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: 0970219
Sex: M
Age: 70
State: TX

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/25/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: After the vaccines lost temperature they were administered; A spontaneous report was received from a nurse practitioner concerning a 70-year-old, White, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the event, after the vaccines lost temperature they were administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 11 Jan 2021, a refrigerator in a vaccine clinic lost power and rose up to room temperature overnight. At approximately 9 p.m., the vaccines inside the refrigerator reached room temperature. On 12 Jan 2021, after the vaccine lost temperature, the patient received their first of two planned doses of mRNA-1273 (Lot number: 027L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. No treatment information was provided. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The event, after the vaccines lost temperature they were administered, was considered resolved on 12 Jan 2021.; Reporter's Comments: This case concerns a 70-year-old, male patient, who experienced an unexpected event of vaccine administered after they lost temperature. This report refers to a case of out of specification product use for mRNA-1273 (Lot number: 027L20A). There were no reported AEs associated with this case of out of specification product use.

Other Meds:

Current Illness:

ID: 0970220
Sex: U
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 01/25/2021
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: Received the 1st dose of Moderna vaccine subcutaneously; A spontaneous report was received from a HCP concerning a patient who received Moderna's Covid-19 vaccine (mRNA-1273) and experienced the 1st dose of Moderna vaccine subcutaneously. The patient's medical history was not provided. Concomitant product use was not provided. The patient received their first of two planned doses of mRNA-1273 on an unknown date subcutaneously for prophylaxis of COVID-19 infection. On an unknown date, a patient received the 1st dose of Moderna vaccine subcutaneously. Treatment for the event was not provided. Action taken with mRNA-1273 in response to the event was not provided. The event, received the 1st dose of Moderna vaccine subcutaneously, were considered resolved.; Reporter's Comments: This report refers to a case of incorrect route of product administration error for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0970221
Sex: U
Age:
State: GA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/25/2021
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: 16 years old patient received 1st dose of moderna vaccine; A spontaneous report was received from a physician concerning a 16-year-old patient who was participating in the mRNA-1273 Emergency Use Program and they gave first dose to a patient 16-years-old. The patient's medical history was not provided. No relevant concomitant medications were reported. The patient received their first of two planned doses of mRNA-1273 on 07-Jan-2021 intramuscularly for prophylaxis of COVID-19 infection. The reporter reported that the patient received the Moderna vaccine on 07-Jan-2021. He stated that the patient was 16-years-old. No adverse reactions were reported. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not provided. The event they gave first dose to a patient 16-years-old was considered resolved on 07-Jan-2021. The reporter did not provide a causality assessment for the event they gave first dose to a patient 16-years-old.; Reporter's Comments: This report refers to a case of 16- year-old patient who experienced non-serious unexpected event of first dose to a patient 16-years-old (product administered to patient of inappropriate age) for mRNA-1273, lot # unknown, Exp date-unknown. There were no reported AEs associated with this case of product administered to patient of inappropriate age.

Other Meds:

Current Illness:

ID: 0970222
Sex: F
Age: 73
State: FL

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/25/2021
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: While receiving the injection something dribbled down her arm.She thinks she did not receive the dose in it's entirety; A spontaneous report was received from a consumer concerning a 73-year-old, female patient who was participating in the mRNA-1273 Emergency Use Program and while receiving the injection something dribbled down her arm.. She thinks she did not receive the dose in it's entirety[Incorrect dose administered]. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 09-Jan-2021, immediately prior to the onset of the event, the patient received their first of two planned doses of mRNA-1273 (Lot # 011L20A) intramuscularly in the arm for prophylaxis of COVID-19 infection. During the administration of the vaccine, the patient reported that she felt something dribble down her arm and she believes she did not receive the dose in its entirety. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not provided. The outcome of the event was not reported.; Reporter's Comments: This report refers to a case of 73- year-old female patient who experienced non-serious unexpected event of vaccine she felt something dribble down her arm and she believes she did not receive the dose in its entirety(Incomplete dose administered) for mRNA-1273, lot # 011L20A), Exp date-unknown. There were no reported AEs associated with this case of Incomplete dose administered.

Other Meds:

Current Illness:

ID: 0970223
Sex: M
Age: 15
State: RI

Vax Date: 01/10/2021
Onset Date: 01/10/2021
Rec V Date: 01/25/2021
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: 15 year old volunteer was vaccinated; A spontaneous report was received from a physician concerning a 16-year-old male patient (also reported as 15 year old volunteer) who was participating in the mRNA-1273 Emergency Use Program and was vaccinated. The patient's medical history was not provided. No concomitant medications were provided. On 10 Jan 2021, the patient received their first of two planned doses of mRNA-1273 in his right deltoid for prophylaxis of COVID-19 infection and the mother is upset. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event inappropriate age at vaccine administration was resolved on 10 Jan 2021. The reporter did not provide an assessment for the event.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age for mRNA-1273. There were no reported adverse events associated with this case.

Other Meds:

Current Illness:

ID: 0970224
Sex: F
Age: 17
State: MI

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/25/2021
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: Administered the Moderna Covid-19 vaccine to a 17-year-old patient; A spontaneous report was received from a pharmacist concerning a 17 year old male patient, who received Moderna's COVID-19 vaccine (mRNA-1273). The patient's medical history was not reported.Concomitant medications were not reported. On 11 Jan 2021 the patient received their first of two planned doses of mRNA-1273 (lot number: 026L20A) intramuscularly in the left deltoid for prophylaxis of COVID-19 infection at the age of 17. The patient did not showed any adverse reactions. Action taken with mRNA-1273 in response to the events was not reported . The event, administered Moderna Covid- 19 vaccine to a 17-year old was considered resolved on 11 Jan 2021.; Reporter's Comments: This report refers to a case of product administered to patient of inappropriate age (vaccine was administrated for 17-years old patient) for mRNA-1273, lot # 026L20A. There were no reported AEs associated with this case of product administered to patient of inappropriate age. The reported event is unlisted and company causality was assessed s not applicable.

Other Meds:

Current Illness:

ID: 0970225
Sex: M
Age: 62
State: MD

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/25/2021
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: injected in his joint; Horrible pain; This spontaneous report was received from a physician, who was also a 62-year-old male patient, who received the Moderna COVID-19 vaccine (mRNA-1273) and experienced injected in his joint and horrible pain. The patient's medical history was not provided. Concomitant medications were not reported. The facility where the vaccine was given was not provided. On 31 Dec 2020, prior to the onset of symptoms, the patient received their first of two planned doses of mRNA-1273 for COVID-19 prophylaxis. He believed he was injected in his joint instead of the muscle of his left arm. He was in "horrible pain" and went to see his physician. Treatment for the event included a steroid shot, ibuprofen, and paracetamol for pain. Action taken with mRNA-1273 in response to the events was not provided. The outcome of the event, horrible pain, was not reported. The outcome of the event, injected in his joint, was resolved on 31 Dec 2020.; Reporter's Comments: This report refers to a case of a 62-year-old male patient who experienced non-serious of injected in his joint (Vaccine administered at inappropriate site) and horrible pain for mRNA-1273, lot # unknown), Exp date unknown. Injection site pain is consistent with the known safety profile of the vaccine, hence, based on the information provided, a causal association between the administration of the vaccine and the event of horrible pain cannot be excluded. The event of injected in his joint is assessed as not applicable.

Other Meds:

Current Illness:

ID: 0970226
Sex: U
Age:
State: OH

Vax Date:
Onset Date:
Rec V Date: 01/25/2021
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: Pharyngeal swelling

Symptoms: 1 ml of vaccine administered; A spontaneous report was received from a health care professional concerning a patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced 1 ml of vaccine was administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20A) intramuscularly for prophylaxis of COVID-19 infection. The patient received a 1 ml dose of the Moderna COVID-19 vaccine, instead of 0.5 ml, during their first dose. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, 1 ml of vaccine was administered, was considered resolved on unknown date.; Reporter's Comments: This report refers to a case of incorrect dose administered for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of incorrect dose administered.

Other Meds:

Current Illness:

ID: 0970227
Sex: U
Age:
State: OH

Vax Date:
Onset Date:
Rec V Date: 01/25/2021
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: 1 ml of vaccine administered; A spontaneous report was received from a health care professional concerning a patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced 1 ml of vaccine was administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20A) intramuscularly for prophylaxis of COVID-19 infection. The patient received a 1 ml dose of the Moderna COVID-19 vaccine, instead of 0.5 ml, during their first dose. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, 1 ml of vaccine was administered, was considered resolved on unknown date.; Reporter's Comments: This report refers to a case of incorrect dose administered for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of incorrect dose administered.

Other Meds:

Current Illness:

ID: 0970228
Sex: U
Age:
State: OH

Vax Date:
Onset Date:
Rec V Date: 01/25/2021
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: 1 ml of vaccine administered; A spontaneous report was received from a health care professional concerning a patient, who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced 1 ml of vaccine was administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On unknown date, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025J20A) intramuscularly for prophylaxis of COVID-19 infection. The patient received a 1 ml dose of the Moderna COVID-19 vaccine, instead of 0.5 ml, during their first dose. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event, 1 ml of vaccine was administered, was considered resolved on unknown date.; Reporter's Comments: This report refers to a case of incorrect dose administered for mRNA-1273, lot # unknown. There were no reported AEs associated with this case of incorrect dose administered.

Other Meds:

Current Illness:

ID: 0970229
Sex: M
Age:
State: NC

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: a 13 year-old boy was administered Flublok instead of Fluzone with no adverse event; Initial information regarding this unsolicited valid non-serious case was received from a other health professional and transmitted to Sanofi on 15-Jan-2021. The case involved a 13 year old male patient who received a 0.5mL dose of a 13 year-old boy was administered INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] (lot: QSAA2050, expiry date: 30-Jun-2021), via intramuscular route in the right arm, for prophylactic vaccination, on 09-Jan-2021, instead of INFLUENZA USP TRIVAL A-B SUBVIRION NO PRESERVATIVE VACCINE [FLUZONE] (wrong product administered). Relevant medical history, past medical treatment, vaccination details, concomitant medications and family history were not provided. It was a case of actual medication error due to wrong vaccine administered (latency same day). At the time of reporting, no adverse event was reported. The nurse stated that immunization was ordered as part of clinic and administered by certified medical assistants (CMA). The reporter would like to know if any adverse events has been reported. This suspected adverse reaction report was submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Disclaimer: Practices. The classification as a medical error was in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party had contributed to or was to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 0970230
Sex: F
Age: 56
State: MD

Vax Date: 01/12/2021
Onset Date: 01/13/2021
Rec V Date: 01/25/2021
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: Gluten

Symptom List: Rash, Urticaria

Symptoms: Sudden intense itching on back of left leg, right at/below back of knee. It felt hot and it swelled. Next morning it was pink and still itched but not as bad. I took pictures. The following evening I also took pictures. By then it was a dark red, looked like a bruise and followed the shape of my vein.

Other Meds: Plaquenil, Irbesartan, Pantoprazole, Zoloft

Current Illness:

ID: 0970231
Sex: F
Age: 65
State: MD

Vax Date: 01/16/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: shell fish occasionally

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

Symptoms: Arm sore for several days. about a week later 4" redness and very itchy started has not stopped yet.

Other Meds: sinimet amlodopime losartan celexa metropolol lipitor vit d

Current Illness: none

ID: 0970232
Sex: F
Age: 61
State: OK

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
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: none

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

Symptoms: 12 hours after shot Headache, stomach upset, fever 100.6, body aches x 36 hours

Other Meds: Mobic, vitamin C gummies

Current Illness: tested positive for COVID December 18, 2020

ID: 0970233
Sex: F
Age: 36
State: NY

Vax Date: 01/24/2021
Onset Date: 01/24/2021
Rec V Date: 01/25/2021
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: Latex, Imitrex, Tobramycin, Thermisol

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

Symptoms: Fever 103, sharp shooting pains down legs and arms, nausea, vomiting, migraine

Other Meds: Biotin, luetin, vitamin b12, vitamin d, hydroxyzine

Current Illness: None

ID: 0970234
Sex: F
Age: 24
State: VA

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Dull chronic stomach pain (center upper abdomen to left upper abdomen) that is aggravated by eating and drinking including swallowing saliva. Has been going on since 11 pm of date of vaccine (2-3 days). I tried ibuprofen on the first day but it did not help.

Other Meds: multivitamin fish oil nutrafol women's hair supplement choline supplement combination birth control pill allegra melatonin

Current Illness: none

ID: 0970235
Sex: F
Age: 59
State: PR

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/25/2021
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: RELAFEN

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

Symptoms: PAIN INJECTION SITE, HEADACHE, CHILLS,PAIN ON JOINTS, TIRED,FEVER BODY PAIN. SINTOMES FOR 3 DAYS.

Other Meds: NONE

Current Illness: NONE

ID: 0970236
Sex: F
Age: 28
State:

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Azithromyacin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Very sore arm the following day (difficulty using and lifting) and tired. Then two days later work up with headache and nausea.

Other Meds: Sertraline

Current Illness:

ID: 0970237
Sex: F
Age: 67
State: WV

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 1-21-2021 vaccinated #2 light headed dizzy - must has passed out during night getting upt o bathroom work up in am with bloody sheets and pillow - went ot ED for staples for laceration on head.

Other Meds:

Current Illness:

ID: 0970238
Sex: F
Age: 62
State: MD

Vax Date: 01/14/2021
Onset Date: 01/14/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Demerol-nausea Erythromycin-i.e.-Augmentin GI distress Celebrex- rash Ceclor- Anaphylaxis's Adhesive- rash

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

Symptoms: Had vaccine at 3:21 pm Started itching at 4:05 pm- eye lids, scalp, bottom of foot, face felt tight- no respiratory issues. Took Benadryl with moderate relief. Area was red and sore about the size of a ping pong ball area. Area cleared on 121/2021. On 1/22/2021 area of vaccine became red, hard and itching. I took Benadryl with no change. Called provider on 1/23/2021 and was seen virtually. Area is now between 6-7 cm . Advised to apply ice, topical steroid cream and marked the area,. Prescription for Bactrim was given incase symptoms increased. This helped some on 1/24/2021 in PM area increased , I had general malaise and a stiff neck with joint pain. I started the prescribed Bactrim-for questionable cellulitis. provider recommended I not receive the second dose

Other Meds: Novolog-via Insulin pump Aspirin 81 Metformin 500mg BID Crestor 5 QOD Losartan 25 Metoprolol 50 QD Advil -prn

Current Illness: Type 1 Diabetes- on an insulin pump

ID: 0970239
Sex: F
Age: 86
State: NC

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/25/2021
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: Phenobarbitol

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

Symptoms: Nausea, diarrhea, tired moderna COVID-19 vaccine EUA

Other Meds: Xanax, hydrocodon,vitamins,amlodipine,benazapril

Current Illness:

ID: 0970240
Sex: F
Age: 63
State: PR

Vax Date: 01/19/2021
Onset Date: 01/21/2021
Rec V Date: 01/25/2021
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: Unevaluable event

Symptoms: PAIN ON SHOULDER IN NECK SWELLING GANGLIOS. SINTOMES FOUR DAYS.

Other Meds: NONE

Current Illness: NONE

ID: 0970241
Sex: F
Age: 58
State: VA

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
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: N/v to a few antibiotics

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

Symptoms: Usual: aches, pain at site, headache Unusual: fever >103, gross hematuria (no history of UTIs or kidney stones)

Other Meds: Tegretol, atenolol, vitamin D3, Zyrtec, aleve

Current Illness: None

ID: 0970242
Sex: F
Age: 49
State: NY

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/25/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Individual was one of the vaccinator and wanted her 2nd dose. She is giving out Pfizer vaccine in her room, unfortunately, she needs the moderna vaccine second dose. She asked me to give her dose now as there was no one in her line. I administered the Pfizer 0.3ml to her and after giving her, she told me that she needed moderna, however she did not tell me and I should have looked at her chart first. She knew she was moderna but did not verbalized this until later.

Other Meds: unknown

Current Illness: none

ID: 0970243
Sex: M
Age: 41
State: PR

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Injection site pain, Menorrhagia

Symptoms: A week after the injection, it was red, swollen, itchy around the injection site (left arm)

Other Meds: N/A

Current Illness: N/A

ID: 0970244
Sex: F
Age: 49
State: VA

Vax Date: 01/14/2021
Onset Date: 01/20/2021
Rec V Date: 01/25/2021
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: Penicillin

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

Symptoms: Itchiness, growing red rash Benedryl, Ice compress rash continues to cover more of left arm

Other Meds: Vitamin D3, Iron Supplement

Current Illness: none

ID: 0970245
Sex: F
Age: 29
State: VA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
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: Amoxicillin, Hydrocodone, Percocet, Tramadol

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 1/22/21, the day after the I received the vaccine I started to have chills, body aches, low grade fever, headache, nausea, lack of appetite, and arm pain in the right arm. This lasted for two days. On day 3 I began to feel dizzy and have extreme low back pain and stomach pain with nausea with again lack of appetite. By this time the body aches and arm pain went away but I still have a headache. Now on day 4 the low back pain has gone away but still I have a headache and lack of appetite and nausea.

Other Meds: Chlorthalidone 25mg, Amlodipine-Besy-Benazepril 5-20mg and Depo-Provera

Current Illness: Hypertension, Hypoglycemic,

ID: 0970246
Sex: F
Age: 52
State: IN

Vax Date: 01/22/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: iv dye

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: body aches, low grade fever - total duration approx 36 hrs

Other Meds: valtrex, fish oil, zinc, vitamin d, vitamin c, calcium,

Current Illness: none

ID: 0970247
Sex: M
Age: 58
State: NH

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/25/2021
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: none

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

Symptoms: injection site ache, mild

Other Meds:

Current Illness:

ID: 0970248
Sex: M
Age: 41
State: NY

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Peanuts

Symptom List: Nausea

Symptoms: 2 hours after administration of vaccine, patient reported shortness of breath, abdominal pain, and difficulty swallowing. Patient returned to the clinic where he was given supplemental oxygen via nasal cannula and EpiPen. Oxygen removed and vitals stable. Due to EpiPen administration and continued feeling of throat swelling, patient sent to ER via EMS. Patient given 1L NS and Solumedrol IV. Discharged home in stable condition from the ER.

Other Meds: None

Current Illness: None

ID: 0970249
Sex: F
Age: 37
State: OH

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Latex, PCN

Symptom List: Injection site pain

Symptoms: On 1/20/21 approximately 8 hours after vaccine noticed redness, tenderness distal to injection site or right deltoid IM. Redness, tender/painful to touch increased over next 48 hours with area increasing in size. By Monday, less red, more pink and diffuse. Still tender to touch and painful it is now almost itch like feeling. I took 5 Zyrtec pills and a Pepcid through the course of 12 hrs. on Saturday as well as iced the red area. Only other treatment to date was putting hydrocortisone cream on it Sunday night. Plan on seeing either urgent care or Dermatologist today, 1/25. I have pictures but am unable to attach them. I can email them if someone will email me with the proper address.

Other Meds: Oral birth control, spironolactone

Current Illness: None

ID: 0970250
Sex: F
Age: 51
State: ME

Vax Date: 01/20/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Pork

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

Symptoms: Raised red rash blotches surrounded injection site. Warm to touch. Fading after24 hours. Very light but still detectable after36 hours.

Other Meds: Tylenol, Zyzal, Omepeazole

Current Illness: No

ID: 0970251
Sex: F
Age: 72
State: GA

Vax Date: 01/17/2021
Onset Date: 01/24/2021
Rec V Date: 01/25/2021
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: Itching at injection site that started on 1/24 - one week after injection

Other Meds:

Current Illness:

ID: 0970252
Sex: F
Age: 61
State: CT

Vax Date: 01/24/2021
Onset Date: 01/25/2021
Rec V Date: 01/25/2021
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: Tremor

Symptoms: Nose bleed never ever do i get nose bleeds 19 hours after vaccine very odd This was my second vaccine nothing happened with the first one

Other Meds: Rizatripten

Current Illness: None

ID: 0970253
Sex: F
Age: 58
State: NJ

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
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: Plavix Hot Dog (Nitrates) Penicillin

Symptom List: Erythema, Pruritus

Symptoms: Slight swollen lips, hive like rash on legs, Nausea and vomiting: all went away with in 24 hours severe vertigo with this for 2 days, vertigo is still happening on 3rd day but has lessened did not seek medical attention: took benadryl 1st day only and it took care of the symptoms except vertigo Started Meclizine 25 mg over the counter on day2 and it makes vertigo tolerable but still persitant at this point

Other Meds: Multivitamin

Current Illness: No acute illness

ID: 0970254
Sex: F
Age: 41
State: TX

Vax Date: 01/16/2021
Onset Date: 01/24/2021
Rec V Date: 01/25/2021
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: None

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

Symptoms: There is a 4" by 5" raised red patch around the injection site. The patch presents with a higher temperature than the rest of the arm, is raised, as well as causes itching.

Other Meds: Prozac 40mg Armor Thyroid

Current Illness: None

ID: 0970255
Sex: M
Age: 58
State: NH

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/25/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: aches, fatigue - flu-like symptoms for 2.5 days

Other Meds: metformin, naproxen, lipitor

Current Illness: none

ID: 0970257
Sex: F
Age: 62
State:

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/25/2021
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: NKA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Conjunctival hemorrhage encompassing 2/3 of right eye; examined by ophthalmologist; resolving now; no loss of vision or any other problem

Other Meds: levothyroxine 88 mcg/d; vitamin D 1000 IU/d

Current Illness: None

ID: 0970258
Sex: F
Age: 70
State: NM

Vax Date: 01/15/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
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: Sulfa

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

Symptoms: Rash 7 days after injection. It's hot and itchy

Other Meds: Progesterone, lisinopril, Prevastatin, Vitamin D, Estradiol, Testoster, Collegen w/biotin, NP Thyroid, DHEA

Current Illness: None

ID: 0970259
Sex: F
Age: 41
State: NY

Vax Date: 01/08/2021
Onset Date: 01/17/2021
Rec V Date: 01/25/2021
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: Penicillin Amoxicillin Cefzil Fentanyl Advair/Flovent Lexapro anti-nausea meds Nickel Bananas, strawberries, kiwi

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

Symptoms: Day after initial shot my arm became sore, red, hot, swollen and hard. This was in addition to other side effects. This subsided after 4-5 days. On day 9 after injection my arm became red, and hot again at the injection site. It was not as inflamed as the initial injection reaction, however very noticeable. On day 10 I woke at night with vertigo as well. I was able to fall back asleep after about an hour, and when I woke the next morning the vertigo has subsided. My arm had redness on and off for about 5 more days, seeming to get worse after my shower. The redness has now subsided completely, however it looks as though I have a minor "bruise" under my skin at the injection site.

Other Meds: Loratadine 10 mg Vitamin D 2000 Vitamin C 500

Current Illness: N/A

ID: 0970260
Sex: F
Age: 22
State: IN

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
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 allergy

Symptom List: Pain in extremity

Symptoms: Got my 2nd does thursday afternoon, Friday I had a fever of 101.3, chills, headache, very weak and tired. I took tylenol and was feeling better on Saturday. Woke up Sunday with a sore throat, red/swollen and this has lingered into today (Monday), throat feeling worse.

Other Meds: None

Current Illness: None

ID: 0970261
Sex: M
Age: 63
State: TX

Vax Date: 01/12/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Gadolinium (MRI contrast media)

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

Symptoms: On Saturday 01/23/2021 morning when I got out of bed I experienced difficulty maintaining my balance. I had to use a wall to be able to stand. I did not fall. I stumbled into the bathroom, still unsteady. I urinated sitting down, still feeling unsteady, head spinning. I took my blood pressure 130/70, which is normal. Was feeling steadier. Was able to walk down stairs to ground floor of home. Still not felling normal, but steady on my feet. After eating breakfast, no additional symptoms through day. I had not consumed any alcoholic beverages over the past week. When I went to bed Sat night, lying in bed I was light headed. Sunday morning same problems. I performed some vehicle maintenance and would get down on the ground. Head would start spinning, everything would return to normal once standing. At bedtime same feelings when lying down in bed. Monday morning (today) same problems.

Other Meds: Metoprolol Succinate ER 25 mg daily Fiber Caplets - 4 daily Aspirin 81 mg daily Vitamin D3 - 1000 iu daily Alteril sleep aid - 2 tablets nightly

Current Illness: none

ID: 0970262
Sex: F
Age: 32
State: TX

Vax Date: 01/12/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
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: On day 10 after the first Moderna injection, injection site became swollen, red, and itchy. It was around 3x2.5 inches across and hot and painful to the touch. Today is day 12 and the injection site still looks the same.

Other Meds: Zoloft 50mg

Current Illness: None

ID: 0970263
Sex: F
Age: 72
State: NY

Vax Date: 01/16/2021
Onset Date: 01/23/2021
Rec V Date: 01/25/2021
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 1/23/21 one week after vaccine administration-itching at injection site, redness (approx. 2 inches in diameter), stiffness in upper arm. Redness is somewhat less today, 1/25, but occasional itching and stiffness still occur.

Other Meds: Levothyroxine (25mcg); Rosuvastatin (5mg); One A Day Women's Vitamin; Citracal Calcium Supplement; Prolia (injection 2x year--next injection February 8, 2021).

Current Illness: None

ID: 0970264
Sex: F
Age: 80
State: MD

Vax Date: 01/24/2021
Onset Date: 01/24/2021
Rec V Date: 01/25/2021
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: Analgin ( pain medication)

Symptom List: Vomiting

Symptoms: Moderna COVID-19 Vaccine EUA My mother got a nose bleed around 9pm after taking her medications that evening. The bleed was not significant and stoped fast. No medical help was sought.

Other Meds: Losartan-HCTZ 100-25mg (1/day morning) , Clopidogrel 75mg (1/evening) Rosuvastatin Concor COR 5mg (1/2/day) Digestive enzymes

Current Illness: No

ID: 0970265
Sex: F
Age: 59
State: PR

Vax Date: 01/11/2021
Onset Date: 01/18/2021
Rec V Date: 01/25/2021
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: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Rash on the Face

Other Meds: Sinjardy, glimepiride, gabapentin, Atacand

Current Illness:

ID: 0970266
Sex: F
Age: 55
State: VA

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
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: none

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

Symptoms: severe nausea and headache followed by 3 episodes of vomiting . onset 24 hours after vaccine. Vomiting over period of 15 hours. Severe body aches, lethargy, no appetite and overall weakness for 2 days .

Other Meds: Tylenol

Current Illness: none

ID: 0970267
Sex: F
Age: 66
State: TX

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 01/25/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 01/15/2021 had constant headache for 2 days. On 1/22/2021, had itching and developed rash/redness around injection site.

Other Meds: Vitamin D, Calcium

Current Illness: none

ID: 0970268
Sex: M
Age: 37
State: MI

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/25/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: For three days after the vaccine I would alternate between chills and hot flashes. I also had body aches all over. I was lethargic, just drained of energy. I did not have a fever at anytime. Three days after the vaccine I developed a scratchy throat and cough.

Other Meds: B12 complex and Vitamin D supplements

Current Illness: none

ID: 0970269
Sex: F
Age: 38
State: NJ

Vax Date: 01/16/2021
Onset Date: 01/24/2021
Rec V Date: 01/25/2021
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: No

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

Symptoms: Sore arm at injection site muscle starting a few hours of injection on 1/16/21, resolved within 24 hours. As of 1/24 I noticed small lump and a hive like rash in the general vicinity of the injection site. Rash has grown since first noting merging two "hives" into one large one.

Other Meds: Multivitamin, elderberry and calcium + D

Current Illness: No

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm