VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1663389
Sex: M
Age: 92
State: WA

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: none the next day I was very tired, couldn't do anything until Mon am felt like a little walk. Tues. felt better, Wed back to normal self. I thought, on the nite of the 25/26 that I was dying, I feel lucky to be alive. I might report that in 2019 I took the larger flu shot and had a very similar experience plus regurgitating everything that i had inmy stomach

Allergies: NONE

Symptom List: Dysphagia, Epiglottitis

Symptoms: by 3pm was in bed feeling weak and tired. Tried to get out of bed @ 5pm and could not. Called my wife and she was able to get me up. Returned to bed with aid of walker and was there for nest 12 houre This was the 3rd or booster shot as my immune system is weak and I was a prime patient for the booster

Other Meds: dofetilide warfarin tamsulosin simvistatin levothroxine mirtazipine magnesim calcium B12 D3

Current Illness: Had dental procedure done on 08/25 2021 two extractions

ID: 1663390
Sex: M
Age: 31
State: HI

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: n/a

Allergies: n/a

Symptom List: Anxiety, Dyspnoea

Symptoms: Hives on hands and feet and injection site lasting for 4 hours the morning after vaccination. Headache for 4 days after requiring an NSAID to stand.

Other Meds: n/a

Current Illness: n/a

ID: 1663391
Sex: M
Age: 33
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: NKA

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

Symptoms: Patient received his second dose of the Pfizer vaccine in his left deltoid. After waiting approx. 10 min in the observation period post vaccine administration, patient verbalized that his "throat is closing". Upon looking in patients throat, no swelling, closure nor redness was noticed. Patient stated he had the same response to his first vaccine but did not receive any medication for his first dose as he left the clinic. Vital signs taken with Sp02 96% on RA. Water was given to patient and was able to drink well with no difficulty swallowing. Patient verbalized no SOB. Patient verbalized itching in throat with dry cough noted. Diphenhydramine 50mg administered orally for patient. Patient preferred oral administration instead of injection and stated he has taken benadryl in the past. After drinking water, patient stating starting to feel better. Patient then left clinic on his own accompanied by his wife and children. Patient was advised to seek medical care/ urgent care if symptoms worsen or new worsening symptoms arise.

Other Meds:

Current Illness:

ID: 1663392
Sex: F
Age: 60
State: MI

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Not Known

Allergies: Not Known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: As per caregiver patient claims she has pain in her shoulder and feels like it is SIRVA (Shoulder Injury Related To Vaccination) shortly after vaccination. Patient called within one hours on same day of vaccine to let pharmacist know that patient is having SIRVA because of the vaccination.

Other Meds: Not Known

Current Illness: As per patient (Multiple Sclerosis)

ID: 1663393
Sex: M
Age: 26
State: CT

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: no known

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

Symptoms: patient had syncopal episode for 5 to 10 seconds after administration then came to. reports having anxiety with needles and feeling lightheaded with other shots but this was the first instance reporting passed out.

Other Meds:

Current Illness:

ID: 1663394
Sex: F
Age: 29
State: NY

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 09/01/2021
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: None

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Half an hour after vaccine my body started getting covered in hives, few hours later I has so many hives you couldn?t see unaffected skin, I started taking Benadryl which seems to move hives from one parts of body to another. Next day my lips swell up and I had difficulty breathing. I went to urgent care and was given prednisone plus Benadryl. Two days later I developed chest pressure, and difficulty breathing still persisted. I went to ER and was given another steroid injection and more prednisone. My chest pressure still exist more than a week after vaccination, I get out of breath easily and get tired faster.

Other Meds: Birth control

Current Illness: None

ID: 1663395
Sex: F
Age: 27
State: GA

Vax Date: 08/19/2021
Onset Date: 08/23/2021
Rec V Date: 09/01/2021
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 reported that she noticed "red dots/patches" all over her legs, back, breast/stomach area after getting the second dose of the Pfizer vaccine which have not gotten better.

Other Meds:

Current Illness:

ID: 1663396
Sex: M
Age: 59
State: NV

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Went to the ER was tested for COVID-19. It turned out positive.

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: Had the shot done 8/24/2021. The very next day on 8/25/2021, he had body aches, bad cough, vomiting and diarrhea.

Other Meds: No

Current Illness: No

ID: 1663397
Sex: M
Age: 24
State: TN

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: felt hot, dizzy, nauseous after receiving vaccine within 10 minutes of receiving vaccine

Other Meds:

Current Illness:

ID: 1663398
Sex: F
Age: 54
State: CO

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: Given 2nd dose as Pfizer instead of Moderna

Other Meds:

Current Illness:

ID: 1663399
Sex: F
Age: 53
State: MI

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin, Erythromycin, sulfa, yellow jackets

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Edema is hands and ankles X 2 days, numbness in hands X 3 days, rapid heart rate (100 on 8/25/21, 90s on 8/26/21, 80 on 8/27/21), increased blood pressure X 2 days, itching in injection site arm on 8/28/21.

Other Meds: Losarten, Multi-vitamin, Vitamin D, Vitamin C

Current Illness: None

ID: 1663400
Sex: M
Age: 54
State: CO

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: GIVEN SECOND DOSE AS PFIZER INSTEAD OF MODERNA

Other Meds:

Current Illness:

ID: 1663401
Sex: M
Age: 18
State: NE

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

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

Lab Data:

Allergies: nka

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

Symptoms: Following tetanus shot while still in center, donor c/o nausea, lightheadedness. s/s subsided w/in @15min.

Other Meds:

Current Illness:

ID: 1663402
Sex: F
Age: 59
State: GA

Vax Date: 08/09/2021
Onset Date: 08/12/2021
Rec V Date: 09/01/2021
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: Unsure which tests were administered and the results from her ER visit on 8/30/21.

Allergies: Allergy to azithromycin

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

Symptoms: Patient started experiencing shortness of breath 3 days post second dose of Moderna. It became progressively worse, she went to urgent care, then to the ER. In the ER it was determined she had pulmonary edema and pericarditis. Her ER visit was on 8/30/21, She told me she had been to urgent care, her PCP, and her pulmonologist. Not sure the dates those visits occurred. Upon discharge from the ER, she was given an inhaler, cefdinir, and prednisone. She had them filled at my pharmacy which is when I learned all the above.

Other Meds: Atorvastatin 20 mg, Glimepiride 4 mg, Singulair 10 mg, Januvia 100 mg, Omeprazole 40 mg, Irbesartan/HCTZ 150-12.5 mg

Current Illness: No illnesses reported

ID: 1663403
Sex: F
Age: 36
State: CA

Vax Date: 07/26/2021
Onset Date: 07/28/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: MRI of brain and spine lots of blood work still ongoing/ awaiting results from doctors

Allergies: Penicillin

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

Symptoms: Nerve pain arms and legs& increasing weakness in legs

Other Meds: None

Current Illness: None

ID: 1663404
Sex: F
Age: 60
State: OR

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: haven't been yet. hoping it will all subside.

Allergies: no

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

Symptoms: Soreness in place of shot. Headaches. Unable to think clearly...ie fuzzy headed. I am at one week tomarrow and feel as though I'm going thru menapause all over again. I'm moody, mean, argumentive, can't think clearly, tired, stress(anxiety)...foggy doing and saying things that are not normal.

Other Meds: no

Current Illness: no

ID: 1663405
Sex: M
Age: 65
State: PA

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 09/01/2021
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: nka

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

Symptoms: Patient received Prevnar vaccine at pharmacy on August 23, 2021 and woke up the next day not able to move neck and arm. He claimed he had to pick up his arm with the other hand. He said it attacked his muscles and nerves. He said he wasn't getting better so he went to an urgent care on August 29, 2021. He was given an anti-inflammatory and muscle relaxant. He said the doctor he saw told us to report it.

Other Meds:

Current Illness:

ID: 1663406
Sex: M
Age: 16
State: CA

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/01/2021
Hospital: Y

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: elevat

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: chest pain

Other Meds:

Current Illness:

ID: 1663407
Sex: F
Age: 52
State: CA

Vax Date: 07/30/2021
Onset Date: 07/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: none

Allergies: Sulfa

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Extreme anxiety, depression, panic attacks, fatigue.

Other Meds: Lexapro 10 mg/day; Lipitor 20mg/day; Multi-vitamin; Evening Primrose Oil; Omega 3 capsules

Current Illness: Perimenopause

ID: 1663408
Sex: F
Age: 43
State: CA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data: Paramedics were called. Patient was not transported to hospital and went home.

Allergies: Pollen

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: After receiving 2nd dose, patient stated her tongue was swelling, throat closing, difficulty breathing and felt warm to touch.

Other Meds:

Current Illness:

ID: 1663409
Sex: F
Age: 55
State: WA

Vax Date: 02/19/2021
Onset Date: 07/26/2021
Rec V Date: 09/01/2021
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: None done.

Allergies: Sulfa drugs

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

Symptoms: I began to have random pain in my left foot below my outer ankle. Feels like nerve pain. It is a sharp pain that goes away quickly. It started a few times a day, then increased to 20+ times a day so I went to the walk in. He had no answers for me, but the pain seemed to go away after that. Week later, it returned Aug 7,8 & 9th. Then again Aug 27th.

Other Meds: Citalopram 30 mg/ daily, vit D, suplement daily, 80 mg asprin 2x/wk, Iron every other day, Ginko days not taking Iron (about 3 days a week.

Current Illness: none

ID: 1663410
Sex: F
Age: 46
State:

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: they said I didn't need to be seen as there is nothing that can be done.

Allergies: penicillin

Symptom List: Unevaluable event

Symptoms: Had shot in the evening. went to bed. woke up and my left upper thigh was numb from the middle of the kneecap around the outside of my leg to the middle of the back all the way up to my hip. I emailed my primary who replied on monday and said to call nurse line. the nurse line then sent me to covid line which then got me to a nurse who was speaking to covid dr. She realyed information that he was telling her. He said yes this has been reported and yes this is not common but is known. They do not know why, or how long this will last other than usually a while. when asked how long was a while they did not know. They said there was nothing that they could do to help and if it moves anymore as at this point it was moving past my knee to the outside of my calf also to go be seen. They do not feel a reason to come in as there is nothing that can be done. As of today I still have no feeling in my left upper leg in the same location with slight to minimal improvement on my back side but it has also moved to my outside calf area slightly. I am 6 days past vaccinations with 12 hours after vaccine reaction but who knows because I was sleeping. It is constant numbness and not intermittent. I am able to walk still, it is just really annoying. I do plan to go to my primary but I do not know what this will solve as they said I do not need to be seen as nothing can be done. I asked if it can travel to my whole leg and they stated that yes it can travel they do not know in my case specifically if it will. I clicked office visit below because I had to speak to nurse/dr. over the phone. Right now I am just trying to ignore it and live my life.

Other Meds: none

Current Illness: none,

ID: 1663411
Sex: F
Age: 25
State: PA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/01/2021
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: SYNCOPE

Other Meds:

Current Illness:

ID: 1663412
Sex: M
Age: 19
State: OR

Vax Date: 06/07/2021
Onset Date: 06/09/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: EKG 9/1/21 normal sinus rhythm

Allergies: NKA

Symptom List: Injection site pain, Pain

Symptoms: Within days to weeks after 2nd Pfizer Covid imm: reports new onset syncopal events, little to no prodrome, and reports palpitations. Had previously had occasional palpitations but describes: frequency and intensity increased after covid imm. Concerned there may be cardiac side effect

Other Meds: none

Current Illness: none

ID: 1663413
Sex: M
Age: 74
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/01/2021
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: No adverse reaction. Patient marked on consent form stating never received any COVID vaccine, but when pharmacy bill the insurance with a rejection "additional dose not allowed." When pharmacy called insurance, insurance said patient had one Janssen vaccine in 6/30/2021. When we called patient to confirmed, patient stated he admitted he received one dose already and he didn't mark correctly on the consent form because he was worried pharmacy would not do it for him. He stated he has immunocompromised condition (didn't mark on the consent form) and worried about the delta variant. Pharmacy staff explained that second dose is not currently approved by CDC.

Other Meds:

Current Illness:

ID: 1663414
Sex: F
Age: 55
State: IN

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None

Allergies: PCN, Sulfa

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

Symptoms: Cellulitis of the posterolateral deltoid region characterized by redness, swelling, induration, and pain. Also had a headache and fatigue following vaccination - relationship unknown.

Other Meds:

Current Illness:

ID: 1663415
Sex: F
Age: 13
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Client received dose 1 of the COVID19 Pfizer vaccine at 15:43. After receiving the injection, the client and her mother went to the observation area to sit for 15 minutes. At 15:57 the client?s mother alerted EMT that the client was feeling a little dizzy and lightheaded. EMT alerted Lead RN who went to assess the client. The client refused transfer into the anti-gravity chair and her mother agreed she was OK in the standard chair. At 16:04, EMT took the client?s vitals (BP: 122/92, HR: 94 & SPO2: 98%). The client and her mother did not know what the client?s normal blood pressure was. That said, the client declined being short of breath, difficulty breathing, and chest pain. The client also communicated to Lead RN that she ate and drank before coming to get vaccinated, and was pretty anxious because she doesn?t like needles, but overall felt OK, just a little dizzy. The client and her mother confirmed that the client does not have any underlying health conditions and takes no medications. The client indicated to Lead RN that she was starting to feel better. Lead RN requested the client and her mother sit for an additional 15 minutes for observation and they agreed. At 16:19 EMT took the client?s vitals (BP: 120/74, HR: 87 & SPO2: 100). The client stated she ?now feels totally fine.? She also explained that she had anxiety about receiving an injection and was just really tired. Lead RN observed that the client?s skin was very fair and asked the client?s mother if her skin tone looked normal, not pale. The client?s mother stated that the client did look pale before and looked much better now, ?back to normal.? Lead RN educated the client and her mother on both the potential side effects and adverse effects of the vaccine, when to seek medical attention, and ER precautions. Lead RN observed the client and her mother leave the observation area at 16:22. The client was walking with a steady gait.

Other Meds:

Current Illness:

ID: 1663416
Sex: F
Age: 33
State: HI

Vax Date: 01/15/2021
Onset Date: 08/26/2021
Rec V Date: 09/01/2021
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: moderate symptoms experienced- body aches, fatigue, cough, congestion starting 8/26/21. Has not seeked medical care. Still with symptoms 9/1/21

Other Meds:

Current Illness:

ID: 1663417
Sex: F
Age: 60
State:

Vax Date: 04/10/2021
Onset Date: 04/13/2021
Rec V Date: 09/01/2021
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: Penicillin

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

Symptoms: Approximately 2-3 days after the 1st dose, I had a colitis flare-up (I had not had any symptoms nor had any medication for the prior 2 years after changing my diet). I had leftover prescription medication, so I took it through 5/10/21 (2nd vaccination date) to counteract another possible autoimmune trigger from the 2nd vaccination. After quitting the prescription medication, I had no symptoms for 2 months. A new colitis flare up began at the beginning of August 2021. I went back on the prescription meds, but continue to have colitis symptoms. My G.I doctor cannot get me an appointment until October 14, 2021, so I have not had a doctor examine me yet.

Other Meds: Sleep Aid, multi-vitamins, fiber supplement, calcium supplement, Vitamin D3 supplement, fish oil supplement.

Current Illness: None

ID: 1663418
Sex: F
Age: 57
State: MA

Vax Date: 04/08/2021
Onset Date: 04/12/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: Flagyl Zithromax Amoxicillin Loratadine Alatrofloxacin

Symptom List: Nausea

Symptoms: Small fiber sensory neuropathy, improving without treatment

Other Meds: None

Current Illness: None

ID: 1663419
Sex: F
Age: 47
State: KY

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data:

Allergies: Almonds, vimpat, depakote,

Symptom List: Injection site pain

Symptoms: 8/27 day after a small area inside on mouth like a cold sore noted, One week later my whole upper lip on inside is a sore, blister . Never had a cold sore like this, inside of mouth . Swollen and painful.

Other Meds: Hydrocortisone, Florinef, gabapentin, zanaflex,

Current Illness: None

ID: 1663420
Sex: F
Age: 24
State: NC

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/01/2021
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 known

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

Symptoms: Mild headache, arm soreness, nausea, and fatigue lasted about 24 hrs. Hives started Saturday afternoon and was present all day Sunday. Disappeared during day on Monday and reappeared at night. Same thing on Tuesday. Doctor on Tuesday told me to take Zyrtec daily.

Other Meds: Birth control (Junel Fe)

Current Illness: None

ID: 1663421
Sex: F
Age: 12
State: PA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/01/2021
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: SYNCOPE

Other Meds:

Current Illness:

ID: 1663422
Sex: F
Age: 37
State: FL

Vax Date: 08/17/2021
Onset Date: 08/24/2021
Rec V Date: 09/01/2021
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: Patient states day after vaccine was given got soreness at injection site. Then about one week after vaccination she started feeling a tightness/heaviness in her chest. When she breathes through her nose she does not feel like she is getting enough air so then has to take a deep breath through her mouth to feel like she is getting enough air. This has continued up to the date of this report.

Other Meds:

Current Illness:

ID: 1663423
Sex: F
Age: 76
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Moderna vaccine given after being kept for 40 days in the refrigerator when guidance is that Moderna only be kept for 30 days in the refrigerator

Other Meds:

Current Illness:

ID: 1663424
Sex: F
Age: 35
State: UT

Vax Date: 12/30/2020
Onset Date: 07/25/2021
Rec V Date: 09/01/2021
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: On both diagnostic ultrasounds, no e/o fetal pole visible; sac noted. On second miscarriage, POC via D&C noted immature chorionic villi; HbA1C WNL, APLA Negative. Awaiting genetics on second miscarriage POC.

Allergies: Shellfish

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

Symptoms: G2P2 prior to vaccination. Two prior uncomplicated pregnancies- both infants born at term by SVD without any complications; born 09/2019 and 01/2018. No prior history of miscarriage. Following injection, experienced a missed miscarriage at 12w5d despite normal genetic testing; then a second missed miscarriage at 10w3d.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1663425
Sex: F
Age: 33
State: CA

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: None

Allergies: No

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

Symptoms: Headache, earache, hot flashes, nausea, chest pain, fatigue, body aches. It's only been a day and I still have symptoms

Other Meds: Wellbutrin. Doxycycline

Current Illness: None

ID: 1663426
Sex: M
Age: 74
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Moderna dose was given after this vial was kept for 40 days in the refrigerator.

Other Meds:

Current Illness:

ID: 1663427
Sex: M
Age: 50
State: IL

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

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

Lab Data: N/A

Allergies: NKDA

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

Symptoms: On Wednesday (9/1/21) at around 11:52 AM, patient came to pharmacy requesting Booster COVID vaccine (patient currently taking Enbrel for rheumatoid arthritis). When asked, patient requested Pfizer. I had then asked the patient if they had recieved previous COVID vaccines and which one if they had. Patient responded with Pfizer. After inputing patient information (new profile + insurance) I had the patient complete a Vaccine Record/Informed Consent sheet. I then asked the patient if they had thei vaccination record card to fill out. Patient said they left the card at home. When I asked if they would be able to go home and retrieve the card, the patient mentioned living a little further away and asked if it was ok if they brought it in next time. I told the patient that was ok and stressed the importance of brining back the vaccination card to ensure all the relevant/accurate information was on their. Patient understood. I then proceeded to administer the Pfizer vaccine. Patient was then monitored for 15min for any delayed reactions, and then given the ok to leave. Around 1:20pm the patient returned with their vaccination card.Their vaccination card listed "Janssen & Janssen" as their prior vaccination with a date of (3/13/21). When I asked the patient to clarify they explained they only received the single dose COVID vaccine (J&J). They then mentioned their PCP told they to go ahead an receive the booster dose. The miscommunication occured because the patient believed that any manufacturer could be usesd as a booster dose. I then proceeded to explain to the patient that only Pfizer and Moderna have approval for a 3rd dose in select patient and that J&J does not. I explained to the patient to return tomorrow and that I would hold on to his vaccination card and follow-up with his PCP and submit the appropriate documentation for the vaccination error and would follow-up with him tomorrow.

Other Meds: ENBREL ONLY PATIENT VERIFIED RX FOR RHEUMATOID ARTHRITIS.

Current Illness: RHEUMATOID ARTHRITIS- MEETS CRITERIA FOR 3RD COVID DOSE

ID: 1663428
Sex: F
Age: 58
State: KY

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 09/01/2021
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: I have no medical care.

Allergies: Morphine Septra Cipro Levaquin Phenergan Compazine Levaquin The Flu shot Albuterol Eggs Milk Microfiber

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

Symptoms: I awoke in bed and had a seizure type effect that caused severe internal shaking of my brain. I?ve never had it before. It was severe and unmistakable. It terrified me. It happened just once that I know of. I fell back asleep and didn?t awaken til 12 hours later. I?ve had blurred vision since and bad exhaustion.

Other Meds: None

Current Illness: Cellulitis Colitis

ID: 1663429
Sex: M
Age: 30
State: WA

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: n/a

Allergies: pt did not report any

Symptom List: Pain in extremity

Symptoms: pt called today, saying shortly after the shot he got numbness of tongue, right side. Then next day 8/31 he developed numbness of lower lop and neck stiffness. Advised pt to report the adverse event and notify his primary doctor. Also, suggested closely monitoring for any worsening of the symptoms and seek help if it happens.

Other Meds: pt did not report any

Current Illness: none reported

ID: 1663430
Sex: F
Age: 48
State: NE

Vax Date: 08/20/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: None

Allergies: Penicillin

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

Symptoms: Pain and numbness in the right arm and hand. 3 specific fingers: thumb and next 2 fingers.

Other Meds: Hair, Skin and Nails vitamin

Current Illness: No

ID: 1663431
Sex: M
Age: 74
State: GA

Vax Date: 02/05/2021
Onset Date: 08/05/2021
Rec V Date: 09/01/2021
Hospital: Y

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: Patient tested positive for COVID-19. Patient was hospitalized and he is fully vaccinated. Patient began experiencing severe fatigue and a fever of 102.5 approximately 2 weeks ago. Patient was hospitalized from 8/5-8/8 after going into urgent care to get tested.

Other Meds:

Current Illness:

ID: 1663432
Sex: F
Age: 72
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Moderna dose was given after Moderna vial was kept in the refrigerator for 40 days.

Other Meds:

Current Illness:

ID: 1663433
Sex: M
Age: 81
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
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: Moderna dose given after vial was kept in the refrigerator for 40 days.

Other Meds:

Current Illness:

ID: 1663434
Sex: M
Age: 85
State: MN

Vax Date: 03/15/2021
Onset Date: 08/31/2021
Rec V Date: 09/01/2021
Hospital: Y

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: Hospitalized

Other Meds:

Current Illness:

ID: 1663435
Sex: F
Age: 75
State: FL

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/01/2021
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: unknown

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: since the vaccine pt has been experiencing tingling in arms, hands and body. she also reported having weakness and episodes of vomitting. recommended pt follow up with prescriber

Other Meds: unknown

Current Illness:

ID: 1663436
Sex: F
Age: 65
State: SC

Vax Date: 03/19/2021
Onset Date: 03/23/2021
Rec V Date: 09/01/2021
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: Oral thrush severe requiring 7 days of diflucan. similar reaction after first vaccine

Other Meds:

Current Illness:

ID: 1663437
Sex: M
Age: 60
State: NY

Vax Date: 03/08/2021
Onset Date: 03/31/2021
Rec V Date: 09/01/2021
Hospital:

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

Lab Data: Numerous all available in my health records

Allergies: None

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Numbness in legs and numbness in hands. Blood pressure reading has increasedSlurring of speech, decrease visibility/vision , increased blood sugar readings, increased authentic pain

Other Meds: Colchicine. Allopurinal , metoprolol, Lasix digoxin, Cosentyx,Levothyroxine ,, Tramadol, D3,

Current Illness:

ID: 1663438
Sex: F
Age: 39
State: ID

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 09/01/2021
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: None

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

Symptoms: It was like having COVID all over again. Aside from the soar arm by the back day I felt fatigue and achy in my ankles, feet, and toes. The fatigue continued the next day and by Saturday (3 days) I had chills, then even more fatigue by Sunday and a cough. By Tuesday my throat and chest burned. Wednesday the congestion was overwhelming a s finally I broke and was completely overcome and had to go to bed as my head felt like it was going to explode and my ears ached. I had very little contact with any person prior to the second vaccine dose and no one I knew had experienced COVID recently or even symptoms. I have been holding off getting vaccinated because others I?ve talked to said they felt this way too, especially those who had COVID. So I decided to set report my experience thinking perhaps these cases just aren?t being reported.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am