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: 1131730
Sex: M
Age: 48
State: AZ

Vax Date: 02/03/2021
Onset Date: 03/06/2021
Rec V Date: 03/24/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: I Started having a rigning on my right ear and lost my hearing for a few days, went to a ear specialist which prescribed steroids for 14 days, my hearing come back but the ringning is not gone yet and it is very noticeable

Other Meds: Bystolic 10 mg, amlodipine 5mg testosterona

Current Illness: None

Date Died: 03/22/2021

ID: 1133749
Sex: M
Age: 70
State:

Vax Date: 03/21/2021
Onset Date:
Rec V Date: 03/24/2021
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: V-Fib, cardiac arrest Narrative: First COVID vaccine administered 2/25/21 with no noted reaction. Patient received his second COVID vaccine 3/21/21 at 1203. Notes in electronic medical record indicate in the morning of 3/22/21 he arrived at a hospital with ER this morning in V-Fib/cardiac arrest. Unclear of potential treatment that was administered at outside facility. Time of Death was about 1330 on 3/22/21.

Other Meds:

Current Illness:

Date Died: 01/23/2021

ID: 1133750
Sex: M
Age: 69
State:

Vax Date: 01/06/2021
Onset Date: 01/23/2021
Rec V Date: 03/24/2021
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: Death Narrative: Pt was at rehab hospital where he rec his vaccine. No info for Lot or site. Was under Hospice for COPD, CHF, MDD. Passed at rehab center. No other info.

Other Meds:

Current Illness:

Date Died: 03/05/2021

ID: 1148803
Sex: M
Age: 72
State:

Vax Date: 02/10/2021
Onset Date:
Rec V Date: 03/24/2021
Hospital: Y

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: COVID-19/hospitalization/death Narrative: Patient received two doses of the Pfizer mRNA vaccine on 1/17/21 and 2/10/21. He was admitted on 3/5/21 with COVID-19 pneumonia which progressed to severe disease. Patient died on 3/21/21 attributed to COVID-19. Patient had underlying B cell follicular lymphoma, previously on chemotherapy. Reported does not feel patient's hospitalization or death was attributable to the vaccines, however following FDA Emergency Use Authorization, "The vaccination provider is responsible for mandatory reporting of the following to the Vaccine Adverse Event Reporting System (VAERS): vaccine administration errors whether or not associated with an adverse event, serious adverse events* (irrespective of attribution to vaccination), cases of Multisystem Inflammatory Syndrome (MIS) in adults and children, and cases of COVID-19 that result in hospitalization or death."

Other Meds:

Current Illness:

ID: 1311818
Sex: F
Age: 75
State: CA

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/24/2021
Hospital: Y

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

Lab Data:

Allergies: see list

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

Symptoms: 2 hours after vaccine patient developed left-sided chest and arm pain. Took nito SL(+hx CAD, no symptom in a year) with temporary relief Symptoms increased in frequency and severity until presented to ER on 03/09/2021. Diagnosed with NSTEMI, Troponin up to 7. Left heart cath uncharged from prior, discharged home on brillinta, no recurrence of symptoms as of 03/18/21

Other Meds: see list

Current Illness: see list

ID: 1392175
Sex: F
Age: 36
State:

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/24/2021
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, Sedation, Myalgia, Arthralgia, Fever, Chills, injection site pain Narrative: After 1st dose on 2/12/21 noted a euphoric feeling x 4 hours, then extreme then extreme fatigue and myalgias for 5 days. Left arm was very sore for 5 days at site and red and swollen. Had pain in neck and head for 3 days. Finally felt baseline at 5 days. After 2nd dose on 3/12/21 noted site pain within 5 hours, still had some disconnected feeling but less than last time. Next day had increased arthralgia. On 3/14/21 ? had fatigue and developed headache that afternoon. Fatigue worsened as day went on. Headache worsened that night. On 3/15/21 still had bad headache and fever/chills. The headache finally lessened by the evening of 3/15/21. Missed work x 1 day. No known prior COVID infection.

Other Meds:

Current Illness:

ID: 1392177
Sex: M
Age:
State:

Vax Date: 01/09/2021
Onset Date: 12/20/2020
Rec V Date: 03/24/2021
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: Headache Narrative: Employee reported headache x 2 days following both 1st and 2nd in series vaccination. Resulted in unable to work 12/20/2021.

Other Meds:

Current Illness:

ID: 1392179
Sex: F
Age: 50
State:

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/24/2021
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: Fever, Rash, FATIGUE, GENERAL WEAKNESS, RASH ON CHEST < DIFFICULTY CLIMBING STAIRS / Narrative:

Other Meds:

Current Illness:

ID: 1392184
Sex: M
Age: 46
State:

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/24/2021
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: Headache, Myalgia, NauseaVomiting, fatigue, chills occurred within days of 3/15 and 3/17 which resulted in unable to work 3/16/2021 and 3/17/2021.

Other Meds:

Current Illness:

ID: 1392193
Sex: M
Age: 51
State:

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/24/2021
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: Pt developed a raised bump and soreness at injection site 3 hours after administration. Noted significant fatigue. Next day reported diffused myalgias and bone pain. Resolved symptoms the next day. Missed work x 1 days due to symptoms. No known prior COVID infection.

Other Meds:

Current Illness:

ID: 1392197
Sex: F
Age: 47
State:

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/24/2021
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, Fever, Rash, lymphadenopathy Narrative: Received 1st dose at 0900 on 3/11/21. Noted increased arm pain that evening and fever that night (up to 100F). Developed swelling in armpit and neck and groin lymph node enlargement on opposite side of injection site. Lymph swelling above clavicle persisted through 3/16/21, though improving. Noted fine papular rash as well. Pt has had COVID infection 11/2020 Other Relevant History:

Other Meds:

Current Illness:

ID: 1392200
Sex: M
Age: 52
State:

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
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: Headache, Myalgia & Fever

Other Meds:

Current Illness:

ID: 1392202
Sex: F
Age: 52
State:

Vax Date: 03/01/2021
Onset Date: 03/04/2021
Rec V Date: 03/24/2021
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 fatigue Narrative: Employee reported fever, myalgia, and fatigue. Resulted in unable to work 3/4 and 3/5/2021.

Other Meds:

Current Illness:

ID: 1392212
Sex: F
Age: 32
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/24/2021
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: Pt developed arm soreness, myalgias and a headache with onset 4 hours after administration. Missed work x 1 day. No known prior COVID infection.

Other Meds:

Current Illness:

ID: 1392213
Sex: M
Age: 49
State:

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 03/24/2021
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: Pt reported lightheadedness approx 25 minutes after receiving vaccine which resolved after about 5-10 minutes.

Other Meds:

Current Illness:

ID: 1392214
Sex: F
Age: 50
State:

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/24/2021
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, Sedation Back pain, arm swollen, Narrative: Noted increased back pain and significant headache day of the 2nd vaccine dose which lasted 36 hours. Arm became swollen and painful 3-4 hours after administration lasting several days. Noted increased fatigue the day after administration. Missed work x 1 day. Pt had COVID infection 11/2020.

Other Meds:

Current Illness:

ID: 1392216
Sex: F
Age: 44
State:

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/24/2021
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: Received 1st dose on 1/26/21 and noted arm pain and swelling with onset several hours after administration. Symptoms lasted x 1 week. Received 2nd dose on 2/26/21. Noted onset of injection site swelling within 1 hour of administration, and headache and emesis that day. Over the next 2 days reported fever, chills, body aches, diarrhea, nausea/vomiting and facial rash. Fever was up to 103F x 3 days. Also noted hives on chest. Missed work x 0.5 day. No known prior COVID infection.

Other Meds:

Current Illness:

ID: 1392218
Sex: F
Age: 53
State:

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/24/2021
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, Sedation, Myalgia, Fever, NauseaVomiting, Chills, arm pain Narrative: Received 1st dose at 1030 03/12/21 and noted onset of arm pain at 1530. Was very painful to move her arm next day. She also noted extreme fatigue, mild headache all day 3/13/21. Also reported fever/chills and nausea/vomiting on 3/13/21 and 3/14/21. Symptoms mostly resolved by 3/15/21, though missed 1 day of. Prior COVID infection 12/28/20.

Other Meds:

Current Illness:

ID: 1392219
Sex: F
Age: 61
State:

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/24/2021
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: Sedation, Myalgia, UrticariaPruritus, Decreased concentration Narrative: After 1st dose on 2/16/21 noted arm soreness and myalgias, and felt random prickling sensation in body. Received 2nd dose 3/16/21 and noted onset of prickling sensation with 2 hours, which lasted through 3/18/21. Noted myalgias the night after injection. Felt feverish during the night, but did not check temperature. Pt awoke the next day with hives on the non-injection arm - which resolved after 3 hours. Also noted fatigue and decreased concentration. Missed work x 1 day. No known prior covid infection.

Other Meds:

Current Illness:

ID: 1392220
Sex: M
Age: 62
State:

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/24/2021
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: Sedation, Myalgia, Arthralgia, Fever Sweats, Narrative: After 2nd dose on 3/12/21 noted onset of fever (up to 102F), sweats, myalgia, arthralgia, and fatigue. Symptoms started within 12 hours of administration and lasted about 8 hours. Had history of COVID infection 10/2020, which required hospitalization x 5 days.

Other Meds:

Current Illness:

ID: 1392221
Sex: F
Age: 53
State:

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/24/2021
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: Sedation, NauseaVomiting, Chills,Sweats, Narrative: Pt developed fatigue, nausea, chills, sweats and a headache with 2nd injection. Missed work x 105 days. No Known prior covid infection.

Other Meds:

Current Illness:

ID: 1402317
Sex: M
Age: 65
State:

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/24/2021
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, Arthralgia, Fever, anxiety was seen by outside provider for c/o anxiety - received Zofran 4mg

Other Meds:

Current Illness:

ID: 1402494
Sex: M
Age: 63
State:

Vax Date: 03/23/2021
Onset Date: 02/24/2021
Rec V Date: 03/24/2021
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: Myalgia & Fever Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402508
Sex: F
Age: 51
State:

Vax Date: 02/24/2021
Onset Date: 03/18/2021
Rec V Date: 03/24/2021
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: Headache & Fever Narrative: EMPLOYEE STAYED HOME IN BED MOST OF THE THE DAY FOLLOWING HER VACCINATION Other Relevant History:

Other Meds:

Current Illness:

ID: 1402510
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/24/2021
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: CHILLS/SHIVERING

Other Meds:

Current Illness:

ID: 1402511
Sex: F
Age: 35
State:

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 03/24/2021
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, Myalgia, SkinRash, Tachypnea, Palpitations, HYPERtension, Tachycardia, facial and R inner antecubital area flushing. Fatigue, bilateral lower leg weakness. Narrative: Ambulance called and transported to Emergency Department with 2 month old infant in baby carrier. Other Relevant History:

Other Meds:

Current Illness:

ID: 1402513
Sex: F
Age: 38
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 03/24/2021
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, Fever, NauseaVomiting, INJECTION SITE PAIN Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402514
Sex: F
Age: 38
State:

Vax Date: 12/21/2020
Onset Date: 12/21/2020
Rec V Date: 03/24/2021
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, Fever, NauseaVomiting, LIGHTHEADEDNESS, FLUSHING, INJECTION SITE PAIN Narrative: GOT TESTED FOR COVID Other Relevant History:

Other Meds:

Current Illness:

ID: 1402516
Sex: F
Age: 51
State:

Vax Date: 12/28/2020
Onset Date: 12/29/2020
Rec V Date: 03/24/2021
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, Arthralgia, Fever, Diarrhea, MUSCLE PAIN/FATIGUE (HX LONG-STANDING 45 YEARS AUTOIMMUNE MUSCLE DISEASE - IMMUNE COMPROMISED), INJECTION SITE PAIN Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402517
Sex: F
Age: 37
State:

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 03/24/2021
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 Narrative:

Other Meds:

Current Illness:

ID: 1402519
Sex: M
Age: 84
State:

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 03/24/2021
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: & altered mental status Narrative: Pt reported the following adverse reaction from his covid vaccine dose #1. Taken from the nurses note- "Veteran reports serious altered mental status folowing first vaccination. reports hulicinations felt like he was "very small in size" and, that he was totally "out of it" but could not elaborate. he denies any other preeding event that could have contributed to his mental status. he is alert oriented and in a good mood during our conversation. no signs of distress or confusion. he denies any other symptoms. all symptoms resolved. advised veteran to discuss with pcp before proceeding with 2nd vaccination, and Veteran agrees" He reported this to nurse at his dose #2 covid vaccine appointment. Pt declined vaccine dose #2 at this appointment.

Other Meds:

Current Illness:

ID: 1402520
Sex: F
Age: 36
State:

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 03/24/2021
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: Headache, Myalgia, Fever, NauseaVomiting, INJECTION SITE PAIN Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402521
Sex: F
Age: 45
State:

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 03/24/2021
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, Fever, EXTREME TIREDNESS, INJECTION SITE PAIN, SWOLLEN GLANDS Narrative:

Other Meds:

Current Illness:

ID: 1402522
Sex: M
Age: 22
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 03/24/2021
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 & NauseaVomiting Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402523
Sex: F
Age: 22
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 03/24/2021
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, Fever, NauseaVomiting, INJECTION SITE PAIN Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402546
Sex: F
Age: 22
State:

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 03/24/2021
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: Myalgia, Fever & NauseaVomiting Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402692
Sex: F
Age: 58
State:

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 03/24/2021
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: FEVER 99.0-100.0

Other Meds:

Current Illness:

ID: 1402693
Sex: F
Age: 45
State:

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 03/24/2021
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: Dizziness, Headache, Myalgia, Arthralgia, NauseaVomiting, EXTREME TIRED AND WEAKNESS, INJECTION SITE PAIN Narrative:

Other Meds:

Current Illness:

ID: 1402699
Sex: F
Age: 25
State:

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 03/24/2021
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: Fever Chills, fatigue, slight cough, excessive sweating at night Narrative:

Other Meds:

Current Illness:

ID: 1402712
Sex: F
Age: 43
State:

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/24/2021
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: Narrative: Syncope a few minutes after receiving COVID vaccine number 1. Went to ER, received 1 L IVF and APAP 1g. Sent home 3 hours later

Other Meds:

Current Illness:

ID: 1402714
Sex: F
Age: 38
State:

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 03/24/2021
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 chills Narrative: Received 2nd vaccine on 3/19/2021 at 130 pm. Reaction started on Sat with HA, arm pain at site of injection. Felt fatigued on Sun and had chills. Employee was notified that these are normal side effects and should reside within 24-48 hours Other Relevant History:

Other Meds:

Current Illness:

ID: 1402716
Sex: M
Age: 62
State:

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/24/2021
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: Narrative:

Other Meds:

Current Illness:

ID: 1402757
Sex: F
Age: 56
State:

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 03/24/2021
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: Narrative:

Other Meds:

Current Illness:

ID: 1402843
Sex: M
Age: 51
State:

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 03/24/2021
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: Pt was reported to have a high degree of anxiety prior to the Vaccine administration. Reported that pt received #1 vaccination, stood up, walked to observation area and fainted. Was assisted to the ground by staff, pt did not fall or strike head. Pt placed in a chair, in/out of consciousness. Original vitals: 90/60, 37. Pt placed on floor, feet elevated, Vitals:114/69, 63. 911 was called and responded. Pt regained full consciousness, A+Ox3, able to sit in a chair. Pt denied any chest discomfort, other pain, illness before receiving the COVID Vaccine. Pt's girlfriend present. Pt refused ambulance transport.

Other Meds:

Current Illness:

ID: 1402846
Sex: M
Age: 76
State:

Vax Date: 03/12/2021
Onset Date: 03/15/2021
Rec V Date: 03/24/2021
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: respiratory distress Narrative: Moderna Covid 19 vaccine on 3/12/2021 Developed respiratory distress one hour after the vaccine On 3/15/2021 BP 100/67 sat 69 ct chest angiogram negative for PE 3/18/2021

Other Meds:

Current Illness:

ID: 1402847
Sex: M
Age: 57
State:

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 03/24/2021
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, Arthralgia, Fever, Diarrhea & Nausea Vomiting

Other Meds:

Current Illness:

ID: 1402849
Sex: F
Age: 56
State:

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/24/2021
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: Narrative:

Other Meds:

Current Illness:

ID: 1402851
Sex: F
Age: 37
State:

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 03/24/2021
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: INJECTION SITE PAIN

Other Meds:

Current Illness:

ID: 1402852
Sex: M
Age: 27
State:

Vax Date: 03/20/2021
Onset Date: 03/20/2021
Rec V Date: 03/24/2021
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, Diarrhea, chills Narrative: Other Relevant History:

Other Meds:

Current Illness:

ID: 1402854
Sex: F
Age: 64
State:

Vax Date: 01/29/2021
Onset Date: 01/29/2021
Rec V Date: 03/24/2021
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, ARTHRALGIA, HEADACHE, DIAPHORESIS, DIARRHEA Narrative: SYMPTOMS LASTED 48-72 HRS

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm