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: 1319253
Sex: F
Age: 64
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319254
Sex: M
Age: 66
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319255
Sex: F
Age: 60
State: CA

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 05/14/2021
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: Sulfa. No other allergies reported.

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Client reports she began to experience muscle twitching to vaccinated arm about 20 minutes after vaccination. Client reports she told the EMT during her observation. Client was guided to private observation room and evaluated by EMTs. Client reports upon assessment EMTs found that she had a blood pressure of 190s systolically. Client cannot recall exact blood pressure. Client denied any other symptoms at this time other than muscle twitching. Client was taken to the Emergency Room where she was evaluated. Client reports her blood pressure went down on its own without the need of medications. Client denies history of hypertension.

Other Meds: Albuterol. No other medications reported.

Current Illness: None reported.

ID: 1319256
Sex: F
Age: 66
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319257
Sex: M
Age: 67
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319258
Sex: F
Age: 67
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319259
Sex: M
Age: 67
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319260
Sex: M
Age: 68
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319261
Sex: M
Age: 69
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319262
Sex: M
Age: 70
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319263
Sex: M
Age: 71
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319264
Sex: M
Age: 72
State: GA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/14/2021
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: none

Symptom List: Rash, Urticaria

Symptoms: sore arm at injection site, lasting 3 days

Other Meds: none

Current Illness: none

ID: 1319265
Sex: F
Age: 46
State: AL

Vax Date: 12/01/2020
Onset Date: 12/01/2020
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies: Levaquin, Requip, Typhoid Vaccine, Dexamethasone Aveeno facial moisturizer

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: 3 hours after receiving the first Moderna Covid vaccine, my tongue had some swelling. Then at around 3.5 hours I started itching all over my body. At 4 hour time frame I had two whelps appear on the opposite arm from the vaccination.

Other Meds: Nexium, Lexapro, Simvastatin, CoQ10, Ferrous sulfate, Vit. D3, Oxybutinin, Mag-Ox

Current Illness: None

ID: 1319266
Sex: M
Age: 73
State:

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319267
Sex: F
Age: 74
State:

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319268
Sex: F
Age: 75
State:

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319269
Sex: F
Age: 76
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319271
Sex: F
Age: 76
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319272
Sex: M
Age: 76
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319273
Sex: F
Age: 77
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319274
Sex: M
Age: 16
State: NM

Vax Date: 05/06/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: none

Other Meds:

Current Illness:

ID: 1319275
Sex: F
Age: 80
State:

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319276
Sex: M
Age: 87
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319278
Sex: M
Age: 17
State:

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319279
Sex: M
Age: 17
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319280
Sex: M
Age: 18
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319281
Sex: F
Age: 18
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319282
Sex: M
Age: 64
State: MN

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies: fresh water fish

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: after 6 hours got very tired.

Other Meds: atenolol/chlorthalidone 25/50mg simvastatin 20mg metformin HCL 500mg

Current Illness: none

ID: 1319283
Sex: F
Age: 19
State:

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319284
Sex: F
Age: 19
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319285
Sex: M
Age: 19
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319286
Sex: M
Age: 20
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319288
Sex: F
Age: 56
State: TN

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 05/14/2021
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: Pt received dose 1 of Pfizer covid vaccine, and immediately upon trying to stand, experienced lightheadedness and said her vision blacked out briefly. She then stated she had lip numbness and lower face numbness. Pt further stated her BP sometimes drops rapidly and causes her to pass out, but she never experienced it with a vaccine previously. Pt requested Gatorade and was monitored for 30 minutes, at which time she stated she was fine, and left with spouse.

Other Meds:

Current Illness:

ID: 1319289
Sex: M
Age: 35
State: CA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/14/2021
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: PT WAS SITTING AT POST-VACCINATION AREA AND SUDDENLY FAINTED. PT FELLED OVER AND WAS SHAKING. HE REGAINED CONSCIOUSNESS RIGHT AWAY WHEN HE HEARD SOMBODY CALLING HIM. HE SAID HIS HANDS WERE COLD

Other Meds:

Current Illness:

ID: 1319290
Sex: M
Age: 20
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319291
Sex: M
Age: 67
State: MI

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 05/14/2021
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: Lipitor

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

Symptoms: Sore arm, chills, fever, nausea, vomiting, hallucinations. The hallucinations and all started about 10 pm the first day. It felt like the front door to the house was, but I was in my bedroom and it wasn't. Then it seemed like curtains were falling around me. Next, I thought I saw stars in my bedroom ceiling and my wife circling around, but she wasn't. This lasted about two nights. The remainder of the symptoms I think lasted about 4 days or 5 days.

Other Meds: none

Current Illness:

ID: 1319292
Sex: M
Age: 22
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319293
Sex: M
Age: 21
State:

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319294
Sex: M
Age: 23
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319295
Sex: F
Age: 24
State:

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319296
Sex: F
Age: 32
State:

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 05/14/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: The covid vaccine was drawn 4/20 at 5pm before it was given and was administered the next day at 155pm on 4/21/21. The vaccine was pre-drawn using the aseptic technique and was kept in the refridgerator the whole time. Called the moderna to seek advise and was told by pharmacist that the second dose is not necessary and that the dose is still viable since it was kept in the refridgerator. Second dose will be given to pt on scheduled date.

Other Meds: none

Current Illness: none

ID: 1319298
Sex: F
Age: 17
State:

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 05/14/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: No allergies

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: The patient received the Moderna vaccine before turning 18 years old. She didn't have any symptoms.

Other Meds: None

Current Illness: No diseases

ID: 1319299
Sex: M
Age: 25
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319300
Sex: M
Age: 32
State:

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/14/2021
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: The same night as getting 2nd Moderna vaccine, I had a 101 F degree fever and chills. Only after taking Tylenol did the temperature decrease to 99.3.

Other Meds: Zyrtec

Current Illness:

ID: 1319301
Sex: M
Age: 25
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319302
Sex: M
Age: 27
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

ID: 1319303
Sex: F
Age: 27
State:

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319304
Sex: F
Age: 27
State:

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319305
Sex: M
Age: 29
State:

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/14/2021
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: Temperature excursion with vaccine administered.

Other Meds:

Current Illness:

ID: 1319306
Sex: M
Age: 30
State:

Vax Date: 05/10/2021
Onset Date: 05/10/2021
Rec V Date: 05/14/2021
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: temperature excursion with vaccine administered

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm