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: 0960780
Sex: F
Age: 61
State:

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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, Chills, Rigors, Bloating

Other Meds:

Current Illness:

ID: 0960781
Sex: F
Age: 28
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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, NauseaVomiting, Chills, sweats Narrative: Off work one day

Other Meds:

Current Illness:

ID: 0961416
Sex: M
Age: 33
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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, Myalgia, NauseaVomiting, left arm myalgia after vaccine on 12/23/2020; on 12/25/2020 lost taste with waxing waning headache and nausea through 12/26/2020; no symptoms on 12/27/2020; today 12/28/2020 has waxing waning headache and nausea.

Other Meds:

Current Illness:

ID: 0961424
Sex: F
Age: 57
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/08/2021
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: Rash & UrticariaPruritus

Other Meds:

Current Illness:

ID: 0961430
Sex: F
Age: 51
State:

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

Other Meds:

Current Illness:

ID: 0961694
Sex: F
Age: 57
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: Arthralgia Arthralgia, body aches

Other Meds:

Current Illness:

ID: 0961702
Sex: F
Age: 31
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: tingling in the R arm and leg; swelling in the R side of the face/cheek Narrative: Employee reports after having vaccine felt tingling in her R arm; later R leg and facial/ cheek swelling on the Right side. Remained the same overnight and was seen the next day 12/29/2020. Benadryl order and employee sent home

Other Meds:

Current Illness:

ID: 0961707
Sex: F
Age: 53
State:

Vax Date: 12/24/2020
Onset Date: 12/25/2020
Rec V Date: 01/08/2021
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, 12/25 2000 noticed sore arm 17:00 followed by myalgias arthralgia, extremities, and lower back, lower LE, fully resolved 12/29.

Other Meds:

Current Illness:

ID: 0961712
Sex: M
Age: 51
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Myalgia, Fever, Sore throat, fatigue

Other Meds:

Current Illness:

ID: 0961719
Sex: F
Age: 33
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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, Myalgia, fatigue

Other Meds:

Current Illness:

ID: 0961724
Sex: M
Age: 55
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 01/08/2021
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: Myalgia Loss of smell, generalized weakness Narrative: Received COVID-19 VACCINE on 12/23/2020. 24 hours after receiving the vaccine I had body aches, loss of smell and general weakness. All symptoms are gone except I still have loss of smell and easily get tired. Other than that I am feeling ok (12/282020).

Other Meds:

Current Illness:

ID: 0961729
Sex: F
Age: 50
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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 & Diarrhea Narrative: Employee called OHC to report side effects that occurred the night of vaccination and now getting better.

Other Meds:

Current Illness:

ID: 0961734
Sex: F
Age: 30
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Tachycardia Narrative: Employee reported elevated Heart Rate for the last hour running in the 110's to 120's. Current heart rate is 124, with no other symptoms reported. Will continue to follow up with employee daily to check on status. Employee was reported to contact 911 or go to the nearest Emergency Room if symptoms worsen.

Other Meds:

Current Illness:

ID: 0961740
Sex: F
Age: 50
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: BlurredVision, NauseaVomiting, Symptoms started eve of 12/28/2020 as above with marked generalized fatigue and pain on left deltoid. Feels better 12/29 with only left deltoid pain remaining.

Other Meds:

Current Illness:

ID: 0961746
Sex: F
Age: 42
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: 0961754
Sex: F
Age: 38
State:

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Dizziness

Other Meds:

Current Illness:

ID: 0961764
Sex: M
Age: 38
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: TINGLING BLE Narrative: Employee reported numbness/tingling to BLE almost immediately upon receipt of vaccine. Within one hour, he reported back to provider, that symptoms had not subsided. I tried to call him today to follow up but was unsuccessful in contacting him.

Other Meds:

Current Illness:

ID: 0961778
Sex: F
Age: 28
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Headache, Myalgia, NauseaVomiting, sore throat, congestion, neck sore to touch, neck stiffness Narrative: Recommend symptomatic treatment with Tylenol, ibuprofen, rest.

Other Meds:

Current Illness:

ID: 0961786
Sex: F
Age: 24
State:

Vax Date: 12/25/2020
Onset Date: 12/26/2020
Rec V Date: 01/08/2021
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, Fever, Rash, NauseaVomiting, Chills Narrative: Unable to work.

Other Meds:

Current Illness:

ID: 0961802
Sex: M
Age: 44
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Myalgia & Fever Narrative: Employee has reported a low-grade fever, muscle and body aches, chills, flu-like symptoms. Informed employee if symptoms get worse call 911 or go to the nearest Emergency Room. Will continue to monitor employee daily.

Other Meds:

Current Illness:

ID: 0961819
Sex: M
Age:
State:

Vax Date:
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Diarrhea Narrative:

Other Meds:

Current Illness:

ID: 0961850
Sex: M
Age: 36
State:

Vax Date: 12/27/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: Headache, Myalgia, Fever, Body aches, low grade fever 99.5, headache

Other Meds:

Current Illness:

ID: 0961852
Sex: F
Age: 53
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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 & Fever

Other Meds:

Current Illness:

ID: 0961853
Sex: F
Age: 58
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Dizziness & NauseaVomiting Narrative: Employee reported dizziness that persisted for 45 minutes, incident occurred 17 hours following injection. Employee further reports that she did not eat breakfast and situation that precipitated event was bending over and standing upright quickly while assisting a patient. Employee has since fully recovered.

Other Meds:

Current Illness:

ID: 0961854
Sex: F
Age: 38
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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, Body aches, headache

Other Meds:

Current Illness:

ID: 0961855
Sex: F
Age: 26
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Headache sweaty, chills Reports headache, sweaty, chills. Affecting work day.

Other Meds:

Current Illness:

ID: 0961856
Sex: M
Age: 42
State:

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
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, Diarrhea, fatigue

Other Meds:

Current Illness:

ID: 0961857
Sex: F
Age: 44
State:

Vax Date: 12/22/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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: Myalgia Chills, Rigors

Other Meds:

Current Illness:

ID: 0961858
Sex: M
Age: 26
State:

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/08/2021
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: Dizziness, Headache, chills, pain at injection site.

Other Meds:

Current Illness:

ID: 0961859
Sex: F
Age: 44
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: Headache, Myalgia, Arthralgia, NauseaVomiting, Received Vaccine 12/28/20 and developed symptoms that evening chills, subjective fever, arm soreness with increased warmth and nodule, and fatigue

Other Meds:

Current Illness:

ID: 0961860
Sex: F
Age: 29
State:

Vax Date: 11/25/2019
Onset Date: 12/26/2020
Rec V Date: 01/08/2021
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, Myalgia, Arthralgia, Fever, Rash, NauseaVomiting Fatigue Narrative: Able to to to work. Hx of COVID 9/18/2020.

Other Meds:

Current Illness:

ID: 0961861
Sex: M
Age: 54
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: SkinRash

Other Meds:

Current Illness:

ID: 0961862
Sex: M
Age: 29
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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, Myalgia & Arthralgia

Other Meds:

Current Illness:

ID: 0961863
Sex: F
Age: 39
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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: Sore arm at site of injection only Narrative: Sore arm at site of injection only

Other Meds:

Current Illness:

ID: 0961864
Sex: F
Age:
State:

Vax Date:
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: HYPERtension tingling lips Narrative: presented back to vaccine clinic 25 minutes after administration with c/o tingling lips. B/P 144/96, HR 78, O2 99% at 10:13, Benadryl 25 mg PO at 10:15. BP 140/87 at 10:20. Lips no longer tingling at 10:35. 10:39 BP 118/77, HR 76, O2 99%. No further monitoring needed.

Other Meds:

Current Illness:

ID: 0961865
Sex: F
Age: 52
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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, Arthralgia, Received COVID Vaccine 12/28 and developed symptoms 1 hour post-vaccination including nasal congestion, chills,and left arm soreness with a nodule at site of injection. Employee has chronic neck and back pain which were worsened after receiving the vaccine. The medications the employee is taking are her chronic meds for her chronic eck and back pain.

Other Meds:

Current Illness:

ID: 0961866
Sex: F
Age:
State:

Vax Date:
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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: Rash localized pain in area of injection Narrative: Reports awoke day after receiving vaccine with "hot and raised" rash surrounding area of injection. measure 4.5 * 3.5 cm, red, blotchy, slightly itchy rash, skin intact, no other clinical findings with regard to rash. She reports localized tenderness in area of rash.

Other Meds:

Current Illness:

ID: 0961867
Sex: F
Age: 32
State:

Vax Date: 12/24/2020
Onset Date: 12/24/2020
Rec V Date: 01/08/2021
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: Headache, Myalgia, Arthralgia & Diarrhea Narrative: Resolved symptoms in 3 days

Other Meds:

Current Illness:

ID: 0961868
Sex: M
Age: 33
State:

Vax Date: 12/23/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: Headache, CoughWheeze, congestion

Other Meds:

Current Illness:

ID: 0961870
Sex: F
Age: 60
State:

Vax Date: 12/21/2020
Onset Date: 12/23/2020
Rec V Date: 01/08/2021
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: Arthralgia fatigue Narrative:

Other Meds:

Current Illness:

ID: 0961871
Sex: F
Age: 43
State:

Vax Date: 12/26/2020
Onset Date: 12/26/2020
Rec V Date: 01/08/2021
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: injection site at upper deltoid, Pain in mid shoulder with ROM above >90 13:30, at 15:30 pain increased in left shoulder with AROM. Shoulder and back warmth. Numbness in left cheek and left lip. All resolved, mild with arm pain with turning apply force c Narrative:

Other Meds:

Current Illness:

ID: 0961873
Sex: F
Age: 48
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/08/2021
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, Arthralgia, CHILLS Narrative: Employee was sent home from work

Other Meds:

Current Illness:

ID: 0961874
Sex: M
Age:
State:

Vax Date:
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: feeling flush

Other Meds:

Current Illness:

ID: 0961875
Sex: F
Age: 57
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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, Myalgia, Arthralgia, NauseaVomiting, Symptoms started evening 12/28/20 -Nasal Congestion Started, Arm soreness,Denies Fever

Other Meds:

Current Illness:

ID: 0961877
Sex: F
Age: 27
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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: Headache, Myalgia, Fever, fatigue, feels hot but temp is normal. Narrative: 12/28 onset of "feeling crummy" - fatigue and "really bad" headache. She went home after work and went to sleep. 12/29 onset of feeling "hot" but her temperature is normal. Body aches, slight headache, and feeling "clammy". She took ibuprofen on 12/29 and is currently at work. Employee reports she usually feels mildly ill the day after a flu vaccine but this adverse reaction is much worse than that. 12/30 - employee reports she developed diarrhea and a temp to 99. Continues to have body aches and mild headache. 12/31 all symptoms resolved.

Other Meds:

Current Illness:

ID: 0961878
Sex: F
Age: 23
State:

Vax Date: 12/25/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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, chills Narrative: Missed 1 d of work

Other Meds:

Current Illness:

ID: 0961880
Sex: F
Age: 56
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/08/2021
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, Arthralgia & Fever Narrative: patients is too sick to come into work

Other Meds:

Current Illness:

ID: 0961881
Sex: F
Age: 33
State:

Vax Date: 12/26/2020
Onset Date: 12/26/2020
Rec V Date: 01/08/2021
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 fatigue, itching/pain/erythema/swelling at injection site

Other Meds:

Current Illness:

ID: 0961883
Sex: M
Age: 38
State:

Vax Date: 12/23/2020
Onset Date: 12/25/2020
Rec V Date: 01/08/2021
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: URTICARIA/PRURITUS TO TORSO,BACK,CHEST

Other Meds:

Current Illness:

ID: 0961885
Sex: M
Age: 57
State:

Vax Date: 12/16/2020
Onset Date: 12/17/2020
Rec V Date: 01/08/2021
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: swollen glands around uvula

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm