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**
PLEASE CHECK BACK SOON
Download the files above while you wait.






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: 1025699
Sex: F
Age: 46
State:

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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: Headache, Myalgia, Arthralgia, Fever, NauseaVomiting, injection site pain, chills, weakness Narrative: The day after receiving the second dose of the vaccine, the patient reported pain in her left (injection) arm, a fever of 101 (F), headache, nausea, generalized body aches and weakness. She took three doses each of acetaminophen 650mg and ibuprofen 400mg that day.

Other Meds:

Current Illness:

ID: 1025700
Sex: F
Age: 58
State:

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
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: Headache, Diarrhea, diarrhea, HA

Other Meds:

Current Illness:

ID: 1025701
Sex: F
Age: 39
State:

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
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: Headache & Arthralgia

Other Meds:

Current Illness:

ID: 1025785
Sex: F
Age: 29
State:

Vax Date: 01/27/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
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: mild arm soreness, mild-moderate flu like symptoms

Other Meds:

Current Illness:

ID: 1025793
Sex: F
Age: 51
State:

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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: Headache, Arthralgia, Fatigue, stuffy nose

Other Meds:

Current Illness:

ID: 1296670
Sex: F
Age: 23
State: ME

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/28/2021
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: Ibuprofen

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

Symptoms: Patient states she received 2nd dose Pfizer Covid 19 vaccine lot #EL3302 on 1/11/2021. Patient reports 7/10 body aches, fever 38.2, nausea and dizziness that prevented patient from standing without being steadied by someone else. Patient reports dizziness and nausea lasted two days. Body aches improved after one day. Fever present only on the second day. Patient had to miss work on 1/12/21 & 1/13/21 due to symptoms. Patient was tested for Covid and reports Covid swab was negative. Patient denies any side effects following the 1st Pfizer vaccine. Patient denies any ongoing symptoms or concerns today. VAERS. D/c from EHS.

Other Meds:

Current Illness: denies

ID: 1296761
Sex: M
Age: 29
State: PA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/28/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Tongue went numb and throat tightened

Other Meds: None

Current Illness: None

ID: 1296818
Sex: F
Age: 30
State: PA

Vax Date: 12/23/2020
Onset Date: 01/08/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies: Seasonal

Symptom List: Pharyngeal swelling

Symptoms: itchy rash - hips , thighs after vaccine #1 12-23-20 rash developed on 1/8/20 had vaccine #2 - 1/13/21 - rash progressed to include upper back, elbows, axilla

Other Meds:

Current Illness:

ID: 1296819
Sex: M
Age: 53
State: PA

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/28/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Pain in right shoulder joint, pan In right hip joint,. Pain in lower pelvic area and leftlower leg swelling. Difficulty keeping balance at times. loss of strength to right shoulder and right hip

Other Meds: Metformin, losartin B12 Basaglar

Current Illness: none

ID: 1296820
Sex: F
Age: 61
State: ME

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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: Tree pollen, chronic hives, dust mites

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient reports she received 2nd Moderna vaccine lot #013L20A on 1/25/2021. Patient reports by 11AM on 1/26, she felt achy, temperature 101.5, states "every joint hurt". Patient left work early 1/26 and stayed home on 1/27/2021. Today 01/28, Patient returned to work since fever resolved. While at work, patient was advised to contact Covid line who directed patient to get tested and quarantine at home. Patient adds injection site has grapefruit size redness, swelling, and feels itchy. Patient contacted her PCP and was advised to self monitor. Patient has intermittently applied ice. Patient takes Allegra daily. Manager suggested warm compress. Patient denies to see EHS. Patient will contact manager with update tomorrow 1/29. Will follow. VAERS.

Other Meds: Allegra, XOLAIR inj monthly

Current Illness: denies

ID: 1296821
Sex: F
Age: 58
State: VA

Vax Date: 01/23/2021
Onset Date: 01/23/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies: taxol, carboplatin, Latex

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

Symptoms: Flushed in waves for 8hrs.

Other Meds: Lisinopril, Atorvastatin, echinacea Jardiance, Multivitamin

Current Illness:

ID: 1296822
Sex: F
Age: 47
State: ME

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Please see continuation page for adverse events

Other Meds: amorthyroid, Ativan, uricept, Spiralactone, Adderall

Current Illness: denies

Date Died: 01/27/2021

ID: 1296823
Sex: F
Age: 50
State: IL

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: According to facility representative on 1/27/2021 at approximately 7:15 am, pt was discovered not breathing with no pulse. Resident was pronounced dead at 7:44 am on 1/27/2021. Resident was previously tested positive for COVID-19 on 12/9/2020.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1296824
Sex: M
Age: 62
State: OH

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
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: Penicillin

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

Symptoms: Severe Chills, mild body aches

Other Meds: Lisinopril, Allopurinol, Atorvastatin, Metoprolol, Aspirin

Current Illness: None

ID: 1407115
Sex: M
Age: 40
State:

Vax Date: 01/06/2021
Onset Date: 01/13/2021
Rec V Date: 01/28/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Headache, Myalgia, NauseaVomiting, weakness, sore arm Narrative:

Other Meds:

Current Illness:

ID: 1407246
Sex: F
Age:
State:

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Myalgia & Fever Narrative:

Other Meds:

Current Illness:

ID: 1407247
Sex: F
Age: 34
State:

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/28/2021
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:

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

Symptoms: Headache, Myalgia, fatigue, chills Narrative:

Other Meds:

Current Illness:

ID: 1407249
Sex: F
Age: 52
State:

Vax Date: 01/15/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Myalgia & Fever Narrative:

Other Meds:

Current Illness:

ID: 1407250
Sex: F
Age: 41
State:

Vax Date: 12/30/2020
Onset Date: 12/29/2020
Rec V Date: 01/28/2021
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: Headache, Arthralgia, Fever, pain at injection , chills Narrative:

Other Meds:

Current Illness:

ID: 1407256
Sex: F
Age: 38
State:

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Fever, fatigue Narrative:

Other Meds:

Current Illness:

ID: 1407260
Sex: F
Age: 32
State:

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Myalgia Narrative:

Other Meds:

Current Illness:

ID: 1407263
Sex: M
Age: 50
State:

Vax Date: 01/27/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Myalgia metalic taste Narrative:

Other Meds:

Current Illness:

ID: 1407264
Sex: M
Age: 65
State:

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 01/28/2021
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:

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

Symptoms: Headache & Myalgia Narrative:

Other Meds:

Current Illness:

ID: 1407269
Sex: M
Age: 49
State:

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 01/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Headache, Diarrhea, congestion, fatigue Narrative:

Other Meds:

Current Illness:

ID: 1407271
Sex: F
Age: 64
State:

Vax Date: 01/20/2021
Onset Date: 01/22/2021
Rec V Date: 01/28/2021
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: Injection site pain, Menorrhagia

Symptoms: Headache, Myalgia, Fever, Diarrhea & NauseaVomiting Narrative:

Other Meds:

Current Illness:

ID: 1407273
Sex: F
Age: 52
State:

Vax Date: 01/12/2021
Onset Date: 01/14/2021
Rec V Date: 01/28/2021
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:

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

Symptoms: NauseaVomiting swollen lymph node, fatigue Narrative:

Other Meds:

Current Illness:

ID: 1407274
Sex: F
Age: 49
State:

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Headache, Myalgia, NauseaVomiting, chills Narrative:

Other Meds:

Current Illness:

ID: 1407275
Sex: M
Age: 47
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Headache, Myalgia, Arthralgia, Fever, Diarrhea & NauseaVomiting Narrative:

Other Meds:

Current Illness:

ID: 1407276
Sex: F
Age: 46
State:

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Myalgia, NauseaVomiting, fatigue, flushed, arm soreness Narrative: Myalgia, nausea, fatigue, flushed, arm soreness

Other Meds:

Current Illness:

ID: 1407278
Sex: F
Age: 49
State:

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Dizziness, Headache & Myalgia Narrative:

Other Meds:

Current Illness:

ID: 1407279
Sex: M
Age:
State:

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Headache & Arthralgia Narrative:

Other Meds:

Current Illness:

ID: 1407281
Sex: F
Age: 29
State:

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/28/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Headache, Myalgia, Fever & Diarrhea Narrative:

Other Meds:

Current Illness:

ID: 1407283
Sex: F
Age: 29
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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: Myalgia, Nausea Vomiting, Fatigue, chills Narrative:

Other Meds:

Current Illness:

ID: 1407284
Sex: F
Age: 51
State:

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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:

Symptom List: Tremor

Symptoms: Headache, Myalgia, Fever, fever, chills, H/A, body aches, fatigue Narrative:

Other Meds:

Current Illness:

ID: 1407285
Sex: F
Age: 59
State:

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Myalgia Fatigue - described as intense Narrative: Described fatigue and myalgia as "intense" from "top to bottom"

Other Meds:

Current Illness:

ID: 1407286
Sex: F
Age: 64
State:

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
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:

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

Symptoms: Headache, Myalgia, Fever, TENDERNESS AT SITE, CHILLS, SOMENELENCE, FATIGUE Narrative:

Other Meds:

Current Illness:

ID: 1407287
Sex: F
Age: 34
State:

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Headache, Myalgia, chills Narrative:

Other Meds:

Current Illness:

ID: 1407289
Sex: M
Age:
State:

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
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:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever Narrative:

Other Meds:

Current Illness:

ID: 1407290
Sex: F
Age: 51
State:

Vax Date: 01/06/2021
Onset Date: 01/14/2021
Rec V Date: 01/28/2021
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:

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

Symptoms: Myalgia right lymphedema, fatigue, chills/sweats Narrative:

Other Meds:

Current Illness:

ID: 1407291
Sex: F
Age: 28
State:

Vax Date: 01/13/2021
Onset Date: 01/14/2021
Rec V Date: 01/28/2021
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:

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

Symptoms: Headache Myalgia, Fever & Nausea Vomiting Narrative:

Other Meds:

Current Illness:

ID: 1407294
Sex: F
Age: 37
State:

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 01/28/2021
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: Pain in extremity

Symptoms: Myalgia chills Narrative:

Other Meds:

Current Illness:

ID: 1407295
Sex: F
Age: 26
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Chills Narrative:

Other Meds:

Current Illness:

ID: 1407298
Sex: F
Age: 52
State:

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
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:

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Headache, Myalgia, Fever, arm pain Narrative:

Other Meds:

Current Illness:

ID: 1407299
Sex: M
Age: 35
State:

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Headache Pain @ injection site, congestion Narrative:

Other Meds:

Current Illness:

ID: 1407300
Sex: F
Age: 33
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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:

Symptom List: Vomiting

Symptoms: tongue tingling Narrative: "Fullness back of neck" 5 min after vaccination 2nd. Hx uncontrolled hypertension on no meds. Observed 30 min. 12:24 182/132, hr 92. 12:27 185/113 mild tongue tingling. 12:50 176/117 tingling resolved. PCP for f/u chronic htn. Asymptomatic HTN.

Other Meds:

Current Illness:

ID: 1407302
Sex: F
Age: 38
State:

Vax Date: 01/25/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Myalgia, Fever, fatigue, headache Narrative:

Other Meds:

Current Illness:

ID: 1407307
Sex: F
Age: 63
State:

Vax Date: 01/27/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Fever & Rash Narrative: Fever 102, myalgia, headache, rash on injection arm, Has standing appt with pcp 1/28 and will address any remaining s/s at the time.

Other Meds:

Current Illness:

ID: 1417140
Sex: F
Age: 27
State:

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 01/28/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Heartburn Narrative:

Other Meds:

Current Illness:

ID: 1417158
Sex: M
Age: 58
State:

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 01/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Arthralgia, chills, joint and muscle pain, HA, injection site tenderness Narrative: Patient took OTC ibuprofen for sx

Other Meds:

Current Illness:

ID: 1417235
Sex: F
Age: 49
State:

Vax Date: 01/26/2021
Onset Date: 01/26/2021
Rec V Date: 01/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Headache, Nausea Vomiting, Fatigue, stuffy nose Narrative:

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm