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: 0964030
Sex: F
Age: 51
State: CA

Vax Date: 01/17/2021
Onset Date: 01/17/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Hive-like rash and redness on chest, swelling of the face, papule rash on chin, mid-cheek and forehead , and mild shortness of breath

Other Meds: Spironolactone 25Mg Tablet, 1 daily (HTN) Metoprolol Er Succinate 50Mg Tablet, 1 daily (HTN)

Current Illness: None

ID: 0964031
Sex: F
Age: 19
State: AZ

Vax Date: 01/11/2021
Onset Date: 01/01/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Swollen Lymph Nodes, Pain

Other Meds:

Current Illness:

ID: 0964032
Sex: M
Age: 83
State: NJ

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

Lab Data:

Allergies:

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

Symptoms: Chills; vitals, rest, monitor x 30 min, po hydration with improvement / symptoms subside/ stable released home

Other Meds:

Current Illness:

ID: 0964033
Sex: M
Age: 38
State: IN

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Muscle and joint pain (mild), tiredness one day following injection. Occasional dizzy spells two days after injection day. Alternating acetaminophen and ibuprofen. Fluids and rest. Unresolved as of 11:23 pm 01/21/2021

Other Meds: Paxil, Claritin is

Current Illness: None

ID: 0964034
Sex: F
Age: 42
State: AZ

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:

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

Symptoms: Itchy skin, rash on face, neck, upper chest, and upper back.

Other Meds: Lamictal

Current Illness:

ID: 0964035
Sex: F
Age: 23
State: GA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
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: None

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA Injection site pain and sore arm occurred within 1 hour after injection but was mild. Sore arm lasted roughly 24 hours and resolved on its own without intervention.

Other Meds: None

Current Illness: None

ID: 0964036
Sex: F
Age: 65
State: GA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bad Skin Reaction to adhesive in medical tape, EKG electrode pads, Medical topical pads such as Estraderm. Same reaction to Gel used during Lithotripsy. Calves and Feet swollen after 2nd injection of Ketorolac within 24 hours following Lithotripsy while also suffering from Shingles at same time. Had previously received Ketorolac uneventfully for kidney stone treatment.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: After leaving drive-up site 15 minutes after injection I removed face mask as was feeling hot and prickly. Looked in mirror and my Face was red/flushed and hot (not my forehead, but entire cheek and chin area). Did not spread to other areas, no breathing problems. Reaction may have actually started immediately after injection but since had to wear facemask I was unable to see my face. It took between 60 and 90 minutes for my face to return to normal color and temperature.

Other Meds: Lipitor 10mg -- every evening Ibuprofen 400mg, Valium 2mg -- Both as needed, usually every day Liquid Allegra -- as needed for allergies

Current Illness: SVT -- chronic Atherosclerosis -- chronic Dysphagia due to a neuro muscular condition -- chronic Cervicalgia and TMJ related to neuro muscular condition -- chronic

ID: 0964037
Sex: F
Age: 19
State: CA

Vax Date: 01/13/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: 3inx1.5in red rash at vaccine site, not itchy or uncomfortable at the moment.

Other Meds: None

Current Illness: None

ID: 0964038
Sex: M
Age: 74
State: NJ

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Feeling lightheaded; vitals obtained/ stable, rest, po hydration, monitor x 30 minutes symptoms subside/ feels better released w/ daughter to home

Other Meds:

Current Illness:

ID: 0964039
Sex: F
Age: 31
State: CA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Tetracycline

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Large red itchy rash on injection site exactly one week after the injection. Also slightly swollen lymph node and dull pain in axilla. Rash seems to be getting worse.

Other Meds: Estarylla birth control

Current Illness:

ID: 0964040
Sex: F
Age: 45
State: CA

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

Lab Data:

Allergies: penicllin, sulfa and keflex

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

Symptoms: eight days after the vaccine, i noticed small bumps near the injection site. within a few hours hives developed. overnight this turned into a large red patch that is swollen and hot to the touch. It is growing in size and is now about 4 inches long and two inches wide

Other Meds: lo lo estrin, vitamin d3

Current Illness:

ID: 0964041
Sex: M
Age: 40
State:

Vax Date: 12/31/2020
Onset Date: 01/04/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Developed fever on the 3rd day after injection but only lasted over night then on the 5th day there was a lose of sense of smell and taste that lasted for 3 days. Two covid test results were negative

Other Meds:

Current Illness:

ID: 0964042
Sex: F
Age: 65
State: NY

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

Lab Data:

Allergies: Fake eyelash glue

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

Symptoms: Red and Itchy at the injection site (arm). Started day after vaccine. Still is itching 2 days later.

Other Meds: None

Current Illness: None

ID: 0964043
Sex: F
Age: 37
State: MI

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

Lab Data:

Allergies: Allergic to sulfa antibiotics and fenugreek

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

Symptoms: My cheeks and upper lip became swollen hours after having the vaccine. I had no other signs of an allergic reaction. In the past, I have had similar, but more severe, facial swelling that from antibiotics containing sulfonamide and fenugreek tea that also did not progress past facial swelling. I took Benadryl (two capsules). The swelling did not progress. They did have me wait 30 minutes after receiving the vaccine due to my history of allergic reactions to other things and nothing occurred during that time frame. My cheeks and lip are still very slightly swollen and I plan to take a second dose of Benadryl to make sure it completely dissipates.

Other Meds: Zoloft and Zyrtec

Current Illness: None

ID: 0964044
Sex: M
Age: 20
State: NJ

Vax Date: 01/15/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: Reports: NKDA

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

Symptoms: Feeling lightheaded and anxious; vitals obtained/ stable, po hydration, rest, monitor x 30 minutes symptoms improve/ feels better released from facility w/parent (mom)

Other Meds: Reports: Prozac 20mg qpm

Current Illness:

ID: 0964045
Sex: F
Age: 39
State: IL

Vax Date: 01/13/2021
Onset Date: 01/21/2021
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: Penicillins - hives, nausea, vomiting Sulfa antibiotics - hives

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

Symptoms: When I received my first dose of the Moderna vaccine 8 days ago, I had pain at my injection site and my arm hurt for a day or so. The pain then was more than what I would feel from a regular flu shot, as it was harder to move my arm, but eventually went away. Last night, I noticed my arm starting to hurt again. This morning, again 8 days since my first dose of the vaccine, the pain near my injection site was more noticeable, the area around it was feeling hard like a lump, and it was red. Throughout the day and tonight the pain has increased, there is more swelling and redness around the injection site, the lump is more noticeable, and I feel itchiness. My main concern is that this is happening over a week later after having a period of no symptoms and seemed to be getting worse throughout the day today.

Other Meds: None

Current Illness: None

ID: 0964046
Sex: F
Age: 54
State: NY

Vax Date: 01/20/2021
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: none

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

Symptoms: mild hive like rash started approx a few hours and increased over the next 24 hours with hives on arms ,chest itchy,red bumps

Other Meds: lisinopril amlodipine metformin

Current Illness: none

ID: 0964047
Sex: F
Age: 30
State: NJ

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

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Feeling anxious with elevated heart rate; vitals obtained/ stable, rest, po hydration, monitor x 30 minutes symptoms improve/ subside, "feels better" released from facility to home

Other Meds:

Current Illness:

ID: 0964048
Sex: F
Age: 33
State: CA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
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 bee venom shellfish soy walnuts lavender

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: At 15 min lips began to double in size, by 30 min unable to swallow, medical personal quickly reacted and gave me a shot of steroids and shot of antihistamine. Stabilized and left. Within 24 hours severe vomiting, by 1/16 hives on face, sensitivity to light, migraine, more vomiting. Spoke with dr got prednisone, continued vomiting, 1/19 spoke to PCP Got higher dose of steroids for hives and 8 mg zofran. 1/20-1/22 developed butterfly rash on face similar to lupus. Prescribed more steroids and Ativan to sleep. Follow up scheduled for two weeks

Other Meds: Benadryl welbutrin

Current Illness: None

ID: 0964049
Sex: F
Age: 30
State: CA

Vax Date: 01/11/2021
Onset Date: 01/13/2021
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: Sulfa medications

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

Symptoms: Two days after receiving my 2nd dose, I began noticing a rash on my stomach that initially appeared like hives. The rash then turned into small red bumps all over my back and stomach the next day. It is one week later and the rash is still extensive (now on armpits, neck and mild on legs). It itches slightly but not bad. I have tried hydrocortisone cream and Benadryl without much benefit.

Other Meds: None

Current Illness: None

ID: 0964050
Sex: F
Age: 33
State: OR

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: Asparin

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

Symptoms: Got to touch, red circle. Went away after 3 days, came back bigger and started itching. Went away again for like 2 days and came back 3rd time with bigger circle. Close what news had in on news. I am healthcare professional.

Other Meds: Levothyroxine and Nadolol

Current Illness: .

ID: 0964051
Sex: F
Age: 69
State: TN

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

Lab Data:

Allergies: Penicillin, Lactose

Symptom List: Unevaluable event

Symptoms: Took Advil going to sleep, woke up at 4:30am, real dizzy: unsteady walking to & from bathroom, walked into the wall. Dizziness was bad all morning & continued on & off all day. 1/20/21 - woke up dizzy again, but not as bad. Remained light headed all day. 1/21/21? lightheaded not as continuous. Finally feel fine in pm.

Other Meds: Atorvastatin, Pantoprazole, Levothyroxine, Citalopram, Vit. D, Aspirin325mg, CoQ 10, Calcium Citrate, Multi Vit, Triple Str Fish Oil, Vit E, Biotin, Probiotic, Iron, Ibuprofen

Current Illness: None

ID: 0964052
Sex: F
Age: 54
State: NJ

Vax Date: 01/18/2021
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:

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

Symptoms: Presents flushed, reports "heart racing"; vitals obtained/ stable, po hydration, rest, monitor x 30 minutes symptoms subside/ status improves/ reports "feels better" released from facility to home

Other Meds:

Current Illness:

ID: 0964053
Sex: F
Age: 31
State: CA

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: dust, mold, grasses and unknown allergies that have caused hives. High histamine levels

Symptom List: Injection site pain, Pain

Symptoms: Immediate headache during the 15 minute wait times and took Tylenol immediately. When I took off the bandaid 2 hours later the injection site was red, swollen and itchy. The later the day went the injection site reaction got worse and was the size of a golf ball. I took Advil and Tylenol every 4 to 6 hours alternating and iced the injection site. I was also fatigued the day after the injection. Swelling, redness, itching continued for a week after

Other Meds: Allegra, Pepcid

Current Illness: Dry cough that started in mid-November tested negative for covid

ID: 0964669
Sex: F
Age: 76
State: NY

Vax Date: 01/11/2021
Onset Date: 01/12/2021
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: Aspirin Evista

Symptom List: Injection site pain, Menorrhagia

Symptoms: Diarrhea 2-3 x daily > 7 days (+) Hx cholecystectomy (-) Risk or hospitalization (-) Abdominal pain Plan: Complete labs to assess for electrolyte abnormality ? CBC Brat Diet 12-14-2020 Covid positive

Other Meds: Celecoxib, Lansoprazol er 15mg, Collagen, Tumeric, Ginko Gabapentin 300mg, cyclobenzaprine, Probiotic

Current Illness: Covid positive 12 -14-2020

ID: 0964681
Sex: M
Age: 1
State: CA

Vax Date: 01/21/2021
Onset Date:
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: NKA

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

Symptoms: patient was given one additional dose of varicella. Proquad was given instead of MMR. No reaction @ the time of visit

Other Meds: N/A

Current Illness: 0

ID: 0964694
Sex: M
Age: 0
State: MD

Vax Date: 01/04/2021
Onset Date: 01/04/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Diarrhea and low grade fever - Patient was seen in the office on 1/16/21. Provider stated that since the diarrhea had become less frequent nothing needed done at the time and noted that if the diarrhea became more frequent or worse a culture would be ordered.

Other Meds: Vitamin D3

Current Illness: GERD - 12/8/2020

ID: 0964702
Sex: F
Age: 64
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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Baclofen Ibuprofen

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Approx. 10-12 post immunization, pt. reports dizziness and nausea. She refused to lay down, remained in wheelchair. She asked for cola, it helped settle stomach. As dizziness subsided she had HA. We observed her for an additional 30 min. until dizziness gone. She still had some nausea & HA. Hx: migraines. (She often feels dizzy/nausea prior to migraines)

Other Meds: not known

Current Illness:

ID: 0964720
Sex: F
Age: 35
State: IA

Vax Date: 01/18/2021
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: RA

Lab Data:

Allergies: Penicillin

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

Symptoms: Started with immediate facial flushing, progressed to light-headed, headache, severe fatigue. Following day had brain fog, dizziness, nausea, slight blurred vision, headache, severe fatigue, body aches. Symptoms mostly resolved after 48 hours post vaccine.

Other Meds: Escitalopram

Current Illness:

ID: 0964732
Sex: M
Age: 1
State: CA

Vax Date: 01/21/2021
Onset Date:
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: NKA

Symptom List: Nausea

Symptoms: patient was given one additional dose of varicella. Proquad was given instead of MMR. No reaction @ the time of visit

Other Meds: N/A

Current Illness: 0

ID: 0964772
Sex: F
Age: 36
State: OR

Vax Date: 12/28/2020
Onset Date: 12/28/2020
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: NKDA

Symptom List: Injection site pain

Symptoms: Vomitting *this vaccine was administered @ another facility

Other Meds:

Current Illness:

ID: 0964782
Sex: F
Age: 29
State: OR

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

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

Symptoms: Hives, fever, feeling faint hot flashes, nausea fatigue clammy

Other Meds:

Current Illness:

ID: 0964792
Sex: F
Age: 34
State: OR

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: NKDA

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

Symptoms: Sore throat

Other Meds:

Current Illness:

ID: 0964801
Sex: F
Age: 23
State: OR

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

Symptom List: Tremor

Symptoms: headache stomach pain blurry vision

Other Meds:

Current Illness:

ID: 0964809
Sex: F
Age: 34
State: OR

Vax Date: 01/05/2021
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: NKDA

Symptom List: Erythema, Pruritus

Symptoms: red, hot, painful lump @ injection site

Other Meds:

Current Illness:

ID: 0964829
Sex: F
Age: 35
State: OR

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

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

Symptoms: itchy, upper arms & back & chest, no visiable rash, hives resolved same day took Zyrtec.

Other Meds:

Current Illness:

ID: 0964844
Sex: F
Age: 41
State: OR

Vax Date: 01/05/2021
Onset Date: 01/08/2021
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: NKDA

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

Symptoms: Achy & fever

Other Meds:

Current Illness:

ID: 0964864
Sex: F
Age: 29
State: OR

Vax Date: 01/05/2021
Onset Date: 01/07/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Nausea & vomiting

Other Meds:

Current Illness:

ID: 0964875
Sex: F
Age: 53
State: OR

Vax Date: 01/05/2021
Onset Date: 01/06/2021
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: troran, demerol

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

Symptoms: red, hot, painful lump at injection site, skin rash

Other Meds:

Current Illness:

ID: 0964885
Sex: F
Age: 26
State: OR

Vax Date: 01/05/2021
Onset Date: 01/12/2021
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: Minocycline

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

Symptoms: Few hives on arm next to injection site. Red lump, painful swollen lymph node

Other Meds:

Current Illness:

ID: 0964893
Sex: F
Age: 47
State: OR

Vax Date: 01/08/2021
Onset Date: 01/09/2021
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: NKDA

Symptom List: Pain in extremity

Symptoms: Mild headache, arm pain @ injection site

Other Meds:

Current Illness:

ID: 0964894
Sex: F
Age: 38
State: OR

Vax Date: 01/12/2021
Onset Date: 01/12/2021
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: NKDA

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

Symptoms: Stomach ache 12 hours after COVID vaccine

Other Meds:

Current Illness:

ID: 0965022
Sex: M
Age: 51
State: IL

Vax Date: 01/15/2021
Onset Date: 01/15/2021
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: morphine

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

Symptoms: rash developed on both forearms. Rosacia in face normal. no itching, no respiratory issues. Patient examined on upper body - no other rash found. Administered 25mg Benadryl, 40mg Pepcid AC - after 1 hr, rash gone. 51y/o male who stated he had a rash on Back and shortly after vaccination. No resp difficulties. No other complaints. No prior tx of allergic Rx Exam - 5% redness on post aspect of forearms No resp findings Plan- offered ED/urgent prefers to go home with observation Assessment - Mild Allergic Rxn-

Other Meds: several: diabetes, asthma meds.

Current Illness: n/a

ID: 0965034
Sex: M
Age: 44
State: NY

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

Lab Data:

Allergies: No

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

Symptoms: as soon as vaccine was administered at 1715 Pt reported dizziness, palpitations and a sudden rush of heat w/shortness of breath. V/S checked BP 144/96 P86 T97.8 SPO2 99% room air. Electrolytes given for rehydration. Pt observed for additional 30 minutes. V/S rechecked at 1810 BP 138/82 P85 RR18 T97.8 SPO2-100% Pt reported feeling better. Discharged at 1815 Pt advised to report to ER if symptoms reoccur or worsen.

Other Meds: No

Current Illness: No

ID: 0965048
Sex: M
Age: 80
State: FL

Vax Date: 11/19/2020
Onset Date: 11/19/2020
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:

Symptom List: Vomiting

Symptoms: Pt report still having "Knot" at injection site and "tingling" feeling when sleeping on that arm. Reports as discomfort. Pt has not contacted medical professional for treatment. 1/21/21 * Primary Dr will call pt to come in for visit (per employee)

Other Meds:

Current Illness:

ID: 0965266
Sex: M
Age: 66
State: CA

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

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Pt walked in clinic complaining of blistering of the skin on LEFT ANTERIOR UPPER ARM and inflammation of the skin, very warm to touch. Patient got the vaccines (Tdap on right side and PCV-13 on left side) on Saturday 1/16/2021 around 9am at clinic. On Sunday night, he noticed mild itching and pain On Monday, more itchy, feeling warm along side with the symptoms mentioned above On Tuesday, burning sensation along side with the symptoms mentioned above On Wednesday, developing blister along side with the symptoms mentioned above and no fever.

Other Meds: amlodipine 10mg qd; atorvastatin 20mg qd; aspirin 81mg qd; losartan 50mg qd

Current Illness: N/A

ID: 0965283
Sex: M
Age: 11
State: FL

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

Lab Data:

Allergies:

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

Symptoms: PATIENT HAD A SYNCOPE W VASO VAGAL REACTION IMMEDIATELY AFTER ADMINISTRATION OF MENACTRA AND HPV FELL to the Floor with Secondary scalp LaceRtioN. VitAl sign/ stablE Transported to EmErgENcy Room VIA Wheelchai

Other Meds: NONE

Current Illness:

ID: 0965353
Sex: F
Age: 32
State: OR

Vax Date: 01/08/2021
Onset Date: 01/08/2021
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: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vasovagel response to COVID vaccine

Other Meds:

Current Illness:

ID: 0965355
Sex: F
Age: 41
State: OR

Vax Date: 01/12/2021
Onset Date: 01/13/2021
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: NKDA

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

Symptoms: Injection site red, hot, swollen

Other Meds:

Current Illness:

ID: 0965356
Sex: F
Age: 45
State: OR

Vax Date: 01/05/2021
Onset Date: 01/13/2021
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: NKDA

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

Symptoms: Small warm itchy bump @ injection site

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm