or purchased any clothes or sheets or anything that would touch my skin to cause this type of reaction. That afternoon (Wednesday Jan 13th) I was itching much worse. Mostly my stomach and chest. I left work a bit early to get some Benadryl and Cortisone cream. I took the Benadryl right away and rubbed cortisone on my chest and stomach. This did not help much at all. I was very itchy and uncomfortable. I decided to shower (that was awful), went back to a store and then got Brand Name Cortisone cream (just in case). This also did not help. I was up until, at lease, 2 am trying not to scratch. I rubbed cortisone on over and over and just couldn't lay still. I was bruised on my chest and stomach from scratching and rubbing. I was going to go to the walk in clinic Thursday morning. I woke up and the rash was a little better. However, it was still itchy (not as bad as the night before) and having clothes touching my skin hurt. I did not go to the walk in clinic. I did some work from home. Thursday night the rash had traveled down onto my thighs, though my legs didn't severely itch; just my chest and stomach. I still couldn't put on clothes Friday either and my legs were sensitive to things rubbing on them but not itchy. Saturday was normal and normal life. Sunday, I woke up and was still tired. I took a nap for about an hour; then another nap a few hours later for 2 hours; and then I was falling asleep sitting up in my chair so I went to be around 8:30 pm and woke up late today (Monday Jan 18th) at about 7:45 am. I am super exhausted today. I didn't get to work until 9 and I am going to leave here shortly. I'm just not very productive and my body is lethargic. My rash is gone. I have just a couple dots on my chest.

Other Meds: Venlafaxine, Lamictal, Amitriptyline, Wellbutrin, Vitamin D, Vitamin B, Prilosec, Emgality

Current Illness: None

ID: 0963177
Sex: F
Age: 27
State: PA

Vax Date: 01/12/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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: Amoxicillin Clindamycin

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

Symptoms: 10 days after vaccination a 3x3in area became red, swollen, and painful at the injection site. No swelling prior.

Other Meds: n/a

Current Illness: n/a

ID: 0963178
Sex: F
Age: 49
State: NY

Vax Date: 12/22/2020
Onset Date: 01/17/2021
Rec V Date: 01/21/2021
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: Patient started to feel dizzy, blurred vision and pounded headache from 1/17/21 to now.

Other Meds: No

Current Illness: No

ID: 0963179
Sex: F
Age: 54
State: CA

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

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

Lab Data:

Allergies: Penicillin-anaphylactic reaction when she was a teenager Motrin and Aleve- Develops rash after taking them. Other NSAIDS like Tylenol is OK.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Rash on the inner side of the arms, both left and right (size if a palm) and under the breasts. Stretch marks-like swelling in the same area. After 30 min the symptoms have disappeared.

Other Meds: Metformin 500 mg 2 tablets 2 times a day Allopurinol 300 mg QD Lozartan 100mg QD Atorvastatin 20 mg QD Amlodipine 5 mg QD Vitamine C 500 mg QD Vitamine E 1 caps QD Calcium and D3 1 tab QD Green Tea - drinks weekly

Current Illness: NO

ID: 0963180
Sex: F
Age: 22
State: IN

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

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

Lab Data:

Allergies: n/a

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

Symptoms: 1st injection - large, tender, red, swollen lump on arm lasting approximately 5 days. Pain treated with tylenol. 2nd injection - 99.5-102.0 fever, chills, sensitive skin, fatigue, headache lasting about 48 hours. Symptoms treated with tylenol and ibuprofen. Asymptomatic after 48 hour window.

Other Meds: Sprintec - birth control

Current Illness: bacterial vaginosis

ID: 0963181
Sex: F
Age: 55
State: AZ

Vax Date: 01/11/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
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: Enbrel, hydroxychloroquine, naproxen, sulfasalazine, tacrolimus, Toradol

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

Symptoms: patient tested positive for COVID-19 on 1/15/2021

Other Meds: simvastatin, citalopram, metformin, cholecalciferol, multi-vitamin, ropinirole, lisinopril, meloxicam, melatonine, diclofenac gel, estrogen, hydrocodone/APAP, pregabalin, medroxy-progesterone

Current Illness: NONE

ID: 0963182
Sex: F
Age: 41
State: MT

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

Symptoms: Body Aches and Headache

Other Meds:

Current Illness:

ID: 0963183
Sex: F
Age: 71
State: WA

Vax Date: 01/01/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
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: none

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

Symptoms: Rash on lower arm between wrist and elbow on side of injection 4 days post injection of dose 1

Other Meds: none

Current Illness: none

ID: 0963184
Sex: M
Age: 75
State: CA

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

Symptom List: Injection site pain, Pain

Symptoms: redness around the injection site redness on chest and groin area pain fatigue fever

Other Meds:

Current Illness:

ID: 0963185
Sex: F
Age: 30
State: KY

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

Symptom List: Injection site pain, Menorrhagia

Symptoms: 15 min of flushed, fever, and tingling in the extremities

Other Meds: 15 minutes of flushing, fever, light tingling in the extremities

Current Illness: unknown

ID: 0963187
Sex: F
Age: 70
State: RI

Vax Date: 01/16/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
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: Cipro = difficulty breathing Dilantin = hives (was given prophylactic after an auto accident as a teenager. I do not have a seizure disorder Contrast dye = difficulty breathing and hives

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

Symptoms: I developed a red raised rash on my legs, arms and torso with a small amount on my face.

Other Meds: 200 mg Hydroxychloroquine, B12 1000 mcg IM, every 3 weeks, Calcium 700mg and Vitamin D3 2000 IU daily, Ventolin 2 puffs, PRN

Current Illness: Asthma, arthritis, 1 functioning kidney

ID: 0963188
Sex: F
Age: 32
State: CT

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
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: Latex, shellfish, gluten, dairy

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Cough, headache, body aches, sweats, stomach ache, red at the site.

Other Meds: Zyrtec, dupixent, nadolol, nortripolyne , spiranolactone

Current Illness:

ID: 0963189
Sex: F
Age: 36
State: TN

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I had a fever, chills, headache, joint pain in my hands, rash, itching, SOB and a cough two days later. I did go to the doctor, she did an xray to check for pneumonia.

Other Meds: No

Current Illness: I had COVID 19 on November 16, 2020

ID: 0963190
Sex: F
Age: 28
State: FL

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

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

Symptoms: Patient reported skin burning and nausea/vomitting for 3 to 4 days

Other Meds: none reported

Current Illness: none reported

ID: 0963191
Sex: M
Age: 62
State: CA

Vax Date: 01/12/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: Keflex: severe rash and swelling on Arms

Symptom List: Nausea

Symptoms: Patient received Moderna COVID Vaccine on 1/12/2021. On 1/20/21 patient noticed redness, swelling, rash appearance looking and area was warm to touch around the injection site. Ice pack applied on patient before bedtime. On 1/21/21 symptoms were improved around 12 noon.

Other Meds: Multivitamins

Current Illness: N/A

ID: 0963192
Sex: F
Age: 47
State: IA

Vax Date: 12/31/2020
Onset Date: 01/17/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: Penicillins

Symptom List: Injection site pain

Symptoms: I experienced an active herpes outbreak. While I cannot conclusively state the vaccine caused the outbreak I can report that I have not experienced an outbreak in approximately 20 years.

Other Meds: Levothyroxine 25 mcg tablet daily lisinopril-hydrochlorothiazide 20-12.5 mg tablet daily venlafaxine 225 mg extended release capsule daily

Current Illness: none

ID: 0963193
Sex: F
Age: 50
State: CO

Vax Date: 01/11/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: penicillin, sulfa, morphine, fentanyl, chamomile, celery, black beans, wheat.

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

Symptoms: Arm had initial swelling and pain for 3 days post injection. Then completely healed until day 8, when I woke up with a large, hot, itchy raised lump at the injection site. By day 9 it was the size of an egg and continued to be very hot, raised and itchy. Day 10 the lump is less pronounced but the diameter of the initial welt has grown to approximately 3". It is still hot and itchy but less hard feeling today.

Other Meds: Sotto Pelle hormone pellets (HRT), progesterone, spironolactone, aciphex, losartan, metformin, probiotics, Vit D3, B 12, digestive enzymes

Current Illness: none

ID: 0963194
Sex: F
Age: 67
State: NM

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/21/2021
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: codeine, ibuprofen, latex, prednisone

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

Symptoms: Pt reported left arm numbness & light-headedness. AAOx3. EMTs arrived and offered a snack and a drink. Released after brief monitoring.

Other Meds: unknown

Current Illness: unknown

ID: 0963195
Sex: F
Age: 20
State: IL

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/21/2021
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: None

Symptom List: Tremor

Symptoms: Moderate chest pain

Other Meds: Zoloft an hour prior to vaccination

Current Illness: None

ID: 0963196
Sex: F
Age: 62
State: HI

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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: No known allergies

Symptom List: Erythema, Pruritus

Symptoms: cervical lymphadenopathy, started 1 day after vaccine administration

Other Meds: Sudafed

Current Illness:

ID: 0963197
Sex: F
Age: 37
State: MT

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

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

Symptoms: Joint Pain, Headache, Fever

Other Meds:

Current Illness:

ID: 0963198
Sex: F
Age: 67
State: NM

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/21/2021
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, ibuprofen, latex, prednisone

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

Symptoms: Pt reported left arm numbness & light-headedness. AAOx3. Rapid response arrived and offered a snack and a drink. Released after brief monitoring.

Other Meds: unknown

Current Illness: unknown

ID: 0963199
Sex: F
Age: 61
State: GA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I took the shot at 6:00P.M. at 6:10P.M. I started feeling a pain running from the shot site down to the bend in my arm, then it radiated down my lower arm to my wrist. I kept feeling it and at 6:15P.M. I started feeling lightheaded and had the sensation I was going to faint. I notified the attendant and she and some other nurses came to my assistance and lowered me to the floor and raised my legs above my head. They took my blood pressure and it was low as was my pulse, but my oxygen was 100%. i kept deep breathing as per their request. After a little bit i started to come to my senses and they gave me water. I was difficult to swallow, my throat felt unusual. After about five minutes my swallowing got back to normal. The pain was still radiating from the shot site to my wrist. I stayed there till 6:50P.M. I felt better but on my way home the pain was still going down my arm. About 8:00P.M. my left upper hand stated to hurt, then my thumb, index and middle fingers stated tingling. That happened on and off through the evening. At 12:00A.M i went to bed. On and off through the night I still had the pain and tingling in my arm and hand. About 3:00A.M. I woke up and my arm and ring finger and little finger were numb like they fell asleep. I raised my arm and the feeling slowly went away. Throughout the day an 01/21/21 my arm was very sore by the injection site. Other than that nothing else has since occurred.

Other Meds: Lisinipril

Current Illness: None

ID: 0963200
Sex: F
Age: 73
State: VA

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
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: systane eye drops

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

Symptoms: minor itching starting day following inoculation. The last couple of days, the itching has increasing noticeably.. There is a red circle of about three quarters of an inch diameter around the place of inoculation.

Other Meds: Amlodipine Besylate 5MG Levothyroxine 75MCG Vitamin B12 Vitamin D Calcium Fish oil

Current Illness: no

ID: 0963201
Sex: M
Age: 78
State: SC

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

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

Symptoms: vomiting - no medication given, watched for 30 minutes and sent home

Other Meds: Triamcinolone topical, betamethasone topical, ketoconazole topical, folic acid 1gm, Breo Elipta 100mcg-25mcg, albuterol 90mcg, doxazosin, amiodarone 200mg, metoprolol 25mg, atorvastatin 40mg, omeprazole 40mg, furosemide 40mg, apixaban 5mg,

Current Illness: none

ID: 0963202
Sex: F
Age: 55
State: AZ

Vax Date: 01/11/2021
Onset Date: 01/15/2021
Rec V Date: 01/21/2021
Hospital:

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

Lab Data:

Allergies: Enbrel, hydroxychloroquine, naproxen, sulfasalazine, tacrolimus, toradol

Symptom List: Pain in extremity

Symptoms: tested positive for COVID-19 on 1/15/2021 after receiving her first COVID-19 vaccine on 1/11/2021; having mild symptoms

Other Meds: simvastatin, citalopram, metformin, cholecalciferol, multivitamin, ropinirole, lisinopril, meloxicam, melatonine, diclofenac gel, estrogen, hydrocodone/APAP, pregabalin, medroxyprogesterone

Current Illness: NONE

ID: 0963203
Sex: M
Age: 72
State: KY

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

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

Lab Data:

Allergies: None

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

Symptoms: Moderna COVID-19 Vaccine EUA Diarrhea, +2F fever, chills, headache, open ear canal, queezy stomach, tired started about 24 hours after vaccination Subsiding 48 hours after except still quite tired, loose stool.

Other Meds: 10 mg lisinopril 10 mg atorvastatin 81 mg aspirin

Current Illness: None

ID: 0963204
Sex: F
Age: 33
State: AR

Vax Date: 01/13/2021
Onset Date: 01/13/2021
Rec V Date: 01/21/2021
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: NAUSEA AND VOMITING

Other Meds:

Current Illness:

ID: 0963205
Sex: M
Age: 92
State: KS

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/21/2021
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: Patient tested positive for COVID on 01/06/2021. Patient received out patient monoclonal antibody treatment on 01/10/2021. Patient received out patient IV fluid bolus (NS 1 liter) on 01/13/2021.

Other Meds:

Current Illness:

ID: 0963206
Sex: F
Age: 58
State: FL

Vax Date: 01/13/2021
Onset Date: 01/18/2021
Rec V Date: 01/21/2021
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: N/A

Symptom List: Vomiting

Symptoms: I have PMR and after using the muscel I got the shot in it would pulse with pain. This happened 2x on Mon 18th and Tues 19th.

Other Meds: Pantoprazole 40mg Spironolactone 25mg Cyclobenzapr 10mg Valacyclovir 1gm Arnica Montana 6x one dose 4x daily Potassium 99mg d3 1000 iu Zinc 50mg

Current Illness: Allergies - post nasal drip

ID: 0963207
Sex: F
Age: 60
State: NY

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/21/2021
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: Corgard, IV Dye, Eggs, Keppra, Nitroglycerine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Shortness of breath and chest pain

Other Meds: Unknown

Current Illness: Unknonw. Reported no acute illness

ID: 0963208
Sex: M
Age: 24
State: MN

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

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

Lab Data:

Allergies: NKA

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

Symptoms: Joint pain Chills Fever Fast heartbeat

Other Meds: Tylenol

Current Illness: N/A

ID: 0963209
Sex: M
Age: 64
State: MS

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

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Reports malaise, achy, fatigue. Had fever with sweats. Lt arm extreme pain.

Other Meds:

Current Illness:

ID: 0963210
Sex: F
Age: 42
State: MT

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

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

Lab Data:

Allergies:

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

Symptoms: Fever Headache

Other Meds:

Current Illness:

ID: 0963211
Sex: F
Age: 33
State: PA

Vax Date: 01/13/2021
Onset Date: 01/20/2021
Rec V Date: 01/21/2021
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: Amoxicillin

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

Symptoms: Moderna COVID-19 Vaccine EUA Injection site became red, hot to the touch, tender and raised. Concerned because it has developed one week after vaccine was originally administered. These symptoms did not appear when the vaccine was first administered.

Other Meds: Daily Vitamin and Seasonique (birth control pill)

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm