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: 0952136
Sex: F
Age: 0
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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, Fever, CoughWheeze, malaise, congestion Narrative:

Other Meds:

Current Illness:

ID: 0952137
Sex: M
Age: 65
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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, Myalgia & UrticariaPruritus

Other Meds:

Current Illness:

ID: 0952138
Sex: F
Age: 45
State:

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: Dizziness Left leg tingling intermittingly, BP163/107 HR 75, BP110/119 HR79 O2 98%

Other Meds:

Current Illness:

ID: 0952139
Sex: F
Age: 58
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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, Myalgia, Arthralgia, Fever, SkinRash, Rash, UrticariaPruritus, NA Narrative: Employee had the Covid 19 vaccination at 14:40 pm, 12/29/20, at 15:30 pm she developed hives at the site of injection , that spread gradually to involve the whole body. There was associated itching all over the body. She stated that she took Benadryl 50mg po one time. The hives started improving and completely subsided by late night Employee claimed that she had 101.4 temperature that is responding to Tylenol 650mg q6h prn, currently 15:30,12/30/20 , the temperature is 100.4 she relates to generalized body ache, joints pain, denied shortness of breath, wheezing. Employee could not come to work today because of the fever and body ache. But she did not seek medical attention

Other Meds:

Current Illness:

ID: 0952140
Sex: F
Age: 58
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Angioedema swelling and redness of face; eyes swollen Narrative: Employee was seen in the clinic the following day and symptoms had resolved.

Other Meds:

Current Illness:

ID: 0952141
Sex: F
Age: 49
State:

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/07/2021
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: Fever fever, fatigue

Other Meds:

Current Illness:

ID: 0952142
Sex: M
Age: 30
State:

Vax Date: 12/24/2020
Onset Date: 12/26/2020
Rec V Date: 01/07/2021
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: fatigue, arm pain

Other Meds:

Current Illness:

ID: 0952143
Sex: M
Age: 54
State:

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/07/2021
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: Myalgia, Arthralgia, Arm pain, fatigue

Other Meds:

Current Illness:

ID: 0952144
Sex: F
Age:
State:

Vax Date:
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: c/o funny taste 10 min after vaccination Narrative: 10 min after vaccination employee c/o funny taste. Denies numbness/tingling to lips or tongue. No difficulty swallowing. Monitored pt for 30 minutes. Emploees states funny taste has resolved.

Other Meds:

Current Illness:

ID: 0952145
Sex: F
Age:
State:

Vax Date:
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: Difficulty breathing and swallowing, dry mouth Narrative: Employee vaccinated in COVID Vaccine Clinic, within 10 minutes developed throat tightness and difficulty swallowing with a dry mouth.

Other Meds:

Current Illness:

ID: 0952146
Sex: F
Age: 33
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/07/2021
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: Headache, Fever, Fatigue Headache, fatigue, and fever starting one day after receipt of the vaccine and continuing though 5 days after vaccine. Tested negative for Covid-19 via PCR test on day 5 after vaccine.

Other Meds:

Current Illness:

ID: 0952147
Sex: M
Age: 54
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952148
Sex: F
Age: 50
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/07/2021
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: Headache, Myalgia, Fever, NauseaVomiting, Fatigue, Chills, Joint Pain, Headache, Myalgia, Fever, Nausea Narrative: Used OTC ibuprofen and acetaminophen

Other Meds:

Current Illness:

ID: 0952149
Sex: F
Age: 68
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Per recipient [at injection site] hard knot that is about the circumference of a golf ball and it is red. It is tender to the touch.

Other Meds:

Current Illness:

ID: 0952150
Sex: M
Age: 60
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952151
Sex: F
Age: 38
State:

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/07/2021
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: Headache, Myalgia, Arthralgia & NauseaVomiting Narrative:

Other Meds:

Current Illness:

ID: 0952152
Sex: M
Age: 40
State:

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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: Left Axillary lymph nodes tender to palpation (swollen glands)

Other Meds:

Current Illness:

ID: 0952153
Sex: M
Age: 67
State:

Vax Date: 12/24/2020
Onset Date: 12/26/2020
Rec V Date: 01/07/2021
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 Body Aches Narrative:

Other Meds:

Current Illness:

ID: 0952154
Sex: F
Age: 46
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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, Myalgia, NauseaVomiting, fever T 99.5 F

Other Meds:

Current Illness:

ID: 0952155
Sex: F
Age: 54
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: Dizziness, Headache, Myalgia, sore throat, fatigue

Other Meds:

Current Illness:

ID: 0952156
Sex: M
Age: 57
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: 0952158
Sex: M
Age: 44
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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 Narrative:

Other Meds:

Current Illness:

ID: 0952165
Sex: F
Age: 45
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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: facial flushing Narrative: Reported facial flushing following vaccine administration

Other Meds:

Current Illness:

ID: 0952186
Sex: F
Age: 40
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Sedation, Myalgia, Immediate post vaccine, employee reported feeling "funny" almost like she was intoxicated. this passed after a few hours. Narrative: Employee missed greater than >1 days of work second to symptoms (aches and extreme fatigue)

Other Meds:

Current Illness:

ID: 0952201
Sex: M
Age: 64
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952210
Sex: M
Age: 63
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952238
Sex: M
Age: 55
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952239
Sex: M
Age: 33
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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

Other Meds:

Current Illness:

ID: 0952240
Sex: M
Age: 45
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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 fatigue

Other Meds:

Current Illness:

ID: 0952241
Sex: M
Age: 66
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952244
Sex: F
Age: 38
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/07/2021
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: 6x6cm indurated, erythmatous, caloric area to right deltoid, well demarcated

Other Meds:

Current Illness:

ID: 0952254
Sex: F
Age: 44
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: Myalgia chills Narrative: 44yo Nurse Assistant. In Employee Health at 0915 hours w/ c/o myalgias, LUE pain and chills. Endorses received Moderna Vaccination on 12/29/20 at approximately 3:45pm in Left Deltoid. Uneventfully completed her tour on unit. Took 600mg of Ibuprofen prior to vaccination at 3:00pm. TOD ended at 8:00pm. Went to sleep as soon as arrived home, did not eat dinner due to tiredness from the 12 hour shift. Awoke 12/30/20 at 5:45(am) with chills and severe LUE pain. LUE pain radiates from injection site to elbow. Influenza Vaccine in September or October 2020, denies ever having a reaction other than mild injection site discomfort. Endorses h/o Influenza Type A in 2019 or 2018. PMHx: None other than Obesity. Allergies: Denies. Afebrile. 98.8F oral, HR 82bpm, RR 20, B/P 109/75 (states "normal" Systolic is in the 90's), SaO2 on RA 97% LUE very tender to touch, not excessively warm, no erythema, appears to be a raised, non-draining area approximately eight (8)cm in diameter; tender from injection site (band-aide was still on) to elbow. Appears to be in great discomfort with very slow guarded movements and extreme facial grimaces and grunts when asked to undress left arm for inspection. Donning Winter Coat and hat and endorses feels chilly. 11yo daughter at home not ill. States does not usually get "colds".

Other Meds:

Current Illness:

ID: 0952258
Sex: F
Age: 56
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/07/2021
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: Headache, Diarrhea, fatigue

Other Meds:

Current Illness:

ID: 0952259
Sex: F
Age: 35
State:

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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: Rash Narrative: hivea at injection site five days after injection. No therapies at ED. She has had this rash before at site of bee stings

Other Meds:

Current Illness:

ID: 0952260
Sex: F
Age: 57
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Headache SWELLING AT INJECTION SITE AND PAIN; HA Narrative: DAY 1 AND DAY 2 SWELLING AT INJECTION SITE AND PAIN HA

Other Meds:

Current Illness:

ID: 0952261
Sex: F
Age: 40
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: nasal congestion, sore throat Narrative: reported congestion and sore throat following vaccine

Other Meds:

Current Illness:

ID: 0952262
Sex: M
Age: 62
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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: Myalgia, Fever, ErythemaMultiform, CHILLS,SWELLING AND PAIN AT INJECTION SITE

Other Meds:

Current Illness:

ID: 0952263
Sex: M
Age: 41
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952264
Sex: F
Age: 45
State:

Vax Date: 12/17/2020
Onset Date: 12/17/2020
Rec V Date: 01/07/2021
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 chest pain, bronchial spasm Narrative:

Other Meds:

Current Illness:

ID: 0952265
Sex: M
Age: 65
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 0952266
Sex: F
Age: 58
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Headache & Myalgia

Other Meds:

Current Illness:

ID: 0952271
Sex: F
Age: 39
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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: NauseaVomiting flushing Narrative: Recipient experienced nausea and flushing s/p vaccination, which lasted about 15 minutes prior to spontaneously resolving. No other issues include no vomiting, shortness of breath, dizziness or diarrhea. No reported prior reactions to vaccinations. States she was feeling anxious about vaccination and had eaten prior to coming to clinic. Vital signs T98.2F, BP 104/70 (stated normal range for recipient), HR51 (stated normal range for recipient), SpO2 99% on RA. Exam benign, able to tolerate oral intake of fluids (declined offer of food) and ambulate prior to leaving vaccination area. Observed another ~8 minutes prior to request to go home.

Other Meds:

Current Illness:

ID: 0952279
Sex: M
Age: 51
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/07/2021
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, NauseaVomiting, Hypertension, lightheadedness Narrative: 51 year old female presented to ED post first dose of COVID-19 vaccine on 12/28/20. Sxs reported include feeling lightheaded, mild nausea and headahce. Nausea resolved 45 minutes after injection, but headache persisted, no facial swelling or difficulty, swallowing, no continued nausea or abdominal pain. Patient was administered a one-time dose of ibuprofen 800mg in the ED at 1510, recovered, and was discharged from ED on 12/28/20 at 1535.

Other Meds:

Current Illness:

ID: 0952287
Sex: M
Age: 30
State:

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/07/2021
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: Myalgia right shoulder pain

Other Meds:

Current Illness:

ID: 0952293
Sex: F
Age: 33
State:

Vax Date: 12/19/2020
Onset Date: 12/19/2020
Rec V Date: 01/07/2021
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: NauseaVomiting

Other Meds:

Current Illness:

ID: 0952300
Sex: F
Age: 54
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Headache, Myalgia, tireness Narrative:

Other Meds:

Current Illness:

ID: 0952316
Sex: M
Age: 37
State:

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: HYPERtension Hot flush Narrative: BP 148/109 HR 88, patient monitored for an additional 15 minutes, repeat BP 147/97 HR 72. Patient recovered and referred to PCP for follow up.

Other Meds:

Current Illness:

ID: 0952325
Sex: M
Age: 62
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/07/2021
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: Myalgia, Fever, chills Narrative:

Other Meds:

Current Illness:

ID: 0952333
Sex: F
Age: 54
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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, CoughWheeze, NauseaVomiting, Palpitations, Syncope, Arm pain, chills and overall weakness Narrative: Employee was unable to work second to symptoms, missing >1 days of work at time of this report.

Other Meds:

Current Illness:

ID: 0952340
Sex: M
Age:
State:

Vax Date:
Onset Date: 12/29/2020
Rec V Date: 01/07/2021
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: Myalgia Fatigue, drowsy Narrative:

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm