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| VAERS_ID | RECVDATE | STATE | AGE_YRS | CAGE_YR | CAGE_MO | SEX | RPT_DATE | SYMPTOM_TEXT | DIED | DATEDIED | L_THREAT | ER_VISIT | HOSPITAL | HOSPDAYS | X_STAY | DISABLE | RECOVD | VAX_DATE | ONSET_DATE | NUMDAYS | LAB_DATA | V_ADMINBY | V_FUNDBY | OTHER_MEDS | CUR_ILL | HISTORY | PRIOR_VAX | SPLTTYPE | FORM_VERS | TODAYS_DATE | BIRTH_DEFECT | OFC_VISIT | ER_ED_VISIT | ALLERGIES | Link 1 | Link 2 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0923510 | 01/06/2021 | TN | 85.0 | 85 | M | PATIENT SPOUSE REPORTS THAT PATIENT RECEIVED VACCINE ON 1/4/2021 AND ON 1/5/2021 PATIENT'S ARM BEGAN TO TURN RED AND SWELL AT THE INJECTION SITE. THE SWELLING AND REDNESS BEGAN TO GO DOWN HIS ARM AND HE BROKE OUT INTO A RASH. PATIENT THEN BECAME SHORT OF B | Y | 1 | Y | 01/04/2021 | 01/05/2021 | 1 | UNKNOWN | PUB | UNKNOWN | UNKNOWN | UNKNOWN | 2 | 01/06/2021 | Y | PCN | 2021VAERSSYMPTOMS | 2021VAERSVAX | 0943698 | 01/14/2021 | TN | 85.0 | 85 | F | She awakened in the middle of the night feeling much pain in arm where injection was. Felt like she would throw up but couldn't move from the bed. Felt like her face was drawn and tight. This morning, she has been very shaky, sounds like some congestion in | N | 01/13/2021 | 01/14/2021 | 1 | SEN | Donepezil, Bayer, Lisinopril, Vitamin D3/K2 | None | None | 2 | 01/14/2021 | None | 2021VAERSSYMPTOMS | 2021VAERSVAX | 0953373 | 01/18/2021 | TN | 85.0 | 85 | F | red, swollen area at injection site | 01/12/2021 | 01/13/2021 | 1 | SEN | 2 | 01/18/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 0991708 | 02/01/2021 | TN | 85.0 | 85 | F | itching, skin was hot and red with welts on both arms would come and go throughout the day lasting 3 days. Went to see PCP recommended antihistamine for treatment. | Y | 01/13/2021 | 01/22/2021 | 9 | n/a | PUB | Amlodipine, Vitamin D3, Vitamin B12, Metoprolol, Rosuvastatin | n/a | hypertension, high cholesterol, chronic kidney disease, unruptured brain aneurysm, fatty liver | 2 | 02/01/2021 | Y | n/a | 2021VAERSSYMPTOMS | 2021VAERSVAX | 0995764 | 02/02/2021 | TN | 85.0 | 85 | F | PATIENT'S SON CALLS TO REPORT THAT HIS MOTHER IS COMPLAINING OF SEVERE SORENESS AND REDNESS/WARMTH AT INJECTION SITE. | N | 02/01/2021 | 02/02/2021 | 1 | N/A | PUB | UNKNOWN | N/A | N/A | 2 | 02/02/2021 | NO KNOWN ALLERGIES | 2021VAERSSYMPTOMS | 2021VAERSVAX | 0997297 | 02/03/2021 | TN | 85.0 | 85 | M | Death on 1/17/21. Death certificate reports: Septic Shock, UTI, Pneumonia, Chronic Renal Failure | Y | 01/17/2021 | N | 01/04/2021 | 01/17/2021 | 13 | PUB | 2 | 02/03/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1017320 | 02/09/2021 | TN | 85.0 | 85 | F | I have had no adverse effects from the Moderna Covid Vaccine. The reason I am using this form of reporting is that I have not been able to use the every day or every week online text reporting system since the link sent to me by text does not work.. I ha | Y | 01/20/2021 | 01/22/2021 | 2 | PUB | recuperating from open heart surgery in July and heart surgery in October 2020 | high blood pressure; back pain | 2 | 02/09/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1031612 | 02/15/2021 | TN | 85.0 | 85 | F | 2nd vaccine ?2nd day Blood pressure dropped to 88/55 Fainted Hit head. Couldn?t get up Bruised, sore Early evening 2 days later Raynauds developed on finger on left hand | Y | 02/01/2021 | 02/10/2021 | 9 | None | PUB | Chlothalidone Eliquis Sertraline Levothyroxine Vitamin D Centrum silver vitamin Potassium Rosuvastatin | Low thyroid High blood pressure | 2 | 02/15/2021 | Augmentin | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1041798 | 02/19/2021 | TN | 85.0 | 85 | F | Two days after I got the shot, I felt severe "brain fog" (disoriented) all day. The third and fourth days after the shot, I felt severe dizziness at all times. (I had seasonal allergies at the time - sneezing and runny nose, and my doctor thinks this af | Y | 02/14/2021 | 02/16/2021 | 2 | None | PVT | Prednisone, Metoprolo, Prevastatin, Calcium, Fish Oil, Multi-Vitamin, Turmeric, Tylenol for Arthritis | Arthritis, hypertension | Artritis | 2 | 02/19/2021 | Penecillin, Voltarin, Zyban, Naprosen | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1091094 | 03/11/2021 | TN | 85.0 | 85 | F | Pt stated that she received the vaccine on 02/03/2021 and started having a fever, headache, chest pain and heaviness in her left arm on 02/06/2021. She stated that she felt better by 02/09/2021. Pt was seen in the office on 02/09/2021 and she was feeling m | Y | 02/03/2021 | 02/06/2021 | 3 | NONE | PVT | carvedilol cetirizine Fish Oil Flovent HFA ipratropium-albuterol levothyroxine liothyronine loratadine losartan simvastatin Spiriva Respimat tamoxifen | none | abnormal thyroid hormone acquired deformity of hand acquired deformity of pelvis allergic rhinitis allergy to fish aortic stenosis, non-rheumatic benign essential hypertension bunion carotid atherosclerosis carpal tunnel syndrome (bilateral) cervical syndr | pt states three to four days after vaccine her left arm turn red and was hot to the touch that lasted about 4 days | 2 | 03/11/2021 | erythromycin base Penicillins Shellfish Containing Products | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1123980 | 03/22/2021 | TN | 85.0 | 85 | M | 1/2/2021 vaccination couple days later, developed swollen lymph nodes. No other symptoms. Lasted a couple days. *PCM to monitor | U | 01/02/2021 | 01/01/2021 | ultra sound | PUB | allopurinol, Lipitor, levothyroxine, Tamsulosin, niacin, citalopram, testosterone injection, b12 injection, aspirin, Anoro, flecainide, metoprolol, multivitamins, ivitamins, probiotics, ginkgobiloba, bvitamins, vit C, fish oil, selenium, | n/a | Hypertension, High Cholesterol, COPD, peripheral neuropathy | vsafe | 2 | 03/22/2021 | Y | Levaquin, pRetinol (auditory reaction) | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1154174 | 04/01/2021 | TN | 85.0 | 85 | F | No adverse event. Patient given 3rd dose. | 03/19/2021 | 03/19/2021 | 0 | OTH | ESRD, Anemia, Chronic Ischemic Heart Disease, HTN, Malnutrition | 2 | 04/01/2021 | None listed | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1169216 | 04/05/2021 | TN | 85.0 | 85 | F | Pt presented to clinic on 3/29/21 with dime-sized lesion on Right upper deltoid region. She stated that this was the injection site of her 2nd Moderna dose. The lesion was raised from the skin, hard to the touch (callous-like), | N | 02/23/2021 | 03/01/2021 | 6 | PUB | 2 | 04/01/2021 | Y | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1204554 | 04/13/2021 | TN | 85.0 | 85 | M | SEVERE.PAINFFUL RASH ON BODY. ARMS,LEGS,BACK, STOMACH | N | 03/03/2021 | 04/03/2021 | 31 | BLOOD WORK TAKEN ,BUT ALL RESULTS NEGATIVE | SEN | amlodipine besylate losartan potassium | none | good health | 2 | 04/13/2021 | Y | none | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1314855 | 05/13/2021 | TN | 85.0 | 85 | M | Pain in bilateral legs and behind knees | N | 05/03/2021 | 05/06/2021 | 3 | PVT | HTN, | 2 | 05/13/2021 | Y | Penicillin | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1364724 | 06/01/2021 | TN | 85.0 | 85 | F | Patient received second COVId 19 vaccine on 4/9/21 @ Health Department. Was admitted to hospital on 5/18/2021 with SOB, Nausea, Vomiting, and Headache. Diagnosed with COVID 19 infection and COVID 19 Pneumonia. Patient expired on 5/19/2021 at hospital. | Y | 05/19/2021 | U | 04/09/2021 | 05/18/2021 | 39 | Unknown | PUB | Unknown | Unknown | Htn, GERD, Type 2 DM, COPD, ESRD, CHF, Afib | 2 | 06/01/2021 | Unknown | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1528988 | 08/05/2021 | TN | 85.0 | 85 | F | Gangrene of right foot with refused treatment No symptoms of COVID Date of death 4/14/2021 | Y | 04/14/2021 | N | 01/07/2021 | 01/27/2021 | 20 | Antigen COVID Positive 4/11/2021 PCR COVID Positive 4/13/2021 | SEN | Tylenol 325mg 2 PO q 12 PRN; Calcium tablet 600mg PO BID; Multi-vitamin PO Daily; Vitamin D 1000 IU BID; amlodipine 5mg PO Daily; Plavix 75mg PO daily; Lotrisone cream to right foot BID; levothyroxine 100mcg PO daily; lovastatin 10mg PO HS; | Gangrene of right foot | ICD 10 codes: U07.1; I73.9; M62.81; R26.2; R41.841; Z74.1; I99.8; I96; R52; I10; E03.9; J30.9; Z79.02; F32.9; E78.5 | 2 | 08/05/2021 | aspirin. caffeine, cephalosporines, esomeprazole, iodinated diagnostic agents, Keflex, Nexium, septra, soap, sulfa antibiotics, trimethoprim | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1539399 | 08/10/2021 | TN | 85 | F | arm is really sore now; Fever; Arm became sore; A spontaneous report was received consumer concerning a from a 85-year-old female who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced sore arm and a fever of 101.5?F. The patient's medical hi | U | 12/30/2020 | 12/30/2020 | 0 | Test Date: 20201231; Test Name: temperature; Result Unstructured Data: 101.5 ?F | UNK | VITAMINS NOS | Medical History/Concurrent Conditions: COVID-19 (Hospitalized for 19 days due to COVID) | USMODERNATX, INC.MOD20200 | 2 | 08/07/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1573353 | 08/16/2021 | TN | 85.0 | 85 | F | This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Injection site was hot to the touch), VACCINATION SITE PRURITUS (Injection site itchy), VACCINATION SITE RASH (Rash on her left arm just below the inj | U | 01/29/2021 | 01/30/2021 | 1 | UNK | USMODERNATX, INC.MOD20210 | 2 | 08/13/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1578744 | 08/17/2021 | TN | 85.0 | 85 | M | About 5 hours after the shot I got up from a chair and immediately became dizzy and started sweating. This lasted about an hour, sweating all the time to the point where my t shirt was completely soaked. I was able to breathe normally and I drank cold wa | Y | 08/05/2021 | 08/05/2021 | 0 | None | PHM | Telemisartan 80 mg-Simvastatin 40mg-Ester C -1000mg-Vitamin D-400mg | none | High blood pressure & high cholesterol | 2 | 08/17/2021 | Beta blockers | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1582648 | 08/18/2021 | TN | 85.0 | 85 | M | positive covid test | Y | N | 02/02/2021 | 02/26/2021 | 24 | PVT | Plavix Irbesartan Toprol XL Crestor Mobic ropinirole metformin | diabetes CAD hypertension | 2 | 08/18/2021 | nkda | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1591433 | 08/20/2021 | TN | 85.0 | 85 | M | COUGH, RUNNY NOSE, FOR TWO WEEKS, GENERAL MALSIE, BODY ACHE | Y | 07/15/2021 | Y | 12 | N | 01/27/2021 | 07/03/2021 | 157 | POSITIVE COVID TEST | PVT | VIT C ASPIRIN PLAVIX WELCHOL ZETIA LOPRESSOR | CHF | 2 | 08/20/2021 | MORPHINE | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1604708 | 08/21/2021 | TN | 86.0 | 85 | M | pains; soreness at place at the injection; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (pains) and VACCINATION SITE PAIN (soreness at place at the injection) in an 86-year-old male patient who received mRNA-1273 (M | Y | 03/05/2021 | UNK | USMODERNATX, INC.MOD20210 | 2 | 08/12/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1605044 | 08/22/2021 | TN | 85.0 | 85 | F | weakness; Infection of a tick bite over the scalp, since after receiving the 1st shot of vaccine and the infection is now spreading down to patient's neck and shoulder and the infection is nowspreading down to patient's neck and shoulder; Infection of a ti | Y | 03/25/2021 | 03/25/2021 | 0 | UNK | VITAMINS NOS | USMODERNATX, INC.MOD20210 | 2 | 08/12/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1641198 | 08/27/2021 | TN | 85.0 | 85 | M | no adverse effect noted after administration of 3rd dose. resident expired on 8/24/21 after long battle with Alzheimer's disease. death does not appear to vaccine related | Y | 08/24/2021 | N | 08/19/2021 | 08/24/2021 | 5 | SEN | Flomax 0.4 mg, Remeron 15 mg, methotrexate 2.5 mg, levothyroxine 88 mcg, Namzeric 28-10 mg, Folic acid 1 mg, Clonidine 0.1 mg, Colace 100 mg, Buspar 10 mg, Aspirin 81 mg | aspiration pneumonia in July | heart failure, hypertension, Alzheimer's disease | 2 | 08/27/2021 | NKA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1661087 | 09/01/2021 | TN | 85.0 | 85 | M | This spontaneous case was reported by a consumer and describes the occurrence of CARDIOMYOPATHY and MYOCARDITIS in an 85-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-seri | U | 03/11/2021 | 03/14/2021 | 3 | UNK | PREDNISONE | Anxiety; Blood pressure high; Thyroid disorder | USMODERNATX, INC.MOD20212 | 2 | 08/31/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1689405 | 09/10/2021 | TN | 85.0 | 85 | M | Case fully vaccinated with Pfizer. Last dose on 2/24/2021. Tested positive for COVID 19 on 08/31/2021. Admitted to Hospital on 8/31/2021. Expired on 9/7/2021 while still hospitalized. | Y | 09/07/2021 | U | 02/24/2021 | 08/31/2021 | 188 | PUB | 2 | 09/10/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1703921 | 09/16/2021 | TN | 85.0 | 85 | F | COVID RELATED DEATH; FULLY VACCINATED | Y | 09/15/2021 | N | 01/28/2021 | 09/15/2021 | 230 | PUB | 2 | 09/16/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1708893 | 09/17/2021 | TN | 85.0 | 85 | F | PATIENT FULLY VACCINATED TESTED POSITIVE FOR COVID 9/7/2021 AND HOSPITALIZED 9/7/2021 | 09/07/2021 | 09/07/2021 | 0 | UNK | 2 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1715495 | 09/20/2021 | TN | 85.0 | 85 | U | Patient presented to ED with Afib with RVR. Patient was confused. Tested positive for COVID 19 on 8/17/2021. patient admitted to inpatient 8/17. Patient developed COVID PNA Transitioned to comfort care on 8/23/2021 and was discharge home with hospice. | Y | 6 | 01/05/2021 | 08/17/2021 | 224 | WBC -21.6 Chest CT possible pneumonia CTA chest no PE | UNK | 2 | 09/20/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1715861 | 09/20/2021 | TN | 85.0 | 85 | F | Ongoing hospitalization Began 9/18/2021 with weakness, difficulty walking | Y | 3 | N | 03/24/2021 | 09/17/2021 | 177 | chest xray 9/18 slightly progressed multifocal airspace opacities. oxygen, | PUB | unknown | Unknown | Dementia, psychoses, essential hypertension, Alzheimer's, | 2 | 09/20/2021 | Iodinated Contrast Media | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1730977 | 09/24/2021 | TN | 85.0 | 85 | M | Site: Bruising at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Followed up with patient 4-6hrs after and he said no changes reported and he feels fine, I iced the injection site for about 2-3mins and kept checking on | Y | 09/23/2021 | 09/23/2021 | 0 | PHM | 2 | 09/24/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1741038 | 09/28/2021 | TN | 85.0 | 85 | F | PT EXPIRED; BREAKTHROUGH CASE OF COVID-19 | Y | 09/28/2021 | N | 02/04/2021 | 09/25/2021 | 233 | PUB | 2 | 09/28/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1779024 | 10/12/2021 | TN | 85.0 | 85 | F | Pt. received a flu vaccine on 08/05/21, forgot she had received a flu vaccine then came back on 09/29/21 for a flu vaccine and received a second flu vaccine in error | Y | 09/29/2021 | 09/29/2021 | 0 | N/A | PHM | Valsartan, metoprolol, trazodone | none | HTN | 2 | 10/12/2021 | NKA | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1785538 | 10/14/2021 | TN | 85.0 | 85 | F | Hospitalized 13 days. Discharged to skilled nurse facility on 2-3 L via nasal cannula. Admitted with acute respiratory failure with hypoxia, pneumonia due to COVID-19 virus, 10 day course of dexamethasone, baricitinib, new onset a-Fib, new onset CHF, IV La | Y | 13 | Y | 04/16/2021 | 09/29/2021 | 166 | CT 9/29 bilateral pneumonia and trace effusion, chest x ray 10/9 bilateral central infiltrates, minimal pleural effusions. | PUB | Unknown | Unknown | Hyperlipidemia | 2 | 10/14/2021 | Gluten | 2021VAERSSYMPTOMS | 2021VAERSVAX | 1808355 | 10/22/2021 | TN | 85.0 | 85 | M | Case fully vaccinated with Moderna with second dose administered on 2/4/2021. Tested positive for COVID 19 on 10/17/2021. Was admitted to hospital on 10/14/2021. Expired on 10/19/2021 while still hospitalized. | Y | 10/19/2021 | N | 02/04/2021 | 10/17/2021 | 255 | PUB | 2 | 10/22/2021 | 2021VAERSSYMPTOMS | 2021VAERSVAX |