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: 0923728
Sex: F
Age:
State:

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
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: My ear started to ring; My blood pressure was kind of up; Lot of anxiety; This is a spontaneous report from a contactable consumer (patient). A 39-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EK9231), via an unspecified route of administration on 30Dec2020 at single dose for covid-19 immunization. Medical history included neuropathy. Concomitant medication included pregabalin (LYRICA) for neuropathy. The patient experienced side effects on 30Dec2020: she had the injection on 30Dec2020 and then about five minutes after like she just walked to sit down, her ear started to ring pretty significantly just like ring in both ears and she spoke with the medical professional there, the nurse was like to see her blood pressure and she did, her blood pressure was kind of up and the ear ring had continued. It never stopped. It got better. She was kind of had a lot of anxiety around this. The outcome of event ear started to ring was resolving, outcome of other events was unknown.

Other Meds: LYRICA

Current Illness:

ID: 0923729
Sex: M
Age: 21
State: WA

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: none that I am aware of

Symptom List: Anxiety, Dyspnoea

Symptoms: 2 3/4 in. by 1 3/4 in. area of redness with some swelling and slight itchiness.

Other Meds: none

Current Illness: none

ID: 0923730
Sex: U
Age:
State: GA

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
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: I am so fatigue, so tired; I have like some lower nasal congestion but it's more or like facial pressure like sinusitis; I have like some lower nasal congestion but it's more or like facial pressure like sinusitis; I have like some lower nasal congestion but it's more or like facial pressure like sinusitis; Now my head is hurting a little bit.; For more than ever I can't either keep myself up; This is a spontaneous report from a contactable consumer (patient). A 43-year-old patient of an unspecified gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 30Dec2020 at a single dose for COVID-19 immunization. Medical history included hypertension, allergy, asthmatic. Concomitant medication included amlodipine for hypertension, hydrochlorothiazide (that's water pill). On 31Dec2020, the patient experienced so fatigue, so tired, so patient had to get out of it. The patient had like some lower nasal congestion but it's more or like facial pressure like sinusitis, head was hurting a little bit, for more than ever patient can't either keep itself up. The outcome of events was unknown. Information on the Batch/Lot number has been requested.

Other Meds: ;

Current Illness:

ID: 0923731
Sex: F
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 01/06/2021
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: Headache; Chills; Joint pain; My fever went up to 102.7; This is a spontaneous report from a contactable nurse. A 54-year-old female patient receive bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number EH9899), via an unspecified route of administration in Left Upper arm on an unspecified date at a single dose for covid. The patient medical history was not reported. Concomitant medication included magnesium hydroxide (MILK OF MAGNESIA). The patient called in to report side effects. The patient received the vaccine at 9 am then woke up in the middle of the night with the headache and chills, joint pain, fever that went up to 102.7. Treatment included Tylenol. The nurse considered the events as related to the vaccine. The outcome of the events was unknown.

Other Meds: MILK OF MAGNESIA

Current Illness:

ID: 0923732
Sex: F
Age: 34
State: MI

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Numbness and tingling in roof of mouth, tongue, and lips; no medications given, Transferred to ED for evaluation and further monitoring

Other Meds: NKDA

Current Illness:

ID: 0923733
Sex: M
Age:
State: CA

Vax Date: 12/30/2020
Onset Date: 12/01/2020
Rec V Date: 01/06/2021
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: flare of arthritis; This is a spontaneous report from a contactable consumer (patient) via a Pfizer-sponsored program. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 30Dec2020 at single dose for COVID-19 immunization. Medical history included arthritis from an unknown date and unknown if ongoing. The patient's concomitant medications were not reported. The patient received Covid-19 vaccine on 30Dec2020, then he had flare of arthritis in Dec2020 (have this before having the vaccine). Asked if take steroids will affect the Covid-19 vaccine. The outcome of the event was unknown. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 0923734
Sex: U
Age:
State:

Vax Date: 12/01/2020
Onset Date:
Rec V Date: 01/06/2021
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: Arm little bit swollen, the arm that I got the shot on; My body feels like tired; This is a spontaneous report from a contactable consumer (patient). A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiry date were unknown) via an unspecified route of administration (arm), on an unspecified date in Dec2020, at a single dose, for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient stated, "I took the COVID vaccine yesterday and my arm has a little bit swollen, the arm that I got the shot on. And my body is just like you know when you are, it just feels like my body feels like tired. I was wondering can I take Tylenol or no? I just have one more question, do you think I should be going to work today?" Outcome of the events was unknown. Information about lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 0923735
Sex: F
Age:
State: CA

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
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: It was like mild lower back pain like on the lower left part of my back on top of my buttocks; Pain just seems to be getting worse; Dizziness/Lightheaded; Headache; This is a spontaneous report from a contactable healthcare professional. A 59-year-old female patient received her first dose of bnt162b2 (BNT162B2 also reported as Covid 19 Vaccine; lot number: EL3246; expiration date: unknown), via an unspecified route of administration left upper arm on 30Dec2020 11:30 AM at a single dose for Covid-19 vaccination. The patient has no medical history and concomitant medications. The patient reported that she got her first dose of Pfizer vaccine (COVID-19 Vaccine) yesterday (30Dec2020) and today (31Dec2020), she was having at first it was like mild lower back pain like on the lower left part of her back, on top of her buttocks and now it's getting worse. The patient inquired if it was like a side effect. The patient further stated that yesterday (30Dec2020), she had a side effects like the dizziness, lightheaded and the headache and that went away after she took Tylenol (treatment) but then today this pain just seems to be getting worse. The paracetamol (TYLENOL) was given to her at hospital yesterday for the headache and the dizziness. She hasn't taken anything today because she was not sure if it is okay for her to take Ibuprofen which is what she would prefer to take. She received her COVID-19 Vaccine at a hospital. The outcome of the events was not recovered.

Other Meds:

Current Illness:

ID: 0923736
Sex: M
Age: 57
State: FL

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: One day after Moderna Covid 19 vaccine eua my wife noticed a blister on my forehead. I initially dismissed it as one of those things. Over the next couple of days the blisters spread in a line on my forehead. Soon after the blisters were around my ear. I went to an urgent care and was diagnosed with shingles. Currently the blisters on my forehead are receding, but the blisters behind my ear are still painful. I received valtrex for the treatment of shingles

Other Meds: Lisinopril lexapro allopuronol trazadone multivitamin

Current Illness: no

ID: 0923737
Sex: U
Age:
State:

Vax Date: 12/26/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
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: headache; This is a spontaneous report from a contactable consumer (patient). A patient of unspecified age and gender received BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine; lot number: EK5730), via an unspecified route of administration on 26Dec2020 at a single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient got the Covid vaccine on 26Dec2020. The patient's daughter has like a fever yesterday with headache. The patient thinks his/her daughter has Covid and was just tested yesterday, so they still do not have results. Today (01Jan2021) the patient woke up with a headache, a different headache than which he/she usually has, but he/she does not have fever. The patient is not sure if she should report this, but he/she was told to report anything to the Pfizer company. The patient asked if he/she should be tested for Covid as well. The outcome of the event was unknown.

Other Meds:

Current Illness:

ID: 0923738
Sex: F
Age:
State: VA

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/06/2021
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: she did not felt great/ felt the worst that she had been feeling; temperature was like 100.3/fever; chills; This is a spontaneous report from a contactable other healthcare professional (patient herself). A 33-year-old female patient received bnt162b2 (BNT162B2 also reported as Covid19 Vaccine a Pfizer, lot EH9899, expiry date not reported), via an unspecified route of administration on 29Dec2020, single dose, for Covid-19 immunisation (prevention of Covid-19). Medical history was none. Concomitant medication included PRENATAL VITAMINS. The patient informed she did not felt great the day (29Dec2020) or 2 that when she got the vaccine. She felt the worst that she had been feeling. Her temperature was like 100.3/fever and had chills (29Dec2020). No treatment was taken. The outcome of the events was unknown.

Other Meds: PRENATAL VITAMINS [MINERALS NOS;VITAMINS NOS]

Current Illness:

ID: 0923739
Sex: F
Age:
State: CA

Vax Date: 12/20/2020
Onset Date: 12/28/2020
Rec V Date: 01/06/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Shingles; This is a spontaneous report from a contactable nurse reporting for herself. A 61-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number PAA156571) via an unspecified route of administration, on 20Dec2020, single dose for COVID-19 immunization. Relevant medical history included hypercholesterolemia. Concomitant medications were not reported. The patient took unspecified medication for hypercholesterolemia however the patient stopped taking it for a month or two already. The patient got the first Pfizer vaccine shot on work (clinic) on 20Dec2020. On 28Dec2020, the patient developed shingles which is now being treated. The patient does not know if this is because of that or a part of it. The patient never had Shingles before. Outcome of the event was unknown.

Other Meds:

Current Illness:

ID: 0923740
Sex: M
Age: 54
State: IL

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: High blood pressure. BP went from 146/84 before immunization to 185/90 post immunization. The day after BP is 193/106 and requires medical evaluation.

Other Meds: none

Current Illness:

ID: 0923741
Sex: F
Age:
State:

Vax Date: 01/02/2021
Onset Date:
Rec V Date: 01/06/2021
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:

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

Symptoms: headache; This is a spontaneous report from a contactable consumer from a Pfizer Sponsored Program. A female patient of an unspecified age received bnt162b2 (BNT162B2 PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 02Jan2021 at a single dose for immunization. The patient's medical history and concomitant medications were not reported. The patient received the vaccine the day prior to the report and she got a headache. The event outcome was unknown. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 0923742
Sex: F
Age:
State: HI

Vax Date: 12/24/2020
Onset Date:
Rec V Date: 01/06/2021
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: scratchy throat; tired; headache; This is a spontaneous report from a contactable nurse (patient). A 58-year-old female received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, lot number and expiry date not reported), intramuscular in 24Dec2020 11:30 at a single dose in the left arm as Covid vaccine. The patient had no medical history. The patient no known allergies. Concomitant medication included propranolol (within the two weeks). The patient had no prior COVID vaccination and was not tested for COVID post vaccination. On an unknown date, the patient experienced scratchy throat, tired, and headache. No treatments received in response to the events reported. The events were reported as not serious (did not result in death, not life-threatening, did not cause/prolonged hospitalization, not disabling/incapacitating and not a congenital anomaly/birth defect). The outcome of the events scratchy throat, tired, and headache was recovered with lasting effects. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 0923743
Sex: F
Age: 32
State: TX

Vax Date: 12/26/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
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: I had a miscarriage on 01/01/2021 Estimated date of Delivery 09/7/ 2021

Other Meds: Prenatal Vitamin

Current Illness: None

ID: 0923744
Sex: F
Age:
State:

Vax Date: 01/03/2021
Onset Date: 01/03/2021
Rec V Date: 01/06/2021
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: severely dehydrated; sweaty; dizzy; This is a spontaneous report from a non-contactable consumer (patient). A 30-year-old female patient started to receive BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), lot/batch number not reported, via an unspecified route of administration from 03Jan2021 14:30 to 03Jan2021 14:30 as single dose for COVID-19 immunization. Medical history included allergies to latex, psoriatic arthritis, asthma, migraines and COVID19 prior vaccination. The patient's concomitant medications were not reported. The patient previously took Vicodin, Codeine, Imitrex and experienced allergies. On 03Jan2021 15:00, the patient got severely dehydrated, sweaty, dizzy. The outcome of the events was recovered. The patient does not received treatment for the events. No follow-up attempts are possible. Information about lot/batch number cannot be requested. No further information is expected.

Other Meds:

Current Illness:

ID: 0923745
Sex: M
Age:
State: WI

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
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: Soreness in injection site; This is a spontaneous report from a contactable other healthcare professional (patient). A 43-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EK5730), via an unspecified route of administration (arm left) on 31Dec2020 (10:00) to 31Dec2020 10:00 at single dose for Covid-19 immunization. The patient's medical history included GERD (gastroesophageal reflux disease). Concomitant medications were not reported. The patient has no allergy to medications, food, or other products. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination. The patient experienced soreness in injection site on 31Dec2020 17:00 with outcome of recovering. There was no treatment received for the adverse event. The patient has not been tested for COVID-19 since the vaccination. This case is non-serious.

Other Meds:

Current Illness:

ID: 0923746
Sex: F
Age: 10
State: FL

Vax Date: 12/20/2020
Onset Date: 12/20/2020
Rec V Date: 01/06/2021
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: given DT instead of Tenivac with no AE; Initial information received on 21-Dec-2020 regarding an unsolicited valid non-serious case received from a consumer/non-healthcare professional (caregiver of the patient). This case involves a 10 years old female patient who was given DIPHTHERIA AND TETANUS TOXOIDS instead of DIPHTHERIA AND TETANUS TOXOIDS (Tenivac) (wrong product administered). The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. Concomitant medication was unknown. The caller said that his daughter had cut her hand on a rusty nail last night and he took her to the ER for a tetanus shot. On 20-Dec-2020, the patient received a once dose of suspect DIPHTHERIA AND TETANUS TOXOIDS instead of DIPHTHERIA AND TETANUS TOXOIDS (Tenivac)(with unknown strength, formulation, dose, frequency and lot number; expiration date: 31-May-2022) via unknown route in unknown administration site. It was a case of actual medication error due to wrong vaccine administered. (latency same day). He was very frustrated and upset. He wanted to know what side effects she might have. At the time of report, no adverse event was reported. There will be no information available on the batch number for this case. This suspected adverse reaction report is 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 practices. The classification as a medical error is 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 has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 0923747
Sex: M
Age: 37
State: FL

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

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

Lab Data:

Allergies: PCN as child

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

Symptoms: Pt received vaccine at 11:45 and was sitting in observation for 8 minutes when he stated he felt like he was getting really warm. Pt was put in wheelchair and taken to a room to lay down. Vital signs BP 139/88, P 68, R 20 SP02 98%. Pt face was flush. No signs of SOB or any other symptoms. After 10 minutes patient stated the "hot feeling" was going away. We monitored him for additional 30 minutes and patient was able to sit up without any difficulties or changes in the way he felt. Patient was released to his command with no limitations.

Other Meds: Protein shakes in the morning

Current Illness: None listed

ID: 0923748
Sex: F
Age: 40
State: NH

Vax Date: 12/30/2020
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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: none

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

Symptoms: lymphatic reaction in left axillary. Hard painful lymph.

Other Meds: none

Current Illness: none

ID: 0923749
Sex: F
Age: 22
State: CO

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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: Fever of 101.7 Fahrenheit, body aches, fatigue, nausea, headache, loss of appetite

Other Meds: Birth control pill, over the counter allergy med

Current Illness: None

ID: 0923750
Sex: F
Age: 28
State: NY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Right arm soreness

Other Meds: Meloxicam, larin

Current Illness:

ID: 0923751
Sex: F
Age: 33
State: WA

Vax Date: 12/27/2020
Onset Date: 12/27/2020
Rec V Date: 01/06/2021
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: Macadamia nuts Almonds Propofol

Symptom List: Injection site pain, Pain

Symptoms: 1st dose to L deltoid around 0725. I went at sat down to wait my 15 minutes and approximately 5-10 mins later I immediately began feeling completely flushed, red hot followed by chest tightness and throat tightness. Upon standing up I felt very dizzy and had a strange sense of 'impending doom'. The RN recording my Vital signs had me take a picture of them to trend and send to the ED which is where I was later sent (see VS below) 0733- bp 171/92, hr 83, sp02 100% "hot flushed, chest tightness" 0735- BP 159/97, HR 91, SP02 99% 0740- BP 170/95, HR 76, SP02 100%, "chest tightness better, no itching, or rash" 0745- BP 155/90, HR 76, SP02 100% 0750- BP 161/94, HR 88, SP02 100% "anxiety,/throat tightness, feeling super hot"- here I again had another episode that felt like total body flushing, and began taking my layers of jackets and scrub cap off feeling diaphoretic. (My normal BP is 120/70's and HR 60's) Upon standing to get to the w/c to be taken to the ER I remember my legs felt tingly and liquidy like jello and that my balance felt off. I got to the Emergency Room a little before 0825 an hour post vaccine. My chest and throat tightness had improved slightly and the flushing reaction had seemed to stop as I now recall feeling very chilled asking for several blankets. I was monitored in the ER for about 1.5hrs thankfully not requiring any epinephrine.

Other Meds:

Current Illness: None

ID: 0923752
Sex: F
Age: 52
State: MA

Vax Date: 12/20/2020
Onset Date: 12/21/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Headache, chill, body aches, fever, malaise, runny nose, sore throat, loss of taste, night sweats, nausea, diarrhea, chest tightness, dry cough

Other Meds: Magnesium, Vitamin D, Zyrtec

Current Illness: None

ID: 0923753
Sex: M
Age: 29
State: MN

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: pale, clammy, warm, low blood pressure treatment - put client into Trendelenburg position, gave water and snack, took vitals, monitored for extra 20 minutes

Other Meds:

Current Illness:

ID: 0923754
Sex: F
Age: 44
State: AZ

Vax Date: 01/01/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: COVID19 1B

Other Meds: levothyroxine 100ml

Current Illness: none

ID: 0923755
Sex: F
Age: 48
State: GA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Headache, muscle aches, joint pain, chills, fatigue

Other Meds: CoQ10, MegaFoods Blood Builder, Krill Oil, Oregon Grape Seed Extract, Citocholine, Mushroom supplement for immunity, Curcumin, Green Vibrance

Current Illness: None

ID: 0923756
Sex: F
Age: 23
State: RI

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Erythromycin, Pseudoephedrine

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

Symptoms: 8:05am-Patient received Covid vaccine and while being monitored c/o upper lip being numb, no other c/o voiced, no nonverbal cues noted at present time. 8:22am- Self medicated with Benadryl 25mg; tolerated without difficulty. 8:28am-Patient c/o throat tingling and verbalized having history of angio8:05am-Patient received Covid vaccine and while being monitored c/o upper lip being numb, no other c/o voiced, no nonverbal cues noted at present time. 8:22am- Self medicated with Benadryl 25mg; tolerated without difficulty. 8:28am-Patient c/o throat tingling and verbalized having history of angioedema; noted anxious, cough present, upon further evaluation noted facial swelling, top lip remains numb; patient assisted to emergency room per staff on duty; upon leaving clinic patient continued to cry for her mom; required reassurance regarding going to emergency department.edema; noted anxious, cough present, upon further evaluation noted facial swelling, top lip remains numb; patient assisted to emergency room per staff on duty; upon leaving clinic patient continued to cry for her mom; required reassurance regarding going to emergency department.

Other Meds: n/a

Current Illness: n/a

ID: 0923757
Sex: F
Age: 33
State: WV

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Arm was sore for 48 hours post injection. Ibuprofen was used for treatment

Other Meds: Calcium

Current Illness: None

ID: 0923758
Sex: M
Age: 42
State: PA

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: Moderna COVID-19 Vaccine EUA Severe pain in injection site. Fever of 102.4, weak, lethargic, chills, achy all over.

Other Meds: Montelukast Sodium Tab 10mg Sertraline HCL TAB 50mg Topiramate 50mg Certirizine Hydrochloride 10mg

Current Illness: N/A

ID: 0923759
Sex: F
Age: 87
State: SC

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: Sulfa Drugs

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

Symptoms: Vaccinated on Wednesday, 12/30/2020 about 1:30PM. The next evening, patient's arm started to swell and become hot and started to itch. She had a fever as well. She stated this continued until 1/5/2021.

Other Meds: Tylenol, Biotin, Melatonin, Probiotic, Pepcid, Viactiv (calcium), CBD oil

Current Illness: Had COVID-19 during holidays

ID: 0923760
Sex: M
Age: 37
State: NY

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: bee stings - swelling/itching

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Pt rec'd vaccine. ~1 hour after, pt began noticing redness and itching to R arm, then became more diffuse, to chest and L arm. Redness was nonblanchable. Pt returned to clinic and 50mg IM benadryl was given by supervisor at ~1400. Now (~1420), redness has almost completely resolved. No SOB, chest tightness, wheezing.

Other Meds: clonazepam - 1mg po nightly PRN seroquel 75mg po nightly PRN

Current Illness: none

ID: 0923761
Sex: F
Age: 38
State: PA

Vax Date: 12/29/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: N/A

Symptom List: Tremor

Symptoms: After the initial, typical, local reaction resolved on Day +3 post-vaccine, I had 4 days with no adverse effects at all. On Day + 7 (1/5/2021) I woke at 6:00am with my injection site incredibly itchy, but no visible rash or swelling. Within 2 hours, splotchy rash was overlying the injection site. Gradually throughout the day, site became confluently red and began to swell. Itching continued pretty intensely. Swelling progressed until it was visible from across the room and skin changed texture in the area and feels almost like a thick, waxy, orange peel like texture. No pain. Itching resolved with 1 dose of zyrtec. Did not return. Redness and swelling persists. Swelling seems to wax and wane.

Other Meds: N/A

Current Illness: N/A

ID: 0923762
Sex: F
Age: 37
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: MINUTES AFTER VACCINE WAS ADMINISTERED PATIENT FELT DIZZY THEN COLD FLUSHING FEELING FROM FEET TO HEART AND THEN THAT STOPPED AND TINGLING FEELING THROUGHOUT BODY AND THEN VERY WARM, AND FAINT FEELING. PATIENT DID NOT FAINT. PATIENT DID VOMIT ONCE. PATIENT HAD NOT EATEN BEFORE VACCINATION WAS ADMINISTERED. 1255 VITALS: BP: 126/91 P:100 SAO2 1303 VITALS: BP: 116/99 P: 96 SA02: 100% PATIENT STATES THEY ARE FEELING BETTER. GIVEN JUICE AND BANANA. 1312 VITALS: BP: 128/87 P: 74 SA02: 100% PATIENTS COLOR HAS RETURNED TO NORMAL. STATES THEY ARE FEELING MUCH BETTER. ABLE TO STAND AND WALK WITHOUT DIZZINESS. PATIENT STATED THAT THEY DID NOT FEEL THEY NEEDED ANY FURTHER TREATMENT OR CARE. PATIENT LEFT WITH HER WORKMATE.

Other Meds:

Current Illness:

ID: 0923763
Sex: F
Age: 26
State: WI

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Fever of 100.3, headache, chills, body aches

Other Meds: None

Current Illness: None

ID: 0923764
Sex: F
Age: 39
State: PA

Vax Date: 12/30/2020
Onset Date: 01/02/2021
Rec V Date: 01/06/2021
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: Patient woke on 1/01/2021 with headache; swelling of left-side of neck; swelling of tongue

Other Meds:

Current Illness:

ID: 0923765
Sex: F
Age: 29
State: TN

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/06/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Lo grade fever, body aches, fatigue, pain at injection site

Other Meds: thiamine, biotin

Current Illness: urinary tract infection

ID: 0923766
Sex: F
Age: 26
State: NY

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/06/2021
Hospital: Y

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

Lab Data:

Allergies: Latex. benzol peroxide

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

Symptoms: Went to the ER on the 31st, my face swelled and chest was covered in hives. Lips swelled. I would get nauseated and I felt like there was acid in my stomach. I also had a headache. I have been taking Zyrtec, Benadryl as needed.

Other Meds: ADDERALL

Current Illness:

ID: 0923767
Sex: F
Age: 58
State: MA

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: Latex Peach Banana Avocado

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

Symptoms: Employee stated she felt dizzy shortly after receiving vaccine. Assessed by RN and EMT's and rested for 30 minutes then went home.

Other Meds: PRN Albuterol inhaler

Current Illness: Asthma flare up last week Negative COVID test

ID: 0923768
Sex: F
Age: 23
State: RI

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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: Pain in extremity

Symptoms: Dose 1 administered on 12/28/2020 Fatigue and body aches on 12/29/2020 morning, resolved by afternoon Tender left axillary lymphadenopathy 01/03/2021-present Swelling, warmth, itchiness, soreness at injection site on 01/04/2021-01/06/2021

Other Meds: Zyrtec

Current Illness: None

ID: 0923769
Sex: F
Age: 12
State:

Vax Date: 10/29/2020
Onset Date: 10/29/2020
Rec V Date: 01/06/2021
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: Patient felt lightheaded, nauseated, blurred vision. Legs and body got weak. Episode occurred momentarily after patient received injection and lasted moments. Pt. improved once laid down and feet elevated. Patient evaluated and treated on site at school by nurse practitioner.

Other Meds:

Current Illness:

ID: 0923770
Sex: F
Age: 42
State: CO

Vax Date: 12/23/2020
Onset Date: 12/30/2020
Rec V Date: 01/06/2021
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: Ciprofloxacin Hcl, Penicillin, Sufa, Cefaclor, Erythromycin, Levofloxacin, Sulfonylureas

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

Symptoms: About 1 week after receiving the vaccine I noticed my right arm itching, it took me a while to realize why. Once I looked at my arm in a mirror I saw that it was swollen, red & itchy. At the time the redness was about the side of a 1/2 dollar. The last few days I have noticed that my arm is itchy, red, swollen & now feels like a rash in the same location but the redness is about the size of a baseball.

Other Meds: Dulaglutide, Metformin, Amlodipine, Losartan, Sertraline, Methenamine Hippurate

Current Illness:

ID: 0923771
Sex: F
Age: 42
State: MA

Vax Date: 12/28/2020
Onset Date: 01/06/2021
Rec V Date: 01/06/2021
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: Ceclor, amoxicillin, zithromax

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

Symptoms: Presented with pain at injection site for days1-4 followed by flat, blanchable welt on left deltoid that was warm to touch and erythemic, approximately 1.5?x2.5? in size, on day 10. Afrebile.

Other Meds: NA

Current Illness: NA

ID: 0923772
Sex: F
Age: 23
State: NY

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: Shell fish allergy (anaphylaxis); Tree nut (anaphylaxis); bee stings (anaphyalxis)

Symptom List: Vomiting

Symptoms: Shortness of breath, hives, and itching. Took benadryl, famotidine, Xyzal at time of reaction. Also 4 puffs on ventolin. Symptoms slowly improved over 4 hours. Epiniphrine not administered.

Other Meds: Xyzal, singulair, Topomax, Paroxetine, Epipen as needed, ventolin as needed, benadryl as needed

Current Illness: no

ID: 0923773
Sex: F
Age: 44
State: OH

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/06/2021
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: No

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Left arm swelled, red, itchy, tender 1 week after injection. Only sore the day or 2 after injection snd then the symptoms started one week to the day of the shot

Other Meds: Vitamin c, D, birth control

Current Illness: No

ID: 0923774
Sex: F
Age: 62
State: FL

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/06/2021
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: Headache for 7 days then resolved

Other Meds: Metoprolol

Current Illness: N/A

ID: 0923775
Sex: F
Age: 45
State: MD

Vax Date: 12/23/2020
Onset Date: 01/01/2021
Rec V Date: 01/06/2021
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: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Significant left subclavicular lymphadenopathy; single area measured 10 mm on ultrasound.

Other Meds: HZTZ 25 mg Zyrtec prn

Current Illness: NONE

ID: 0923776
Sex: F
Age: 36
State: VA

Vax Date: 12/22/2020
Onset Date: 12/26/2020
Rec V Date: 01/06/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: 12/26/2020: Nausea, vomiting, diarrhea for 24 hours 12/29/2020: shortness of breath, chest tightness for 36 hours. Went to ER. COVID and flu tests done. Both negative.

Other Meds: Lexapro, oral contraceptive

Current Illness: None

ID: 0923777
Sex: F
Age: 53
State: NE

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/06/2021
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: none

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

Symptoms: Injection area is red, swollen, warm to touch

Other Meds: Lisinopril 20mg, Citalopram 40mg, Simvastatin 40mg

Current Illness: none

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm