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: 0965884
Sex: F
Age: 36
State: OH

Vax Date: 01/11/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Kiwi

Symptom List: Dysphagia, Epiglottitis

Symptoms: Delayed redness of the injection site with slight swelling and itching, warm to touch

Other Meds: Birth control

Current Illness: N/A

ID: 0965885
Sex: F
Age: 47
State: MO

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/22/2021
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: patient reported being ill after receiving vaccination

Other Meds:

Current Illness:

ID: 0965886
Sex: F
Age: 25
State: CA

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: nka

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

Symptoms: On 12/20/2020 I got my first dose Pfizer: only symptoms slight headache and sore arm. On 1/20/2021 I received my 2nd dose. First day, I only had a sore arm. On 1/21/2021 @800am my food was not tasting appetizing. Around 930am I started to feel nauseous, fatigue, headache. @1000am I started to feel really hot. I took my temp around 1020am and it was 100.2. I was immediately sent home from work. I continue to have the same symptoms the rest of the evening and slight body aches. @530pm I started to feel chills and felt like I was freezing. @8pm I started to feel better, only symptoms I had at that time was headache. @930pm-1200am I started to feel very hot and began to sweat. On 1/22/2021 only symptoms I currently have is a headache.

Other Meds: na

Current Illness: na

ID: 0965887
Sex: F
Age: 50
State: CA

Vax Date: 01/11/2021
Onset Date: 01/13/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Skin burning, severe joint pain, dizziness, headache, fatigue lasted for 5 days. Missed several shifts.

Other Meds:

Current Illness:

ID: 0965888
Sex: F
Age: 54
State: TX

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/22/2021
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: Around the hour of 1:42 pm, complained of lightheaded and tingling in her right arm. On assessment, oriented; no sign of respiratory distress was noted. BP 145/97, O2 sat 98%, Pulse 90. She gave a history of hypertension, taking blood pressure medication. She admitted her blood pressure reading runs high. The client was monitored closely. At 2:00, the client remains stable, BP 142/90, O2 sat 99%, Pulse 84. The client verbalized the lightheaded and tingling in her right arm has resolved. The client left the facility at 2:05 with no other complaint.

Other Meds:

Current Illness:

ID: 0965889
Sex: M
Age: 89
State: FL

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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:

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

Symptoms: Moderna COVID-19 Vaccine EUA About 8-10 hours after my wife and I first noticed that my left (vaccinated) arm was sore. Within a few hours, my left hand began to tingle and my right leg felt stiff. I experienced a loss of balance that made walking difficult. For the next 24 hours I became very fatigued. But two days after the vaccination, I have begun to regain my strength.

Other Meds: Atorvastatin

Current Illness:

ID: 0965890
Sex: F
Age: 25
State: IL

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/22/2021
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: RN administered 0.5 mL of the COVID-19 vaccine instead of 0.3 mL. No adverse reaction was reported.

Other Meds:

Current Illness:

ID: 0965891
Sex: F
Age: 35
State: CT

Vax Date: 12/29/2020
Onset Date: 01/10/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: carrots, plums, figs, honeydew, cantaloupe, stone family fruits and vegetables, environmental.

Symptom List: Pharyngeal swelling

Symptoms: I started getting what seemed like eczema on my right hip crease. Then a few days later, the left hip crease. And a week later between my breasts. the rash was and raised but about an inch or so. It is itchy and burns a little.

Other Meds: yazmine, singular, lysine 500, women's daily vitamin,

Current Illness: none

ID: 0965892
Sex: M
Age: 24
State: NV

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Dizziness lasting a few minutes. Vitals; 12:42 pm: BP= 123/75, HR= 70, O2 sats RA= 97%. Temp= 36.3 C, RR=18; 13:13 pm: BP= 135/81, HR= 63, O2 sats RA= 98%. Temp= 35.7 C, RR=18

Other Meds: Vitamin D, vitamin C, zinc

Current Illness: None

ID: 0965893
Sex: F
Age: 38
State: WA

Vax Date: 01/01/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Chills, headache, body aches , tiredness and stuff nose

Other Meds:

Current Illness:

ID: 0965894
Sex: F
Age: 27
State: KS

Vax Date: 01/14/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: patient reports left arm itching/rash/raised area at injection site. Patient reports axillary lymph nodes swollen that started at 6am this morning 1/21/2021

Other Meds: None

Current Illness: None

ID: 0965896
Sex: F
Age: 41
State: OR

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

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

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Tightening of throat, facial swelling, and ear pressure 15 minutes post injection. Treatment given-epi 3mg via epi pen. Outcome- called 911 and medics took over

Other Meds: Omeprazole, levothyroxine

Current Illness: none

ID: 0965897
Sex: M
Age: 47
State: WI

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
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

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

Symptoms: Per Client received vaccine on 1/19/2021 at 12:30 pm in left deltoid. Per Client four hours after vaccine, around 4:30 pm started to have itchiness and skin turned "beet red" on scalp, torso:chest, back, bilateral sides, bilateral arm pits and bilateral arms. Per Client also noticed red "welps" that appeared on areas already listed. Per Client started taking Bendryl 50 mg by mouth every six to eight hours and red welps would dissipate, beet red skin would resolve and itchiness would subside for several hours. Per Client is still taking the Bendryl 50 mg by mouth every six to eight hours for symptoms that are continuing to come and go. Per Client will be following up with his PCP if by this weekend r/t symptoms.

Other Meds: none

Current Illness: none

ID: 0965898
Sex: F
Age: 69
State: FL

Vax Date: 01/12/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Avelox; Tizanidine; Effexor;Prozac; Toradol; Escitalopram Oxalate

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

Symptoms: Rash with itching to both arms and on right thigh. Slight tingling on face/lower lip. injection of methylprednisolone sod. in office. Rx for prednisone 20 mg twice a day oral for 5 days. Pepcid 20mg twice daily and Benadryl 25mg at bedtime for next 3-5 days or until Rash improves.

Other Meds: Vitamin B2; Calcium with Vit D3; Magnesium; Gabapentin; Omeprazole; Tylenol; Naproxen; Linzess; Elderberry syrup with raw honey, cider vinegar and propolis

Current Illness: None

ID: 0965899
Sex: M
Age: 28
State: MD

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Arm itchy and some redness and darker red spots

Other Meds: Vitamin C and D

Current Illness: Tested positive for Rhinovirus 2 weeks prior to receiving the vaccine

ID: 0965900
Sex: M
Age: 26
State: MD

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient received a covid vaccine with a 1ml syringe. The vaccine was administered into the patients arm and as the vaccine was injected the nurse and patient noticed the vaccine to be dripping down the patients arm and leaking out around the plastic of the syringe. The pharmacy was made aware and the patients vaccine was repeated. Management and pharmacy was made aware.

Other Meds:

Current Illness:

ID: 0965901
Sex: F
Age: 32
State: NY

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/22/2021
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: undisclosed

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

Symptoms: Vaccine administration error. It is suspected the a 1/2" needle syringe was used instead of a 1" needle syringe.

Other Meds: Undisclosed

Current Illness: undisclosed

ID: 0965902
Sex: F
Age: 77
State: IN

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Moderna COVID-19 Vaccine EUA Mild rash on both fore arms very itchy just using anti itch lotion which relives the itch temporally

Other Meds: aspirin 325 vitamin D B12 Metoprol 25mg Xaretto 15 mg Losartin potassiu 100 mg

Current Illness: none

ID: 0965903
Sex: M
Age: 31
State: NC

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 3:20pm-patient c/o numbness and tingling in fingertips of left arm. Vital signs taken: 98.4-68-20-98/62. patient alert, oriented x 3. Denies SOB, dizziness or difficulty breathing. bottled water and crackers given. Requested patient wait another 10 mins to be observed. 3:30pm-vital signs: 98.4-70-20-108/60. Remains alert, oriented x3. Denies SOB, dizziness or difficulty breathing. No signs of resp. distress noted. Pt. states feels no worse nd numbness and tingling the same. Pt. states he feels fine to go home and knows to go to ER if start to feel worse. 4:30pm- Called patient. Patient states he feels fine. Numbness and tingling is better.

Other Meds: unknown

Current Illness: unknown

ID: 0965904
Sex: F
Age: 33
State:

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: localized erythema and swelling of right deltoid at injection site

Other Meds:

Current Illness:

ID: 0965905
Sex: F
Age: 59
State: NE

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: DEVELOPED HEADACHE, BODY ACHE, AND FATIGUE LASTING 24 HOURS.

Other Meds:

Current Illness:

ID: 0965906
Sex: F
Age: 50
State: CA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: Patient became nauseous, diaphoretic, dizzy and felt as if she was going to "pass out"

Other Meds: Cabergoline - 0.5 one time per week Tramadol 50 mg once per day Amitriptyhline 10mg once per day

Current Illness: No

ID: 0965908
Sex: M
Age: 25
State: TX

Vax Date: 01/07/2021
Onset Date: 01/11/2021
Rec V Date: 01/22/2021
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: Bell's Palsy (left-sided) - diagnosed on 1/14/2021. Onset of symptoms on 1/11/2021 with altered taste, earache. Progressed to left facial muscle weakness on 1/13/2021. Visited urgent care on 1/14/2021 where diagnosis was made. Received Prednisone 50mg for 5 days, Valacyclovir 1g TID for 7 days. Earache resolved. Facial weakness continued to worsen from 1/14 - 1/18 despite steroid treatment reaching minimal movement of left facial muscles, able to close left eye with difficulty. Left sided loss of taste still present. At follow-up appointment on 1/21/2021 with PCP, patient was prescribed additional steroid taper for 7 days.

Other Meds: None

Current Illness: None

ID: 0965909
Sex: F
Age: 33
State:

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: erythema and swelling at injection site

Other Meds:

Current Illness:

Date Died: 01/01/2021

ID: 0965910
Sex: F
Age: 53
State: DC

Vax Date: 01/11/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: not known

Symptom List: Injection site pain, Menorrhagia

Symptoms: The employee found dead at her home on 1/21/2021.

Other Meds: not known

Current Illness: not known

ID: 0965911
Sex: F
Age: 22
State: WI

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Cephapririn, PCN, Tamiflu, Cephalosporins

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

Symptoms: A 22 y.o. female presenting with fever, tachycardia viral symptoms in the first 12 hours after receiving second dose of Covid vaccine. Was feeling well prior to that. Has soreness at her arm as well. She has a history of POTS and did detect a rapid heart rate at home. She has mild sinus tachycardia at this time reports a gradual improvement in symptoms. Fever is improving, had not had any antipyretic prior to coming in. I have low suspicion for acute infection and would favor immune response to the vaccine itself which has been reported in multiple persons receiving same vaccine. She is not hypoxic, has clear breath sounds. No thrombocytopenia on CBC. IV was placed, IV fluids given. Heart rate improved, blood pressure remained stable. Patient feels well enough for discharge on reevaluation and declined need for analgesic or antipyretic here.

Other Meds: Loratadine and Microgestin

Current Illness: None

ID: 0965912
Sex: F
Age: 20
State: ND

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: At about 7:00 p.m. on 1/21, I began to feel chills and feverish. I checked my temperature and it was at 99.8. By the time I went to bed around 11:00 p.m. my temperature was 100.6. When I woke up on 1/22 around 6:30 a.m., my temperature was 100.3. I blacked out as I was walking to the bathroom and feel very nauseous. Whenever I stand up for more than a few minutes, I feel like I am going to black out again.

Other Meds: Zoloft

Current Illness: No

ID: 0965914
Sex: F
Age: 38
State: PA

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/22/2021
Hospital: Y

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

Lab Data:

Allergies: Ancef and morphine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Acute abdominal pain= acute appendicitis

Other Meds: N/a

Current Illness: None

ID: 0965915
Sex: F
Age: 59
State: NE

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/22/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: DEVELOPED HEADACHE, BODY ACHE, AND FATIGUE LASTING 24 HOURS.

Other Meds:

Current Illness:

ID: 0965916
Sex: F
Age: 73
State: CA

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Nausea

Symptoms: Tip of tongue burning feeling and dry throat

Other Meds: none known

Current Illness: none known

ID: 0965917
Sex: F
Age: 33
State:

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: erythema and swelling of injection site

Other Meds:

Current Illness:

ID: 0965918
Sex: F
Age: 69
State: NY

Vax Date: 01/10/2021
Onset Date: 01/12/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: new leucopenia in labs 01/12/2021 at Quest 2 days after vaccine. Currently asymptomatic

Other Meds: cabergoline, Synthroid, ASA 81, Adderal

Current Illness: none

ID: 0965919
Sex: F
Age: 48
State: IA

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/22/2021
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:

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

Symptoms: Patient was given Covid-19 vaccine. No previous reactions to vaccines, allergy to Nitro (swelling). She was being monitored and within 15 minutes her upper lip was swelling. She also had redness on her face. Oxygen levels were stable. Blood pressure monitored and was high (200s/ low 100s). Gave patient 2 tablets of Benadryl. Patient had no throat swelling or trouble breathing. She was taken to the local ER. At the ER, the patient was given steroids. She was release from the ER within a few hours. She is currently at home and is stable.

Other Meds:

Current Illness:

ID: 0965920
Sex: F
Age: 69
State: NY

Vax Date: 01/13/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: sulphonamides, quinolones, gluten sensitiviity

Symptom List: Tremor

Symptoms: hives at site of injection, appeared 8 days after injection - no treatment at this time per patient request

Other Meds: atenolol, fenofibrate, Neurontin, multivitamins, turmeric,

Current Illness: none

ID: 0965921
Sex: F
Age: 71
State: FL

Vax Date: 01/06/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: Bee stings and Glutin foods.

Symptom List: Erythema, Pruritus

Symptoms: Client immediately got a metallic burning in her mouth. Within two days she had thrush. Her physician ordered a "Miracle wash" for her thrush. It took about 2 weeks for that to disappear. On 01/21/2021 she woke up with a horrible burning on her tongue. She also developed a huge egg shaped rash at the injection site on 01/19/2021.

Other Meds: Thyroxin .88 mcg Asthma Inhaler

Current Illness: None.

Date Died: 01/22/2021

ID: 0965922
Sex: M
Age: 75
State: MD

Vax Date: 01/19/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
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: pt answered no

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

Symptoms: We were alerted that the patient died at home.

Other Meds: unknown

Current Illness: pt denied

ID: 0965923
Sex: F
Age: 25
State: IL

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 01/22/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: RN administered 0.5 mL of the COVID-19 vaccine instead of 0.3mL. No adverse reactions were reported.

Other Meds:

Current Illness:

ID: 0965924
Sex: F
Age: 33
State: PA

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/22/2021
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: Nuts, strawberries, soy

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Approximately 20 minutes after I received the Moderna vaccine, my body began to heat up and my tongue swelled and got heavy, I started to feel dizzy. This lasted for approximately 3 minutes.

Other Meds: Birth control, multivitamins, Zyrtec, Tradjenta

Current Illness: Diabetes

ID: 0965925
Sex: F
Age: 43
State: TX

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/22/2021
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: None

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

Symptoms: crushing feeling all over, left neck/shoulder stiff-PT taking Tylenol around the clock but does not touch neck/shoulder discomfort.

Other Meds: None

Current Illness: None

ID: 0965926
Sex: F
Age: 42
State: MN

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/22/2021
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: Decadron

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

Symptoms: nausea, rash, joint pain, muscle aches

Other Meds: Bromocryptine, Allegra, Aspirin, Tylenol

Current Illness: none

ID: 0965927
Sex: F
Age: 72
State: KY

Vax Date: 01/13/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Turned red after 6 days and burning

Other Meds: Lisinopril

Current Illness: None

ID: 0965928
Sex: F
Age: 79
State: NC

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: Sulphate drugs

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

Symptoms: Within 5 minutes of receiving the vaccine, my heart started racing, my blood pressure shot up to 190 over ? (Usually my BP is low normal), my face was very flushed.

Other Meds: No prescriptions, no medications. Liquid magnesium and liquid mineral solution daily

Current Illness: None

ID: 0965930
Sex: M
Age: 58
State: IN

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Headache and temperature nausea

Other Meds: Metoprolol 8mg aspirin

Current Illness: None

ID: 0965931
Sex: F
Age: 62
State: WI

Vax Date: 10/16/2020
Onset Date: 10/16/2020
Rec V Date: 01/22/2021
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: None

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

Symptoms: On 01/21/21, patient was in a booth next to the donor I was speaking to, and she stated that she got really sick that night after receiving the shot earlier in the day. She went to work and was extremely dizzy that night, and she stated that the next day she felt even more dizzy, shaky, nauseated, and ended up throwing up a small amount that she stated was mostly acid. The next day, she stated she felt back to normal.

Other Meds: None

Current Illness: None

ID: 0965932
Sex: M
Age: 59
State: NV

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/22/2021
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: sulfa

Symptom List: Vomiting

Symptoms: Dizziness. Vitals: 12:42 pm: BP= 123/75, HR= 70, O2 sats RA= 97%. Temp= 36.3 C, RR=18; 13:13 pm: BP= 135/81, HR= 63, O2 sats RA= 98%. Temp= 35.7 C, RR=18

Other Meds: Vitamin D, vitamin C, zinc

Current Illness: None

ID: 0965933
Sex: F
Age: 26
State: CA

Vax Date: 01/14/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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: Tree nut allergy

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Injection site has turned into red hive-like bump, approximately 1.5-2 in. in diameter, and is incredibly itchy. There has been minor itchiness since time of injection (1/14/21, 2:30 pm), nothing major. Starting 1/21/21 approximatelt 5:30-6:00 pm, noticed the injection site is now large red bump and has remained there and itchy.

Other Meds: None

Current Illness: None

ID: 0965934
Sex: F
Age: 75
State: AL

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/22/2021
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: epinephrine,aspirin

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

Symptoms: After the shot, I went home and felt fine. I did some housework (cleaning) for about thirty minutes, then sat to rest . Shortly thereafter, I began feeling pain in my left arm. The pain became more severe as the day progressed until it was very severe and movement of my arm was limited. The pain progressed throughout the night and also moved into my shoulder. I got very little sleep even after taking Tylenol and trying heat and ice applications. Now, on the third day I am still having pain and am unable to lift my arm or move it outward without severe pain. I am definitely hindered in my movement and use of left arm. This is disturbing as I am an artist and need both arms to do my work.

Other Meds: cetirizine 10mg,xarelto 20mg,losartan potassium 50mg (171/2),famotidine 20mg,metroprolol succinate 50mg,esomeprazole 40mg, oxybutynin chloride 5mg,simvastatin 20mg,, singulair 10 mg,synthroid 100 mcg,amlodipine rmg, multivitamin, vitamins c

Current Illness: none

ID: 0965935
Sex: F
Age: 35
State: PA

Vax Date: 01/07/2021
Onset Date: 01/17/2021
Rec V Date: 01/22/2021
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: Penicillin, Sulfa.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: During the day on 01/17/21 noticed slight itching at injection site. Later on in the day, approximately 5pm, noticed small red patch at injection site with raised bumps, very itchy. Took photographs to document and emailed chief medical officer. In the morning on 01/18/21 red patch continued to itch and became more circular in shape. Completed telehealth session and physician stated it may be a delayed immune response to the vaccine. Prescribed hydrocortisone cream and antibiotic and stated I should also take antihistamine. Same day relayed this to the CMO and immediate supervisor. As of today, 01/19/21 after taking Zyrtec & applying cream, no change in size, itching subdued.

Other Meds: Not disclosing via form.

Current Illness: None.

ID: 0965936
Sex: F
Age: 43
State: AK

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/22/2021
Hospital:

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

Lab Data:

Allergies: Sensitivities

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

Symptoms: Lightheaded, pale, rapid pulse, chest pain, anxiety, clammy.

Other Meds: Unknown

Current Illness: Unknown

ID: 0965937
Sex: F
Age: 46
State: MS

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/22/2021
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:

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

Symptoms: Body aches, joint pain, low grade fever, fatigue

Other Meds: Celexa, scopolamine

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm