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From the 10/15/2021 release of VAERS data:

Found 29,365 cases where Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Serious



Case Details

This is page 7 out of 2,937

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VAERS ID: 917855 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-31
Onset:2021-01-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest X-ray, Differential white blood cell count, Electrocardiogram, Full blood count, Human chorionic gonadotropin, Metabolic function test, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. HOWEVER I DID TAKE BENADRYL PROPHYLACTICALLY JUST IN CASE BECAUSE I HEARD OF PEOPLE HAVING ADVERSE REACTIONS TO BOTH MODERNA AND PFIZER COVID VACCINE.
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: SULFA
Diagnostic Lab Data: CBC WITH DIFFERENTIAL, COMPREHENSIVE METABOLIC PANEL, HCG QUANTITATIVE, ECG 12 LEAD, CHEST X-RAY, TYLENOL, IV OF NORMAL SALINE
CDC Split Type:

Write-up: ON 1/1/21 THE DAY AFTER I RECEIVED THE VACCINE I WAS TAKING A NAP AND MY WATCH KEPT SENDING ME ALERTS. HOWEVER I DID NOT CHECK MY WATCH UNTIL 5:30 WHEN I WOKE UP AND I FELT LIKE I WAS HAVING HEART PALPITATIONS. I WENT TO THE EMERGENCY ROOM WHERE I WAS TREATED. I WAS TOLD THAT I WAS FEBRILE WITH A TEMPERATURE OF 102. I WAS GIVEN IV FLUIDS, CHEST X-RAY, EKG AND LAB WORK. I WAS RELEASED ON 1/2/21 AT APPROXIMATELY 0030 (MIDNIGHT).


VAERS ID: 917882 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Dizziness, Dyspnoea, Erythema, Flushing, Nausea, Palpitations, Respiratory distress, SARS-CoV-2 test negative, Swollen tongue, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Biotin 1 mg PO daily, Levothyroxine 112 mcg PO daily, MVI tablet PO daily, Paroxetine 20 mg PO QHS
Current Illness: none reported
Preexisting Conditions: Past Medical History (as noted in H&P) ? Acquired hypothyroidism ? ? Anxiety ? ? Chronic deep vein thrombosis (DVT) of distal vein of lower extremity ? ? Chronic midline low back pain ? ? Complex regional pain syndrome I ? ? Essential hypertension ? ? Fibromyalgia ? ? Gastroesophageal reflux disease without esophagitis ? ? History of pseudoseizure ? ? Laryngospasm ? ? MDD (major depressive disorder) ? ? RSD (reflex sympathetic dystrophy)
Allergies: cefuroxime (shortness of breath), gadolinium (anaphylaxis, March 2018), iodine (anaphylaxis), quinolones (shortness of breath, "paralyze"), gabapentin (hallucinations), vancomycin (itching)
Diagnostic Lab Data: COVID-19 antigen negative, BP 126/52, pulse 96 on admission to ED
CDC Split Type:

Write-up: Patient is hospital employee who completed screening form for COVID-19 vaccine by answering "no" to all contraindication questions. Approx 10 minutes after receiving COVID-19 vaccine dose # 1, patient was still in vaccine clinic area and complained of dizziness, palpitations and flushing. I observed patient fanning herself with papers. She was escorted out of the immediate clinic room, and assessed by paramedics present as having an anaphylactic reaction. Epinephrine 0.3 mg IM and diphenhydramine 50 mg IV given in clinic, Rapid Response was called overhead and patient immediately transported down the hall to the Emergency Dept. In ED, pt was noted as having swollen tongue, large areas of erythema on face, arms and chest, shortness of breath, nausea, dizziness (per ED physician notes). Pt reported being hospitalized in ICU with COVID disease more than 3 months ago, including intubation (not treated at this hospital), and has been back at work since August 2020. ED physical exam noted bilateral wheezing and patient in acute distress. In ED, pt administered racemic epinephrine 2.25% 0.5 mL via neb, epinephrine 0.3 mg IM, diphenhydramine 50 mg IV, Solu-Medrol 125 mg IV, famotidine 20 mg IV and epinephrine 5 mg/250 mL IV drip (started at 0.118 mcg/kg/min). Acute symptoms reported to resolve in ED. COVID test was negative. ED physician discovered that pt had history of multiple medications, including previous anaphylactic reaction to radiocontrast dye requiring intubation (which was not disclosed on the vaccine screening form). Pt admitted to Telemetry floor for observation. Overnight course was unremarkable, and patient was discharged the following day with prescription for Prednisone taper and prescription for Epi-pen. Advised not to return for second dose of COVID vaccine. EMR updated to reflect possible anaphylactic reaction to Moderna COVID-19 vaccine.


VAERS ID: 917961 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-31
Onset:2020-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Angiogram cerebral, Aphasia, Arteriogram carotid, Blood magnesium, Blood thyroid stimulating hormone, Brain natriuretic peptide, C-reactive protein, Chest X-ray, Computerised tomogram head, Culture urine, Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Fibrin D dimer, Full blood count, Glycosylated haemoglobin, Lipids, Magnetic resonance imaging brain, Metabolic function test, Perfusion brain scan, Platelet count, Red blood cell sedimentation rate, Respiratory viral panel, SARS-CoV-2 test, Scan with contrast, Tachycardia, Tachypnoea, Troponin I, Ultrasound kidney, Urine analysis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort inhaler: 2-puffs / twice daily Metoprolol 25mg: 1-tab / daily Lipitor 80mg: 1-tab / daily Zestril 5mg: 1 tab / daily Brilinta 90mg: 1-tab / twice daily Prilosec 20mg: 1-tab / daily HCTZ 25mg: 1-tab / daily ASA 81mg: 1-tab / daily
Current Illness: June 22,2020: COVID19 positive July 2020: Diagnosed with restrictive airway disease, small airway disease, lung nodules November 11, 2020: STEMI, required angioplasty and stent placement
Preexisting Conditions: HTN Conditions highly related to COVID19 infection per provider: Restrictive airway & small airway disease CAD Depression Anxiety
Allergies: Losartan
Diagnostic Lab Data: BASIC METABOLIC Jan 2, 2021 MAGNESIUM Jan 2, 2021 ECG 12-LEAD Jan 1, 2021 D-DIMER,QUANTITATIVE Jan 1, 2021 TROPONIN I Jan 1, 2021 COMPREHENSIVE METABOLIC PANEL Jan 1, 2021 CBC W/ DIFF Jan 1, 2021 C-REACTIVE PROTEIN Jan 1, 2021 US RENAL COMPLETE Jan 1, 2021 MRI BRAIN WO CONTRAST Jan 1, 2021 TROPONIN I Jan 1, 2021 SEDIMENTATION RATE, AUTOMATED Jan 1, 2021 TSH Jan 1, 2021 LIPID PANEL Jan 1, 2021 HEMOGLOBIN A1C Jan 1, 2021 HEMOGRAM 2 (H&H) Jan 1, 2021 PLATELET COUNT Jan 1, 2021 MAGNESIUM Jan 1, 2021 UA W MICROSCOPIC (C&S IF INDICATED) Jan 1, 2021 CT CEREBRAL PERFUSION Dec 31, 2020 CT ANGIOGRAM HEAD NECK W CONTRAST Dec 31, 2020 CT HEAD WO CONTRAST Dec 31, 2020 XR CHEST AP PORTABLE Dec 31, 2020 ECG 12-LEAD Dec 31, 2020 UPPER RESPIRATORY PATHOGEN PANEL W SARS-COV-2 (COVID-19) Dec 31, 2020 CBC W/ DIFF Dec 31, 2020 COMPREHENSIVE METABOLIC PANEL Dec 31, 2020 ER TROPONIN-I Dec 31, 2020 BNP (NT-PROBNP, NT-PRO B-TYPE NATRIURETIC PEPTIDE) Dec 31, 2020 C-REACTIVE PROTEIN Dec 31, 2020 SEDIMENTATION RATE, AUTOMATED Dec 31, 2020
CDC Split Type:

Write-up: I suffer from lingering SOB with exertion after COVID infection. On the night of 12/31/2020 I began to feel more SOB than usual and was unable to correct my SOB with rescue inhaler. Became more SOB with exacerbated tachycardia and tachypnea, My family had to call 911 because I became aphasic and showing signs of possible stroke. I was taken to the ER and admitted for respiratory recovery and to role out stroke. The stroke was ruled out and I recovered with IV prednisone therapy, twice daily and supplemental oxygen. Released after HR, BP, & respiratory effort returned to normal: 01/03/2021


VAERS ID: 918051 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-30
Onset:2021-01-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026LZOA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abdomen abnormal, Laboratory test, Liver function test, Ultrasound abdomen, Ultrasound pelvis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: prenatal vitamin
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Liver panel and chemistry lab: 1/1/21 Abdominal ultrasound: 1/1/21 Abdominal CT scan: 1/1/21 Pelvic Ultrasound: 1/2/21
CDC Split Type:

Write-up: At around 40 hours post vaccination, developed severe abdominal pain and went to an emergency room for evaluation on 1/1/21. Abdominal pain was eventually diagnosed as appendicitis requiring appendectomy on 1/2/21. Emergency room visit and hospital discharged patient early on 1/2/21. It was then determined that the on-call team covering mis-read the CT scan and acute appendicitis was found. Patient then went to Medical Center on 1/2/21 for appendectomy and was discharged later that night following operation.


VAERS ID: 918065 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-30
Onset:2021-01-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: - Invega Trenza 546mg Q3months - Lithium 300mg BID - Oxybutynin 5mg QID - lipitor 20mg QHS - cogentin 2mg BID - Norvasc 5mg QD - Dyazide Capsule 37.5-25 MG (Triamterene-HCTZ) QD
Current Illness: - covid-19
Preexisting Conditions: - SCHIZOPHRENIA, UNSPECIFIED - ANEMIA, UNSPECIFIED - OVERWEIGHT - OVERACTIVE BLADDER - ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS - HYPOTHYROIDISM DUE TO MEDICAMENTS AND OTHER EXOGENOUS SUBSTANCES - NICOTINE DEPENDENCE, UNSPECIFIED, UNCOMPLICATED - CHRONIC VIRAL HEPATITIS C - UNSPECIFIED AGE-RELATED CATARACT - ESSENTIAL (PRIMARY) HYPERTENSION - CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED - UNSPECIFIED CONVULSIONS - INHALANT ABUSE, UNCOMPLICATED - OTHER SEIZURES
Allergies: - Clozaril - Tegretol
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1/1/2020: Residents was found unresponsive. Pronounced deceased at 6:02pm


VAERS ID: 918086 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-01-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025120-2A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Intensive care, Sinus tachycardia, Supraventricular tachycardia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Dehydration (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: 2016, Age 27, Flu Vac QS 2016
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Flu Vaccine
Diagnostic Lab Data: EKG- Intermittent SVT with sinus tachycardia
CDC Split Type:

Write-up: Patient developed SVT 15 minutes after receiving vaccine. Admitted to ICU. ER presentation: BP: 160/109 heart rate 132. No e/o anaphylaxis or allergic reaction.


VAERS ID: 918487 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Michigan  
Vaccinated:2020-01-02
Onset:2021-01-04
   Days after vaccination:368
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L2OA / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine, Plavix, flomax, Lisinopril, atrovastatin, amlodipine, Pentoxifylline, ASA, Donepezil, trazodone, Metoprolol tartrate.
Current Illness: NSTEMI, Dementia, TIA, COVID-19, HTN, CVA, PVD
Preexisting Conditions: HTN, PVD, Dementia
Allergies: Beta Adrenergic Blockers
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Two days post vaccine patient went into cardiac arrest and passed away.


VAERS ID: 918518 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2020-12-31
Onset:2020-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Cardio-respiratory arrest, Death, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: To be determined
Current Illness: To be determined
Preexisting Conditions: To be determined
Allergies: To be determined
Diagnostic Lab Data: Autopsy being performed
CDC Split Type:

Write-up: syncopal episode - arrested - CPR - death


VAERS ID: 918552 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-12-30
Onset:2021-01-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 5 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Influenza virus test negative, Nausea, Pyrexia, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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: None
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: NKA
Diagnostic Lab Data: Pt was tested for Influenza and COVID and lab work was normal
CDC Split Type:

Write-up: Severe diarrhea, cold chills, 101 fever, and nausea


VAERS ID: 918839 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2020-12-24
Onset:2021-01-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cholecystectomy, Lymphadenopathy, Sepsis
SMQs:, Gallbladder related disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

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

Write-up: Gallbladder removed, septic, 11mm axillary lymph node.


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