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From the 1/7/2022 release of VAERS data:

Found 40,345 cases where Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Serious

Government Disclaimer on use of this data



Case Details

This is page 27 out of 4,035

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VAERS ID: 939087 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-07
Onset:2021-01-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood culture negative, Body temperature increased, CSF test normal, Mental status changes, Urine analysis normal, White blood cell count normal
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Cholecalciferol, Coumadin, Pantoprazole
Current Illness: Was staying at Rehab Center after having hip surgery after 12/20/2020 but unsure of exact date of surgery.
Preexisting Conditions: Mass on brain, TIAs, Craniotomy 8/2018, HTN, cholecystectomy, appendectomy, tubal ligation, R total hip replacement, Hepatitis years ago, cancer of brain and lung, IVC filter, tonsillectomy
Allergies: NKA
Diagnostic Lab Data: She had a temp of 102 and altered mental status. She had a full septic workup including CSF. It was all neg. Normal WBC, urine, blood cultures and CSF. Normalized and sent back to Rehab.
CDC Split Type:

Write-up: Attempting to confirm which COVID 19 vaccine was given (Moderna or Pfizer). They did not send the record when they sent the patient to General ER the next am. Did not answer the phone.


VAERS ID: 939216 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-08
Onset:2021-01-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cyanosis, Dyspnoea, Feeling abnormal, Headache, Hyperhidrosis, Muscle fatigue, Pallor, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Self Treated via personal medical knowledge
CDC Split Type:

Write-up: Blurred vision, difficulty breathing (pale skin/blue lips), profuse sweating, muscle fatigue, headache. This lasted about 15 minutes. Until severity went down. Followed by 20 minutes of profuse sweating and headache. I thought I was going to die


VAERS ID: 939564 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-22
Onset:2021-01-05
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Lipase increased, Magnetic resonance cholangiopancreatography, Nausea, Pancreatitis acute
SMQs:, Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro 20mg daily, Wellbutrin 300mg daily, Zyrtec OTC
Current Illness: None
Preexisting Conditions:
Allergies: Peanuts
Diagnostic Lab Data: Lipase on 1/5/2020 was $g1800 CT on 1/5/2020 of the abdomen/pelvis showed pancreatitis MRCP on 1/5/2020 was negative
CDC Split Type:

Write-up: On 1/5/2020, I, the patient woke up at 3:30 with sharp boring epigastric pain. Progressed to include nausea. On evaluation in the ED was diagnosed with acute pancreatitis. Prior hx includes 2 episodes with hospitalization for gallstone pancreatitis in 2016. Subsequently had laparoscopic cholecystectomy in 2016. Last alcoholic beverage prior to 2020 ED presentation was 3 weeks prior. No tobacco or drug use.


VAERS ID: 963163 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-01-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative:


VAERS ID: 963164 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure congestive, Diabetes mellitus, Hyperglycaemia, Hypertension, Pyrexia, Tachycardia, Tachypnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Tachypnea, HYPERtension, Tachycardia & HYPERglycemia Narrative: Was inpatient overnight in a telemetry until. DC with diagnosis of DM and CHF


VAERS ID: 1402179 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure chronic, Cardiac telemetry, Diabetes mellitus, Hyperglycaemia, Hypertension, Pyrexia, Tachycardia, Tachypnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Tachypnea, HYPERtension, Tachycardia & HYPERglycemia Narrative: Was inpatient overnight in a telemetry until. DC with diagnosis of DM and CHF


VAERS ID: 939629 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-01-05
Onset:2021-01-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA L27L20A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatinine increased, Blood glucose normal, Blood potassium increased, Blood urine present, Confusional state, Culture urine, Diarrhoea, Fatigue, Haematocrit decreased, Haemoglobin decreased, Nausea, Pollakiuria, Pyrexia, Urinary incontinence, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 10mg/day, Eliquis 2.5mg/day, Cyanocobalamine 1000mg Gabapentin 300/day, Lisinopril, 40mg/day, Metformin 500mg XR/day, Lopressor 25mg/day, Zofran 4mg/day, Protonix 40mg/day
Current Illness: Anticoagulant use, arthritis, asthma, AFib, bacteremia, CHG, lLumbar fractures, COPD, DM, DVT, Abcess, lung CA, Lupus, MRSA, Osteoporosis, PVD, Psoriasis, Sjorgrens, stroke, venous insufficiency of leg
Preexisting Conditions: See extensive list
Allergies: Bactrim, Codeine, Methotrexate, PCN, Sulfamethox
Diagnostic Lab Data: Hgb 9.1, HCT 29.8, Gluc 113, K+ 5.4, Cr. 2.0, urine culture taken
CDC Split Type:

Write-up: The patient presented to hospital on 1/6/2021 with a primary complaint of Fatigue (pt had covid vaccine yesterday. Now displaying increased weakness, blood in urine, increased confusion and urinated on herself today. Fever of 101.9 ) 79-year-old female presents to the emergency room with fatigue. The patient states yesterday she had the Moderna COVID-19 The patient states today she had a temperature 101.8? prior to arrival. Her son noted that she was having episodes of urinary frequency and also that she was profoundly weak and fatigued. They denied falling or hitting her head. The patient also states she been having nausea vomiting with diarrhea.


VAERS ID: 940067 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-04
Onset:2021-01-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, Hypotension, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fever-Severe, Systemic: hypotension, dyspnea-Severe; symptoms lasted 1 day


VAERS ID: 940351 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-05
Onset:2021-01-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abscess neck, Blood culture negative, Blood lactic acid normal, C-reactive protein increased, Chills, Computerised tomogram neck, Dysphagia, Dysphonia, Full blood count normal, Headache, Inflammation, Malaise, Metabolic function test, Necrosis, Pyrexia, Red blood cell sedimentation rate increased, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Painful Lower right tooth
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 1/11/21: ESR 74/CRP 156. CT neck soft tissue 3x2cm L neck necrotic mass with significant inflammatory surrounding changes level 2. blood cultures negative, lactate negative, CBC, CMP unremarkable
CDC Split Type:

Write-up: Patient day after vaccination had fever, chills, headache and malaise but recovered the next day. starting four days after vaccination started to have left neck swelling . Of note day prior vaccination had left wisdom teeth removal and maxillary root canal. 1 week after vaccination and 8 days after oral procedures worsening left neck swelling, trouble swallowing''s and change voice found resulting left neck 3x2cm necrotic neck abscess and significant neck inflammation. Patient was seen by ENT and started on IV Unysan and admitted for airway monitoring due to swelling with improvement over next 48 hours.


VAERS ID: 940438 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-01-08
Onset:2021-01-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid increased, Chest X-ray abnormal, Chills, Culture negative, Hypotension, Lung hyperinflation, Nausea, Urine leukocyte esterase, Vomiting, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Oxybutynin Levothyroxine Meloxicam Metoprolol Pantoprazole ASA Tylenol PM Potassium Acetate Calcium Carbonate Glucosamine
Current Illness: Urinary Incontinence (UA negative 12/29/2020)
Preexisting Conditions: Hearing Loss Hyperlipidemia Hypothyroidism Osteoarthritis Osteopenia Urinary Incontinence
Allergies: Naproxen
Diagnostic Lab Data: 1.9.2021 Lactic Acid 3 WBC 19 Urine with Moderate Leuk. Est. Few Bacteria, WBC 65-70. Sent for culture (Culture negative) B/P 84/50, 96/58, 104/64, 96/60 Chest X-ray Chronic Mild hyperinflation with coarse interstitial markings. No focal consolidation, pleural effusions, or pneumothorax 1/10/2021 WBC 13.97
CDC Split Type:

Write-up: Had Covid Vaccine AM of 1.8.2021. Woke up with Nausea, Vomiting X 4, Chills the following AM. Presented to ED. Found to be hypotensive during ER. Nausea Vomiting resolved. Tx with fluid replacement and dismissed home instructed to monitor BP. B/P dropped again at home returned and admitted to hospital.


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