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: 0997919
Sex: F
Age: 42
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: SkinRash, Rash, UrticariaPruritus & NauseaVomiting Narrative:

Other Meds:

Current Illness:

ID: 0997920
Sex: M
Age: 62
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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, Pain at injection site, then fatigue

Other Meds:

Current Illness:

ID: 0997921
Sex: F
Age: 60
State:

Vax Date: 12/29/2020
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: Rash Narrative: reports onset of rash 8 days post injection, localized around area of injection site. red, slightly raised, skin intact.

Other Meds:

Current Illness:

ID: 0997922
Sex: M
Age: 49
State:

Vax Date: 12/28/2020
Onset Date: 12/30/2020
Rec V Date: 01/09/2021
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, Diarrhea, NauseaVomiting, fatigue

Other Meds:

Current Illness:

ID: 0997924
Sex: F
Age: 40
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Myalgia fatigue. redness and itchy at the injection site

Other Meds:

Current Illness:

ID: 0997929
Sex: F
Age: 51
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Dizziness, Myalgia, NauseaVomiting, Palpitations, swollen lymph nodes in neck, SOB

Other Meds:

Current Illness:

ID: 0997934
Sex: F
Age: 51
State:

Vax Date: 12/28/2020
Onset Date: 01/05/2021
Rec V Date: 01/09/2021
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: UrticariaPruritus Narrative: Employee self treating with benadryl. It started on 1/5/21

Other Meds:

Current Illness:

ID: 0997947
Sex: F
Age: 42
State:

Vax Date: 12/29/2020
Onset Date: 01/05/2021
Rec V Date: 01/09/2021
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: SkinRash, Rash & UrticariaPruritus

Other Meds:

Current Illness:

ID: 0997953
Sex: F
Age: 37
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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 Narrative:

Other Meds:

Current Illness:

ID: 0997958
Sex: M
Age: 53
State:

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/09/2021
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: muscle weakness, fatigue

Other Meds:

Current Illness:

ID: 0997964
Sex: F
Age: 72
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 01/09/2021
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: Rash, UrticariaPruritus, itchy, redness, hardened area that is growing Narrative:

Other Meds:

Current Illness:

ID: 0997970
Sex: M
Age: 52
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/09/2021
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: fingers tingling, fatigue Narrative:

Other Meds:

Current Illness:

ID: 0997977
Sex: F
Age: 43
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/09/2021
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, NauseaVomiting, HA, nausea, fatigue Narrative:

Other Meds:

Current Illness:

ID: 0997983
Sex: F
Age: 40
State:

Vax Date: 01/04/2021
Onset Date: 01/05/2021
Rec V Date: 01/09/2021
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 HA (migraine), pain at injection site Narrative:

Other Meds:

Current Illness:

ID: 0997989
Sex: F
Age: 36
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, felt warm-feverish Narrative: Taking OTC NyQuil every 4-6 hours.

Other Meds:

Current Illness:

ID: 0997999
Sex: F
Age: 30
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/09/2021
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 Narrative: Mild headache started 2 minutes after injection

Other Meds:

Current Illness:

ID: 0998008
Sex: M
Age: 72
State:

Vax Date: 12/18/2020
Onset Date: 12/18/2020
Rec V Date: 01/09/2021
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: Hx. DM. Noted during observation he was forgetful but able to verbalize but speech noted to slur, Juice given 120/90, 78, 18. c/o of tightness in chest and was transported to ED for evaluation in stable condition. 140/78, 68, 18. Acu chceck 240 in ED. Di Narrative: After vaccine, during observation seemed forgetful but able to verbalize. Speech noted to slur, History of DM verbalized by pt. Juice given 120/90, 78, 18. c/o of tightness in chest and was transported to ED for evaluation in stable condition. 140/78, 68, 18. Acu chceck 240 in ED. Discharged asymptomatic from ED to f/u with PCP.

Other Meds:

Current Illness:

ID: 0998015
Sex: F
Age: 60
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/09/2021
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: Dizziness Narrative: Dizzy 10 minutes after injection

Other Meds:

Current Illness:

ID: 0998020
Sex: F
Age: 35
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/09/2021
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: Dizziness Narrative: Dizzy approximately 2-3 minutes after vaccine injection

Other Meds:

Current Illness:

ID: 0998027
Sex: F
Age: 61
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 01/09/2021
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: Injection site soreness Narrative:

Other Meds:

Current Illness:

ID: 0998034
Sex: F
Age: 63
State:

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/09/2021
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: Flushing Narrative: Flushing 10 minutes after vaccine administration

Other Meds:

Current Illness:

ID: 0998050
Sex: M
Age: 47
State:

Vax Date: 12/22/2020
Onset Date: 12/22/2020
Rec V Date: 01/09/2021
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 Lightheadedness Narrative:

Other Meds:

Current Illness:

ID: 0998057
Sex: F
Age: 42
State:

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Rash & UrticariaPruritus Narrative:

Other Meds:

Current Illness:

ID: 0998064
Sex: F
Age: 59
State:

Vax Date: 12/23/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Myalgia right arm red, warm, raised area. Itchy with moderate firmness Narrative: Vaccine on 12/23/2020, Right arm warm, red area 3 inches in diameter, Itchy, moderate firmness (less firm than a few days ago). Sore, has psoriasis on elbow, has not missed work. Temp 97.2

Other Meds:

Current Illness:

ID: 0998117
Sex: F
Age: 46
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Face and neck flushing and tingling. Narrative:

Other Meds:

Current Illness:

ID: 1000713
Sex: M
Age: 40
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Dizziness Flushed. Buzzing in ears.

Other Meds:

Current Illness:

ID: 1000714
Sex: F
Age: 63
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Fever pain at injection site

Other Meds:

Current Illness:

ID: 1000715
Sex: F
Age: 45
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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, Fever, chills

Other Meds:

Current Illness:

ID: 1000716
Sex: M
Age: 52
State:

Vax Date: 12/29/2020
Onset Date: 12/30/2020
Rec V Date: 01/09/2021
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: Headache & Myalgia

Other Meds:

Current Illness:

ID: 1000717
Sex: F
Age: 49
State:

Vax Date: 12/22/2020
Onset Date: 12/26/2020
Rec V Date: 01/09/2021
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: Right upper quadrant dull pain 4/10 around the liver area, has not checked liver enzymes Narrative: has not seeked medical care

Other Meds:

Current Illness:

ID: 1000718
Sex: M
Age: 41
State:

Vax Date: 12/28/2020
Onset Date: 12/28/2020
Rec V Date: 01/09/2021
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 & NauseaVomiting

Other Meds:

Current Illness:

ID: 1000719
Sex: F
Age: 39
State:

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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, Fever, noticed sore arm this AM (1/6/21) then myalgias and fever this afternoon to 101.1, now 100.6 and tingling feeling all over

Other Meds:

Current Illness:

ID: 1000720
Sex: F
Age: 39
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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: Fever

Other Meds:

Current Illness:

ID: 1000769
Sex: M
Age: 68
State:

Vax Date: 12/31/2020
Onset Date: 01/03/2021
Rec V Date: 01/09/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Headache, Myalgia & Fever

Other Meds:

Current Illness:

ID: 1000772
Sex: F
Age: 49
State:

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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, Myalgia & Fever

Other Meds:

Current Illness:

ID: 1000810
Sex: M
Age: 62
State:

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/09/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Fever & Diarrhea

Other Meds:

Current Illness:

ID: 1000813
Sex: M
Age: 37
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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, Purpura, "Spotty skin discoloration (slight reddish/purple color) down the arm L > R, Pain at injection site"

Other Meds:

Current Illness:

ID: 1000816
Sex: F
Age: 53
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: "Lightheaded", "woozy", "stressed that may play a role" @ 1524 BP 168/100 HR 68 SPO2 97% RA, @1527 BP 161/87, @1532 BP 158/84, @1538 BP 151/97 Narrative: Report provided to this RN by staff, monitor post Covid vaccination: @1524 (Post 15 min monitoring after receiving vaccination) Employee reported to staff, monitor, a mild feeling of being lightheaded or "woozy" and stated " have been a bit stressed regarding news and uncertain if that is playing a role, vitals were taken. Employee agreed to stay for another 15 mins, @1538 last BP taken and Employee stated she felt better. Symptoms resolved and employee was able to go.

Other Meds:

Current Illness:

ID: 1000825
Sex: F
Age: 46
State:

Vax Date: 12/31/2020
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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, Myalgia, sore throat

Other Meds:

Current Illness:

ID: 1000835
Sex: F
Age: 49
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: NauseaVomiting Chills

Other Meds:

Current Illness:

ID: 1000837
Sex: F
Age: 28
State:

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/09/2021
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: Chills, dizzy, headache, injection site pain

Other Meds:

Current Illness:

ID: 1000838
Sex: F
Age: 54
State:

Vax Date: 12/31/2020
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: UrticariaPruritus Infection site red and warm

Other Meds:

Current Illness:

ID: 1000839
Sex: M
Age: 54
State:

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: Myalgia, Fever, Chills

Other Meds:

Current Illness:

ID: 1000841
Sex: F
Age: 42
State:

Vax Date: 12/28/2020
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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 Swollen glands (armpits and neck), Injection site warm and red

Other Meds:

Current Illness:

ID: 1000842
Sex: F
Age: 61
State:

Vax Date: 12/30/2020
Onset Date: 01/01/2021
Rec V Date: 01/09/2021
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: Confusion, Headache, Myalgia, Arthralgia, Diarrhea & NauseaVomiting Narrative:

Other Meds:

Current Illness:

ID: 1000845
Sex: M
Age: 55
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/09/2021
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, Arthralgia, NauseaVomiting, Chills, Shaking Cold, Fatigue Narrative:

Other Meds:

Current Illness:

ID: 1000846
Sex: F
Age: 26
State:

Vax Date: 12/30/2020
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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: Red, swollen injection site

Other Meds:

Current Illness:

ID: 1000848
Sex: F
Age: 45
State:

Vax Date: 12/28/2020
Onset Date: 01/01/2021
Rec V Date: 01/09/2021
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: Headache, UrticariaPruritus, Arm pain with urticarial rash Narrative: Given antibiotic with what appears localized infection area

Other Meds:

Current Illness:

ID: 1000850
Sex: M
Age: 68
State:

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/09/2021
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, Bradycardia, FLUSHING, TINGLING OF LOWER EXTREMITIES, GENERALIZED WEAKNESS Narrative:

Other Meds:

Current Illness:

ID: 1000851
Sex: M
Age: 60
State:

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/09/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Arthralgia, Fever, very fatigued Narrative: Temp was 98.7F

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm