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: 0958547
Sex: F
Age:
State: PA

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/20/2021
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: Vaccine Administered from A Punctured Vial Beyond the 6 Hour limit; A spontaneous report was received from a pharmacist concerning a 36 year old, female patient who received Moderna's Covid-19 vaccine (mRNA-1273) and experienced vaccine administered from a punctured vial beyond the 6 hour limit. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 on 31 Dec 2020 for prophylaxis of COVID-19 infection. On 31 Dec 2020, the patient received the Moderna COVID-19 vaccine in the unknown arm on 31 Dec 2020 from a vial that was used beyond the 6 hour limit. The vial was first punctured on 30 Dec 2020. Treatment for the event was not provided. Action taken with mRNA-1273 in response to the events was not provided. The event, experienced vaccine administered from a punctured vial beyond the 6 hour limit, was considered resolved on 31 Dec 2020.; Reporter's Comments: This report refers to a case of a 36-year old female consumer who received Moderna's COVID 19 and experienced vaccine administered from a punctured vial beyond the 6-hour limit. The vaccine lot number and the consumer's medical history were not provided. There were no reported AEs associated with this case of female consumer who received Moderna's COVID-19 vaccine and experienced vaccine administered from a punctured vial beyond the 6-hour limit.

Other Meds:

Current Illness:

ID: 0958548
Sex: F
Age:
State: PA

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 01/20/2021
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: Administered Punctured Vial Beyond 6 hours; A spontaneous report was received from a pharmacist concerning a 60 year old, female patient who received Moderna's Covid-19 vaccine (mRNA-1273) and experienced administration from a punctured vial beyond 6 hours. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 on 31 Dec 2020 for prophylaxis of COVID-19 infection. On 31 Dec 2020, the patient received the Moderna COVID-19 vaccine in the unknown arm on 31 Dec 2020 from a vial that was used beyond the 6 hour limit. The vial was first punctured on 30 Dec 2020. Treatment for the event was not provided. Action taken with mRNA-1273 in response to the events was not provided. The event, experienced administered punctured vial beyond 6 hours, was considered resolved on 31 Dec 2020. The reporter did not provide an assessment of the event, out of specification product use.; Reporter's Comments: This case concerns a 60 year old female subject who experienced a nonserious unexpected event of out of specification product use. There were no reported AEs associated with this case of out of specification product use.

Other Meds:

Current Illness:

ID: 0958549
Sex: F
Age:
State: LA

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/20/2021
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: Vial was shaken vigorously before she received the vaccine; A spontaneous report was received from a consumer who was a female patient who was received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced out of specification product use. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. Prior to the administration of the vaccine, the vial was vigorously shaken. The patient received their first of two planned doses of mRNA-1273 on 07 Jan 2021 intramuscularly for prophylaxis of COVID-19 infection. Because the dose was administered from the vial that had been vigorously shaken, the patient experienced out of specification product use. Treatment information was not provided. Action taken with mRNA-1273 in response to the event, product preparation error, was not provided. The event, out of specification product use, was considered recovered/resolved on 07 Jan 2021.; Reporter's Comments: This report refers to a case of Out of specification product use for mRNA-1273. There were no reported AEs associated with this case.

Other Meds:

Current Illness:

ID: 0958550
Sex: M
Age:
State: NY

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/20/2021
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: A male patient under the age of 18 was administered Moderna's COVID-19 vaccination; A spontaneous report was received from a nurse concerning a male patient under the age of 18 who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the event, a male patient under the age of 18 was administered Moderna's COVID-19 vaccination. The patient's medical history was not provided. No relevant concomitant medications were reported. On 4 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 7 Jan 2021, the nurse reported the Moderna COVID vaccine was given to a patient under the age of 18. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, a male patient under the age of 18 was administered Moderna's COVID-19 vaccination, was considered resolved on 4 Jan 2021.; Reporter's Comments: This case concerns a male subject under the age of 18 who experienced a non-serious unexpected event of Inappropriate age at vaccine administration. There were no reported AEs associated with this case of Inappropriate age at vaccine administration.

Other Meds:

Current Illness:

ID: 0958551
Sex: F
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 01/20/2021
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: Liquid was running down the subject's arm while they were injecting the vaccine; A spontaneous report was received from a nurse concerning a 49-year-old, female patient who received Moderna's COVID-19 Vaccine, and liquid was running down the patient's arm while they were injecting the vaccine. The patient's medical history was not provided. Concomitant medications were not provided. The patient received their first of two planned doses of mRNA-1273 (Batch number 039K20A) on 07 Jan 2021 intramuscularly in the left deltoid for prophylaxis of COVID-19 infection. On an unknown date, liquid was running down the patient's arm while the vaccine was being injected. The nurse was unsure why this had occurred. Treatment information was not provided. Action taken with the drug in response to the event was not applicable. The outcome of the event was considered resolved.; Reporter's Comments: This report refers to a case of incorrect dose administered for mRNA-1273 (lot # 039K20A). There were no reported AEs associated with this case of incorrect dose administered.

Other Meds:

Current Illness:

ID: 0958552
Sex: U
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 01/20/2021
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: Person under the age of 18 was administered the vaccine; A spontaneous report was received from a nurse concerning a pediatric patient who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the event, person under the age of 18 was administered the vaccine. The patient's medical history was not provided. Concomitant medications were not reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, a patient under the age of 18 was administered the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The outcome of the event, person under the age of 18 was administered the vaccine, was considered resolved.; Reporter's Comments: This case concerns a patient under the age of 18 years and of unknown gender. The patient's medical history is not provided. The event occurred on an unknown date, where the patient was administered the first dose of the mRNA-1273. This report refers to a case of medication error where mRNA-1273 has been administered to the patient of inappropriate age.

Other Meds:

Current Illness:

ID: 0958553
Sex: U
Age:
State: NE

Vax Date:
Onset Date:
Rec V Date: 01/20/2021
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: Patient received some of the vaccine but not the entire 0.5 ml dose; Vanish point needle sent in the ancillary box malfunctioned; A spontaneous report was received from a nurse practitioner concerning a patient who received Moderna's COVID-19 vaccine (mRNA-1273) and the vanish point needle sent in the ancillary box malfunctioned and the patient received some of the vaccine but not the entire 0.5ml dose. The patient's medical history was not provided. No concomitant product use was reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, during vaccine administration, the vanish point needle sent in the ancillary box malfunctioned and retracted too soon. The patient received some of the vaccine but not the entire 0.5ml dose. Action taken with mRNA-1273 in response to the events was unknown. The events, vanish point needle sent in the ancillary box malfunctioned and the patient received some of the vaccine but not the entire 0.5ml dose, were considered resolved.; Reporter's Comments: This report refers to a case of incorrect dose administered and device malfunction for mRNA-1273 (lot # unknown). There were no reported AEs associated with this case of incorrect dose administered and device malfunction.

Other Meds:

Current Illness:

ID: 0958554
Sex: U
Age:
State: CA

Vax Date: 01/04/2021
Onset Date: 01/04/2021
Rec V Date: 01/20/2021
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: Immunized at age 12; Administered vials that were exposed to room temperature for more than 12 hours; A spontaneous report was received from a physician concerning an 12-year-old patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the events, immunized at age 12 and administered vials that were exposed to room temperature for more than 12 hours. The patient's medical history was not provided. Concomitant product use was not provided by the reporter. On 04 Jan 2021, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 04 Jan 2021, the patient received a vaccine dose of mRNA-1273 that had been left at room temperature more than 12 hours. It was originally thought that the freezer which stored the mRNA-1273 vaccine died on 04 Jan 2021 at 2am, so vaccine administration occurred up until 2pm. After checking freezer temperature logs, it was discovered the freezer had died at 1:11am. Treatment for the events was not provided. Action taken with mRNA-1273 in response to the events was not provided. The events, immunized at age 12 and administered vials that were exposed to room temperature for more than 12 hours, were considered resolved on 04 Jan 2021.; Reporter's Comments: Company comment: This report refers to a case of 12- year-old patient who was administered vaccine outside the lower age limit for Moderna's mRNA-1273 vaccine, and received a vaccine dose that had been left at room temperature more than 12 hours (lot # unknown, Exp. unknown). There were no reported AEs associated with this case of vaccine and is outside the lower age limit for Moderna's mRNA-1273 vaccine and vaccine dose of mRNA-1273 that had been left at room temperature more than 12 hours.

Other Meds:

Current Illness:

ID: 0958556
Sex: F
Age: 44
State: OK

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 01/20/2021
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: because the needle was not secured to the syringe 0.1-0.2mL of the dose leaked from the syringe; 0.1-0.2mL of the dose leaked from the syringe; A spontaneous report was received from a nurse concerning a 44-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and not a complete dose administered. The patient's medical history was not provided. No relevant concomitant medications were reported. On 06 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot number: 025G20-2A, Exp. date: 25 Feb 2021) intramuscularly in the left arm for prophylaxis of COVID-19 infection. The nurse reported that while administering, the needle was not secured to the syringe and believes 0.1-0.2mL of the dose leaked from the syringe. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The outcome of the event, not a complete dose administered, was considered resolved on 06 Jan 2021.; Reporter's Comments: Company comment: This report refers to a case of 44- year-old female patient who experienced event of some dose 0.1-0.2mL of the dose leaked from the syringe for mRNA-1273, lot # 025G20-2A, Exp. date: 25 Feb 2021. There were no reported AEs associated with this case of dose leaked from the syringe.

Other Meds:

Current Illness:

ID: 0958557
Sex: M
Age: 17
State:

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 01/20/2021
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: We gave the vaccine to a 17 year old; A spontaneous report was received from a healthcare facility staff member concerning a 17-year-old, male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and who experienced product administered to patient of inappropriate age. The patient's medical history was benign. Concomitant product use was not provided by the reporter. The patient received their first of two planned doses of mRNA-1273 (LOT number unknown) on 07 Jan 2021 intramuscularly in the left deltoid for prophylaxis of COVID-19 infection and experienced product administered to patient of inappropriate age. Treatment information was not provided. Action taken with mRNA-1273 in response to the event, product administered to patient of inappropriate age, was not provided. The event, product administered to patient of inappropriate age, was considered resolved on 07 Jan 2021. The reporter did not provide a causality assessment for the event, product administered to patient of inappropriate age.; Reporter's Comments: This report refers to a case of 17- year-old female patient who experienced non-serious unexpected event of gave the vaccine to a 17-year-old by mistake (product administered to patient of inappropriate age) for mRNA-1273, lot # unknown, Exp date-unknown. There were no reported AEs associated with this case of gave the vaccine to a 17-year-old by mistake.

Other Meds:

Current Illness:

ID: 0958558
Sex: F
Age:
State: IL

Vax Date:
Onset Date:
Rec V Date: 01/20/2021
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: Health department gave 16 year old the Moderna 18+ vaccine; A spontaneous report was received from a 16-years-old female healthcare facility staff member who received Moderna's COVID-19 vaccine (mRNA-1273) resulting in the event, product administered to patient of inappropriate age. The patient's medical history was not provided. No relevant concomitant medications were reported. On an undisclosed date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection and experienced product administered to patient of inappropriate age. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The event, product administered to patient of inappropriate age, was considered resolved.; Reporter's Comments: This report refers to a case of 16- year-old female patient who experienced non-serious unexpected event of health department gave 16-year-old the Moderna 18+ vaccine (product administered to patient of inappropriate age) for mRNA-1273, lot # unknown, Exp date-unknown. There were no reported AEs associated with this case of health department gave 16-year-old the Moderna 18+ vaccine.

Other Meds:

Current Illness:

ID: 0958559
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 01/20/2021
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: stroke (cerebrovascular accident); Initial information was received on 07-Jan-2021 regarding an unsolicited valid serious case from a consumer/non-health care professional. This case involves a female patient (age unspecified) who had a stroke (cerebrovascular accident), after she received INFLUENZA VACCINE. Medical history, concomitant medications, past vaccinations and family history were not reported. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (batch number and expiry date not reported) via an unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient developed serious stroke (cerebrovascular accident) in less than a month following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. It is unknown if the patient experienced any additional symptoms/events. There were no lab data/results available. It was not reported if the patient received a corrective treatment. At the time of report, the outcome of event was unknown. The information on batch number was requested; Sender's Comments: This case concerns a female patient (age unspecified) who experienced cerebrovascular accident in less than a month after vaccination with INFLUENZA VACCINE produced by unknown manufacturer. Information regarding medical history, condition at the time of vaccination and lab data excluding other predisposing etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 0958564
Sex: M
Age: 82
State: PA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: Joint lubricant

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

Symptoms: Fever last night 99.6

Other Meds: Vit C Multi Vit Metacmucil ProBiotic

Current Illness: None

Date Died: 01/12/2021

ID: 0958565
Sex: M
Age: 71
State: FL

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/20/2021
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: None Known

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Clients wife reported on 1/18/2021, that her husband died unexpectedly the day after receiving the COVID 19 vaccine. I called and spoke with her. She stated that the client had started experienced some tightness in his chest the evening of 1/11/2021. She stated that it was normal for him to have the tightness in his chest if he got stressed. She stated that she found him on the garage floor on 1/12/2021 at 2120. He was taken by ambulance to the hospital. She stated that the hospital told her that his COPD had caused him to go into arrythmia.

Other Meds: Albuterol nebulizer, Saline nebulizer, Metoprolol, Vespi, Albuterol Inhaler, antibiotic 2-3 times per week

Current Illness: lung infection treated with antibiotics a couple of weeks ago

ID: 0958566
Sex: F
Age: 60
State: NY

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: None

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

Symptoms: Fatigue, Chills, Sweats, body aches, nausea.

Other Meds: vitamin supplements; advil occasionally as needed.

Current Illness: None

ID: 0958567
Sex: F
Age: 32
State: NJ

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 01/20/2021
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: denies

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: left deltoid with rash size 10 cm x 10 cm, hot, itchy, red and is getting larger in size since 01/11/21 at 06:30 pm. Denies pain.

Other Meds: denies

Current Illness: denies

ID: 0958568
Sex: F
Age: 89
State: NE

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/20/2021
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: Sulfa drugs

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Rash around face and chest; bloodshot left eye. Hydrocortisone cream prescribed by facility APRN on 1/13; skin less red on 1/14 and peeling - no pain or itch. Dermatology recommendation of Aquaphor for the peeling.

Other Meds: Acetaminophen, Soriatane, Fosamax, amlodipine, apixaban, vitamin c, Imuran, folic acid, levothyroxine, lisinopril, prednisone, simvastatin, magnesium hydroxide, preservision areds oral, methotrexate

Current Illness: None

ID: 0958569
Sex: F
Age: 32
State: TX

Vax Date: 01/13/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: Right Supraclavicular and axillary lymph swelling with pain began on day 6 post vaccination . No treatment. Does not interfere with ADLs

Other Meds:

Current Illness:

ID: 0958570
Sex: F
Age: 50
State: NC

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 01/20/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: No allergies.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Went to bed on 1/6/2021 and woke up in middle of night with severe chills and nausea. Got out of bed at 6 am on 1/7/2021 with temp of 102.8 , very sore left arm that was swollen, severe headache, and body aches and fatigue. Symptoms continued all day. Was able to get temp down to 101 with Tylenol and ibuprofen but it would return to 102 once med wore off. Headache all day with out relief. Used Ice pack on left arm to relieve swelling and pain. Symptoms continued on 1/8/2021 with temp up to 101.8, severe HA, sore and swollen arm, body aches and fatigue. Low grade temp on 1/9/2021 of 100.5, headache, sore arm with less swelling, less body aches and less fatigue. No temp on 1/10/2021 but headache and sore arm continued. Headache resolved by 1/11/2021. Sore arm lessened every day. It is still slightly sore only with palpation.

Other Meds: Allegra, Vit D, Vit C, CoQ10, multivitamin, Elderberry immune supplement.

Current Illness: Treated for sinus infection 12/29/2020 with Doxycycline Hyclate 100 MG Oral Capsule: take 1 capsule by mouth twice a day for 7 days, and Mucinex D 60-600 MG Oral Tablet Extended Release 12 Hour. Took Mucinex for 2-3 days then stopped because it was not helping. Completed antibiotic on 1/3/2021. I was prescribed steroids on 12/30/20, took 20 mgs on 12/30/2020, 20 mgs on 12/31/2020 and 10 mgs on 1/1/2021. I felt completely better on 1/3/2021 and for the rest of the days prior to vaccination date on 1/6/2021.

ID: 0958571
Sex: M
Age: 50
State: WA

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
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: HEADACHE, NAUSEA. HAD TO LEAVE WORK TO RECOVER AT HOME.

Other Meds:

Current Illness:

ID: 0958572
Sex: F
Age: 44
State: FL

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: Opioids

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Nausea, headache, diarrhea. Symptoms less day after. Laid in bed with lots of rest and water

Other Meds: Leflunamide MVI ibuprofen Phentermine

Current Illness: None

ID: 0958573
Sex: F
Age: 71
State: NY

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Unevaluable event

Symptoms: Chills, bodyaches, tiredness Symptoms started at 10 pm after receiving the shot at 1:30pm Took 2 tylenol at 10 am the day after the injection and syptoms slowly began to subside felt much better by 3PM

Other Meds: Amlodipine, pegasys

Current Illness: None

ID: 0958574
Sex: F
Age: 48
State: AR

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
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: food: peaches, fruit, avocado, apple, nuts

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Headache occurred, body aches, chills, nausea, and fever of 99.4

Other Meds: Migraine medication

Current Illness: n/a

ID: 0958575
Sex: F
Age: 39
State: CO

Vax Date: 01/05/2021
Onset Date: 01/06/2021
Rec V Date: 01/20/2021
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: fever, aches, vomiting headache

Other Meds:

Current Illness:

ID: 0958576
Sex: F
Age: 44
State: VA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Injection site pain, Menorrhagia

Symptoms: Systemic: Anaphylaxis, Systemic: Seizure-Severe

Other Meds:

Current Illness:

ID: 0958577
Sex: F
Age: 42
State: OH

Vax Date: 01/08/2021
Onset Date: 01/13/2021
Rec V Date: 01/20/2021
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: None

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Jan 8 vaccine night: left arm pain that resolved next day Day 6 post-vaccine: severe left arm and left axillary pain Day 8: arm swelling, injection site localized erythema < 1 inch. Arm firm with significant pain Day 9: injection site urticaria like rash spreading approximately 3 inches wide, persistent arm swelling and firmness with significant axillary pain and tenderness Day 10: cutaneous patch of erythema observed on left upper chest near axilla with warmth and persistent arm and axillary symptoms Day 11: coalesced cutaneous discoloration upper left chest and axillary region with persistent arm and axillary pain Day 12-13: cutaneous changes very slowly fading and arm pain improving, axillary pain persistent

Other Meds: None

Current Illness: None

ID: 0958578
Sex: F
Age: 44
State: TN

Vax Date: 12/28/2020
Onset Date: 01/04/2021
Rec V Date: 01/20/2021
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: preservative in plasma

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: noticed very light pink color on the upper arm where the injection was one week after. The next morning (day 8), it was more noticeable, about 3 x 4 cm. No itching or warmth, maybe a little swollen. Gone the next morning (Jan 6).

Other Meds: multivitamin, fiber gummy, vitamin D, zinc, immune tablet

Current Illness: seasonal allergies

ID: 0958579
Sex: F
Age: 41
State: GA

Vax Date: 12/19/2020
Onset Date: 01/01/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: unknown

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: "Pfizer-Bio-Tech COVID-19 Vaccine EUA" Physician contacted staff in regards to an individual who received the Covid-19 Vaccine on 12/19/2020. The individual reported sand paper face rash and full swollen face that started 3 days after receiving the vaccine (1/1/2021). Individual reported that she had Botox and facial fillers on 12/15/2020. This event was an unwitnessed by the staff at County Health Department. The event was reported to Epidemiologist.

Other Meds: unknown

Current Illness: unknown

ID: 0958580
Sex: F
Age: 35
State: WA

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: NKDA

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: body aches, chills, temp 101.4, mild SOB, site pain (site hot and swollen)

Other Meds: multi vitamin, lisinopril, tylenol, ibuprofen

Current Illness: none

ID: 0958581
Sex: F
Age: 34
State: MD

Vax Date: 01/20/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: When asked how she was doing she reported that her "heart rate was fast". Asked if she wanted to lie down, she said "yes" and was walked to the designated cot. Her blood pressure was 124/90. She also reported not eating all morning. She laid down for about 45 minutes and was provided a bottle of water; a snack (crackers) was offered but she refused. She left for home feeling better.

Other Meds: Vitamin D3

Current Illness: None

ID: 0958582
Sex: F
Age: 40
State: NY

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: non

Symptom List: Injection site pain

Symptoms: headache from 2 pm 18th of January to evening 19th of January, fever, pain in the left arm until 20th of January. I did not take any medicine, just took a rest home.

Other Meds: non

Current Illness: non

ID: 0958583
Sex: F
Age: 34
State:

Vax Date: 01/11/2021
Onset Date: 01/12/2021
Rec V Date: 01/20/2021
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, chills, aches

Other Meds:

Current Illness:

ID: 0958584
Sex: F
Age: 29
State: WA

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 01/20/2021
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: Sulfa drugs

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Approximately 1 week post dose, I woke up with significant skin redness around the injection site about 1 inch wide by 3 inches long. I did not experience any injection site skin reactions prior to this, just muscle pain in that shoulder for a couple days after the dose. The redness faded away within 24 hours.

Other Meds: Prenatal multivitamin, choline, fish oil, vitamin D3, calcium

Current Illness: None

ID: 0958585
Sex: F
Age: 19
State: MN

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: Penicillin

Symptom List: Tremor

Symptoms: Approximately 15-20 minutes after vaccination patient developed weakness in her limbs. BP and glucose were normal. Approximately 10 minutes after the onset of symptoms the patient developed bright red rash on the face, increased breath rate, and swelling of the lips and tongue. She was having difficulty talking due to shortness of breath and swelling in the tongue. 911 was called and epinephrine 0.3mg IM was administered as well as diphenhydramine 100mg orally. Her rash improved fairly quickly, swelling went down a small amount. She stated breathing still felt labored and she was feeling like her heart was racing but she was also tired (likely due to medications administered). She was still having difficulty talking, taking short breaths between almost each word. Paramedics arrived approximately 12 minutes after epinephrine was administered. They attempted to walk her to the ambulance per her request, however she was unable to feel her legs. She was placed on a stretcher and into the ambulance. The patient stated she was given additional epinephrine in the ambulance as her condition had worsened by the time they got her in there. She was taken to the ER and given additional diphenhydramine and was observed until approximately midnight, when she said she was discharged. Follow up was completed the following day, and she had improved dramatically. She was still feeling a bit weak, but no longer had any issues breathing.

Other Meds: Fish oil

Current Illness: Unknown; test for Lupus pending

ID: 0958587
Sex: F
Age: 26
State: OH

Vax Date: 01/16/2021
Onset Date: 01/17/2021
Rec V Date: 01/20/2021
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: No

Symptom List: Erythema, Pruritus

Symptoms: Swelling and pain of the parotid gland in the neck starting the day after getting the vaccine

Other Meds: Pristiq

Current Illness: No

ID: 0958588
Sex: F
Age: 35
State: IN

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
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: None

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

Symptoms: Fever 102.6, chills, body aches, extreme fatigue, headache and nausea. Started 2.5 hrs after vaccination and has continued. Following up with PCP for further actions to return to work

Other Meds: Levothyroxine 75 Mcg

Current Illness: None

ID: 0958589
Sex: U
Age: 51
State:

Vax Date: 01/05/2021
Onset Date: 01/12/2021
Rec V Date: 01/20/2021
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: Swelling, redness, bruising at injection site

Other Meds:

Current Illness:

ID: 0958590
Sex: F
Age: 71
State: IN

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vomiting , diareeah, nauaea. lots of sinus drainage. overall tiredness. lasted a day . feeling better but not 100%.

Other Meds: amlodipine besylate/benazepril hcl cap5-20mg ,pantoprazole sodium 40mg ,biotin10,000mcg, vitamin d3 25mg,,calcium 600mg, natrolj fruit,natrol veggie rosuvastatin calcium 10mg

Current Illness: none

ID: 0958591
Sex: F
Age: 56
State: CA

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 01/20/2021
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: Unknown.

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Five minutes after receiving the first dose of the Moderna vaccine, reported an acute headache. had vital signs monitored and was watched for 30 minutes for any additional reactions, then released to return home. She stated that the headache lasted for two days.

Other Meds: Unknown.

Current Illness: Unknown.

ID: 0958592
Sex: F
Age: 40
State: AR

Vax Date: 01/19/2021
Onset Date: 01/20/2021
Rec V Date: 01/20/2021
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: Received vaccine at 1100. Patient woke up at 0151 with headache, chills and body aches. Symptoms the same this afternoon at 1200.

Other Meds:

Current Illness:

ID: 0958593
Sex: F
Age: 63
State: TN

Vax Date: 01/09/2021
Onset Date: 01/17/2021
Rec V Date: 01/20/2021
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: erythema, swelling, tenderness, small blisters in proximity to injection site.

Other Meds: Losartan, Hydrochlorothizide, Fluoxetine, ASA 81mg, JuicePlus

Current Illness: none

ID: 0958594
Sex: F
Age: 39
State: IN

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 01/20/2021
Hospital:

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

Lab Data:

Allergies: Nka

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

Symptoms: No adverse eventa occured after first vaccine. Three hours after second vaccination I started to feel adverse reactions. It started with sore throat, tiredness, body ache. Next morning work up with swollen lymph nodes, body ache, tiredness, headache, and the chills. Today feel alot better and adverse reactions have seem to subside.

Other Meds: Wellbutrin, lexapro

Current Illness: None

ID: 0958595
Sex: F
Age: 71
State: FL

Vax Date: 01/05/2021
Onset Date: 01/05/2021
Rec V Date: 01/20/2021
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: Sulfa

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: 20 minutes after vaccine rash on face and bilateral arms. **Pt states still has rosey cheeks and chin**

Other Meds: HCTZ, Atenolol, Multivitamin, Turmeric, Calcium, & Tylenol

Current Illness: No

ID: 0958596
Sex: M
Age: 50
State: VT

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 01/20/2021
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: on the night of 1/5/2021, headache and right arm pain. starting in the pm on 1/16/21 vomiting started and lasted through Tuesday 1/19/21. As of today lasting symptom is fatigue.

Other Meds:

Current Illness:

ID: 0958597
Sex: F
Age: 23
State: NC

Vax Date: 01/14/2021
Onset Date: 01/16/2021
Rec V Date: 01/20/2021
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: None

Symptom List: Vomiting

Symptoms: Macular erythematous rash on legs, arms, trunk and neck; treated with benadryl, zyrtec and hydrocortisone cream; later requiring oral steroids

Other Meds: None

Current Illness: None

ID: 0958598
Sex: F
Age: 60
State: CA

Vax Date: 01/12/2021
Onset Date: 01/12/2021
Rec V Date: 01/20/2021
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: Sore arm Swelling at injection site

Other Meds:

Current Illness:

ID: 0958599
Sex: F
Age: 63
State: CA

Vax Date: 01/07/2021
Onset Date: 01/08/2021
Rec V Date: 01/20/2021
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: Injection site through elbow felt like arthritis Constant aching pain

Other Meds:

Current Illness:

ID: 0958600
Sex: F
Age: 38
State: TX

Vax Date: 01/19/2021
Onset Date: 01/19/2021
Rec V Date: 01/20/2021
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: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Systemic: Anxiety / itchiness

Other Meds:

Current Illness:

ID: 0958601
Sex: U
Age: 39
State:

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 01/20/2021
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: aches, neck/back pain

Other Meds:

Current Illness:

ID: 0958602
Sex: M
Age: 49
State: IN

Vax Date: 01/18/2021
Onset Date: 01/01/2021
Rec V Date: 01/20/2021
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: N/A

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

Symptoms: Achy left arm and left armpit resulting in me taking Ibuprofen. (Took 3 -400mg pills over 12hrs)

Other Meds: Valsartan, Aspirin, Amlodopine

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm