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: 1392178
Sex: F
Age: 46
State:

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/22/2021
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: Patient received 2nd dose of vaccine on 3/11/21 at 1 pm and began to experience symptoms by 7pm that evening. Reported symptoms included headaches, body aches, and tiredness. No medications were used for symptoms per patient report. Patient did have mild adverse reaction to 1st dose as well: arm soreness.

Other Meds:

Current Illness:

ID: 1392180
Sex: M
Age: 45
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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: Myalgia, Fever & NauseaVomiting Narrative: Patient received 2nd dose of vaccine on 3/17/21 at 1130am and began experiencing symptoms by noon (30 min later). Reported symptoms include fever (102 F), body aches, nausea, and stomach cramps. Reports use of Motrin (no dose/frequency recorded). Other Relevant History:

Other Meds:

Current Illness:

ID: 1392181
Sex: F
Age: 39
State:

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 03/22/2021
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, Arthralgia, Fever & NauseaVomiting Narrative: Patient received 1st dose of vaccine on 3/10/21 at 3pm and began experiencing symptoms 3/11/21 by 10am. Reported symptoms include injection site pain/discomfort, redness, and itching, as well as headaches, fever (100.4 F), chills, body aches, joint pain, nausea, and fatigue. Reports husband complained of same symptoms after receiving his vaccine the same day. Used Tylenol 500mg x doses on 3/11/21 and 3/12/21. Other Relevant History:

Other Meds:

Current Illness:

ID: 1392182
Sex: F
Age: 30
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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: Abdominal Pain, Dyspnea, Throat Irritation Narrative: 30 yo F with PMH multiple allergies, chronic pain syndrome, cervical and lumbar radiculopathy, and chronic plantar fasciitis, presenting with c/f anaphylaxis after receiving COVID-19 (Pfizer) vaccine. Had scheduled COVID-19 vaccine appointment at a medical center. Shortly after (about 1 minute) of administration she noted some GI upset initially and some dizziness on standing Then developed lip and finger tingling, some throat discomfort and tightness and SOB where she felt that she was not able to get any air out. Was instructed to come to the ED for further eval. Has an epi-pen at home but did not administer. She said this felt very similar to prior allergic reactions she has had in the past. In the ED, was tachycardic to the 120s, vitals otherwise wnl. Labs notable for Cr 1.3 (baseline 0.8), hypokalemia to 3.0, d-dimer and trop neg. Given solumedrol 125mg IV, Benadryl 50mg IV and 0.5mg Ativan and symptoms significantly improved. Epi ordered but not given. Her symptoms improved after medication admin. Transferred to the floor for further eval. She has an extensive allergy history to azithromycin, morphine, peanuts, red dye, shellfish/seafood, oranges. She saw an allergist as a child but has not for some time. She has had similar reactions to this episode with exposures and usually take Benadryl/famotidine with resolution. Also has history of allergic rhinitis and chronic sinus issues. Patient's symptoms improved with overnight evaluation, although noted 2 episodes of emesis and EKG with sinus tachycardia. Patient stable with planned discharge with outpatient evaluation of sinus tachy. Per medical team this development is not likely related to acute event due to persistence.

Other Meds:

Current Illness:

ID: 1392183
Sex: M
Age: 48
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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, Myalgia, Arthralgia & Fever Narrative: Patient received 2nd dose of vaccine on 03/18/2021 at 945 AM. Symptoms began that afternoon/evening. Reported symptoms include fever/facial flushing, headaches, body aches, and joint pain. Reports use of Motrin 800mg x 1 dose helped with symptoms. Reports experienced similar symptoms after receipt of flu vaccine this year.

Other Meds:

Current Illness:

ID: 1392185
Sex: F
Age: 53
State:

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Headache, Myalgia, Fever, Nausea Vomiting, chills temp101.7 Narrative:

Other Meds:

Current Illness:

ID: 1392187
Sex: F
Age: 64
State:

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/22/2021
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: Dizziness, Headache, Myalgia, Fever, Nausea Vomiting, FATIGUE,BRAIN FOG, REDUCED APPETITE, ALYERED SENSE OF SMELL Narrative:

Other Meds:

Current Illness:

ID: 1392188
Sex: F
Age: 39
State:

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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: Body aches ,Injection site upper arm sore and swollen under arm pit. Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392189
Sex: M
Age: 30
State:

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 03/22/2021
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: Fever Narrative:

Other Meds:

Current Illness:

ID: 1392190
Sex: M
Age: 37
State:

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/22/2021
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: Dizziness, Headache, Fever, NauseaVomiting, LOSS SENSE OF TASTE; ARM SORENESS; BODY ACHES; WEAKNESS; FATIGUE Narrative: Employee (a physician)states: about 4 hours after vaccination his arm was sore about 6 hours after vaccination, he lost his sense of taste he was concerned and received a COVID test which was negative about 10 hours after vaccination he experienced body aches, frontal headache, and nausea. about 12 hours after vaccination had a fever which peaked to 102.7 F; and dizziness and generalized weakness. Most of the symptoms resolved the following morning including the loss of taste, with the exception of extreme fatigue. On 3/10 he states he awoke around 9:30am and by 11am had felt so exhausted that he went back to bed for a 4 hour nap after which seemed pretty much back to normal. Other Relevant History:

Other Meds:

Current Illness:

ID: 1392191
Sex: F
Age: 52
State:

Vax Date: 03/02/2021
Onset Date: 03/03/2021
Rec V Date: 03/22/2021
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 CHILLS, FATIGUE Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392192
Sex: M
Age: 68
State:

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
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: Dizziness & Bradycardia Narrative:

Other Meds:

Current Illness:

ID: 1392194
Sex: F
Age: 30
State:

Vax Date: 03/21/2021
Onset Date: 03/21/2021
Rec V Date: 03/22/2021
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: Dizziness

Other Meds:

Current Illness:

ID: 1392195
Sex: F
Age: 58
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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, Arthralgia, Chills

Other Meds:

Current Illness:

ID: 1392196
Sex: F
Age: 52
State:

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 03/22/2021
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, Fever, Diarrhea & NauseaVomiting Narrative: Patient received vaccine on 3/5/2021 and began experiencing symptoms on 3/6/21. Reported symptoms include injection site pain/discomfort, fever (101.2 F), chills, headaches x 2 days, body aches, fatigue, nausea, and diarrhea. Patient reports "medium risk exposure to COVID + individual on 2/22/21. Test performed this date. Results unknown. Reports use ibuprofen 800mg x 2 doses. Other Relevant History:

Other Meds:

Current Illness:

ID: 1392198
Sex: F
Age: 59
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative:

Other Meds:

Current Illness:

ID: 1392199
Sex: F
Age: 27
State:

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 03/22/2021
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: FEVER, CHILLS, MYALGIA Narrative: FEVER 102 Other Relevant History:

Other Meds:

Current Illness:

ID: 1392201
Sex: F
Age: 58
State:

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 03/22/2021
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: FEVER, CHILLS, HEADACHE, MYALGIA Narrative: FEVER 100.5; CHILLS AND HEADACHE CONTINUED FOR AT LEAST 3 DAYS

Other Meds:

Current Illness:

ID: 1392203
Sex: F
Age: 52
State:

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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 Employee reports self-treating w/: "Just Aleve, I took 2 Aleve earlier, just the standard OTC bottle."

Other Meds:

Current Illness:

ID: 1392204
Sex: F
Age: 44
State:

Vax Date: 03/19/2021
Onset Date: 01/27/2021
Rec V Date: 03/22/2021
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: FEVER, HEADACHE, NAUSEA/VOMITING, LYMPHADENOPATHY Narrative: SEVERE HEADACHE; LYMPHADENOPATHY OCCURRED ON THE LEFT SIDE (INJECTION SIDE) OF BODY

Other Meds:

Current Illness:

ID: 1392205
Sex: M
Age: 71
State:

Vax Date: 03/13/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Narrative: Patient experienced upper left arm redness from below injection site to medial aspect of upper arm to elbow following 2nd moderana covid vaccine - dose of 0.5ml .

Other Meds:

Current Illness:

ID: 1392206
Sex: F
Age: 35
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative

Other Meds:

Current Illness:

ID: 1392207
Sex: M
Age: 34
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392208
Sex: M
Age: 0
State:

Vax Date: 02/02/2021
Onset Date: 02/17/2021
Rec V Date: 03/22/2021
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: Narrative:

Other Meds:

Current Illness:

ID: 1392209
Sex: F
Age: 68
State:

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392210
Sex: F
Age: 51
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392211
Sex: F
Age: 61
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative:

Other Meds:

Current Illness:

ID: 1392222
Sex: F
Age: 37
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative:

Other Meds:

Current Illness:

ID: 1392223
Sex: F
Age: 70
State:

Vax Date: 12/23/2020
Onset Date: 12/24/2020
Rec V Date: 03/22/2021
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: Injection site pain Narrative:

Other Meds:

Current Illness:

ID: 1392224
Sex: F
Age: 48
State:

Vax Date: 03/19/2021
Onset Date: 01/19/2021
Rec V Date: 03/22/2021
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: FATIGUE, MALAISE, ARTHRALGIA, FEVER, HEADACHE, CHILLS. SYMPTOMS OCCURRED FOR AT LEAST 2 DAYS

Other Meds:

Current Illness:

ID: 1392225
Sex: M
Age: 39
State:

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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 & Fever Narrative: 3/18/21 1500: Myalgia, headache, fever 100.5, fatigue; taking Tylenol. Other Relevant History:

Other Meds:

Current Illness:

ID: 1392226
Sex: M
Age: 52
State:

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 03/22/2021
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: FEVER, MYALGIA, NAUSEA, HEADACHE Narrative: SYMPTOMS BEGAN APPROX 12 HRS AFTER VACCINE WAS RECEIVED; FEVER 10; PATIENT MISSED ONE DAY OF WORK

Other Meds:

Current Illness:

ID: 1392227
Sex: M
Age: 35
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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 & Diarrhea Narrative:

Other Meds:

Current Illness:

ID: 1392228
Sex: F
Age: 54
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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, Arthralgia & Fever

Other Meds:

Current Illness:

ID: 1392229
Sex: M
Age: 60
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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, Arthralgia, chills, sore left arm Narrative:

Other Meds:

Current Illness:

ID: 1392230
Sex: F
Age: 58
State:

Vax Date: 01/26/2021
Onset Date: 01/27/2021
Rec V Date: 03/22/2021
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: DIZZINESS, FEVER, CHILLS, MY ALGIA Narrative: DIZZINESS OCCURRED IMMEDIATELY AFTER INJECTION1/26/2021; OTHER SYMPTOMS OCCURRED THE NEXT DAY 1/27/21 (EMPLOYEE MISSED WORK THAT DAY)

Other Meds:

Current Illness:

ID: 1392231
Sex: F
Age: 46
State:

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Headache, Myalgia, Arthralgia, Tachypnea, With both doses, sore arm, HA and fatigue. After 2nd dose sx lasted longer plus SOB. Narrative:

Other Meds:

Current Illness:

ID: 1392232
Sex: F
Age: 43
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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, low grade fever, upset stomach, chills Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392233
Sex: F
Age: 53
State:

Vax Date: 03/18/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: Dizziness, Arthralgia, feels hot, achy sore all over Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392234
Sex: M
Age: 58
State:

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Headache Brain fogginess

Other Meds:

Current Illness:

ID: 1392235
Sex: F
Age: 51
State:

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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: Arthralgia, NauseaVomiting, back ache, chills Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392236
Sex: F
Age: 59
State:

Vax Date: 03/17/2021
Onset Date: 03/19/2021
Rec V Date: 03/22/2021
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, Fever, fatigue Narrative:

Other Meds:

Current Illness:

ID: 1392237
Sex: F
Age: 62
State:

Vax Date: 01/19/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
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: tested positive greater than 14 days after vaccination

Other Meds:

Current Illness:

ID: 1392238
Sex: F
Age: 27
State:

Vax Date: 01/05/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
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: Employee tested COVID positive greater than 14 post second vaccine on 3/16 Narrative:

Other Meds:

Current Illness:

ID: 1392239
Sex: F
Age: 49
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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, HYPERtension, metallic taste/loss of taste appx 30 min after vaccine; bodyaches, headache, bp elevated. taken to ER for further observation; treated with toradol, pepcid, zofran, ivf. d/c same day. had an episdoe of emesis (per er note, might have beenn due to eating at outside restaurant the day before)

Other Meds:

Current Illness:

ID: 1392240
Sex: F
Age: 39
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
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: Dizziness, Headache, Myalgia, Fever, Diarrhea, NauseaVomiting, INSOMNIA, FATIGUE Narrative:

Other Meds:

Current Illness:

ID: 1392241
Sex: F
Age: 31
State:

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 03/22/2021
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: NauseaVomiting Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1392242
Sex: M
Age: 53
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 03/22/2021
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 Blood pressure, swollen arm

Other Meds:

Current Illness:

ID: 1392243
Sex: F
Age: 54
State:

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/22/2021
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: Dose # 2 NOT administered on 3/20/21 d/t pt reporting anaphylaxis reaction after receiving the first dose of Moderna COVID vaccine on 2/22/21. Pt reported symptoms of tongue swelling, throat closing and tachycardia within 30 minutes of receiving the first dose. Pt reported being given Benadryl after reaction w/ resolution.

Other Meds:

Current Illness:

ID: 1395353
Sex: M
Age: 67
State:

Vax Date: 03/13/2021
Onset Date: 03/16/2021
Rec V Date: 03/22/2021
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: Narrative:

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm