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: 1708779
Sex: M
Age: 49
State: FL

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: All tests and lab results were performed on 8/23/2021---see list below: Basic Metabolic panel, CBC auto differential, CK total and CKMB, Expediated COVID--negative Light green to light green top tube Lipid panel Manuel differential Purple top tube SST Tube Troponin-performed 2 times EKG 12 lead X-ray chest 1 view portable ED Cardiac Monitoring Blood pressume 129/98 Temperature 98.2 Pulse 68 Oxygen saturation 99% There were abnormal results from the bloodwork that were indicative of reaction to a virus or vaccine. Blood results were elevated and were indicated in the "My Chart" documents accessed online after leaving the hospital. However, the doctor did not advise us of any elevated results. The diagnosis was listed as "adverse effects of medication". (vaccine) It should be noted that after further research we discovered that periocarditis was an explanation of the adverse reaction that Patient had and can be connected to COVID vaccines. **Also note that Patient did test positive for COVID on April 18, 2021.

Allergies: Shellfish/Iodine

Symptom List: Dysphagia, Epiglottitis

Symptoms: On Thursday, 8/19/21 at 2am, Patient begin to experience severe symptoms of fever, chills, pounding headache, fatigue, and unbearable body aches. These symptoms lasted until Saturday, 8/21/21. By Sunday, symptoms had improved and Patient was feeling better and able to do normal activities. On the morning of 8/23/21 at approx. 5:30am, Patient was woken up by chest pains. He experienced severe chest pains, heaviness, and described the pain as a stabbing pain that would come in waves. He experienced tingling/numbness down his arm (left side) and in his jaw (right side). He experienced nausea, was extremely anxious, and his breathing was compromised. Patient let me know that he needed medical. attention. The walk-in clinic sent us immediately to the emergency room at the local hospital for medical attention. We spent the entire day in the ER where they took tests and did lab work to determine why Patient was having these adverse reactions. See Q 19 for all tests/lab and diagnosis. Note that Patient is still not feeling "himself" since the vaccine and visit to the ER. He experiences a lack of motivation to work on projects at home that have never been an issue for him before and forgets things easily as many describe as "COVID brain".

Other Meds: None

Current Illness: None

ID: 1708780
Sex: F
Age: 51
State: MN

Vax Date: 01/19/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: Tested positive for COVID 9/16/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1708781
Sex: F
Age: 30
State: WV

Vax Date: 09/14/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: N/A

Allergies: Sulfa

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

Symptoms: Fatigue, Nausea, Leg pain, ?jello? legs, sweaty palms

Other Meds: Metformin

Current Illness: None

ID: 1708782
Sex: M
Age: 64
State: VA

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: HEARING TEST 08 MARCH STEROID INJECTION 12 MARCH STEROID INJECTION 19 MAR SECOND VACCINE MARCH 17 MRI 24 MARCH CT SCAN 12 MAY COCHLEAR IMPLANT SURGERY RT EAR

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Woke up 36 hours after vaccine totally deaf in right ear.

Other Meds: Crestor, Toviaz, Lisinopril, Pantoprazole, Eliquis, Desvenlafaxine, Nifedipine, Humulin R U-500

Current Illness: None

ID: 1708783
Sex: M
Age: 69
State: MI

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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 Allergies

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

Symptoms: Patient received vaccine that was stored in the freezer for 19 days prior to moving to the refrigerator.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708784
Sex: F
Age: 68
State: OR

Vax Date: 03/18/2021
Onset Date: 03/20/2021
Rec V Date: 09/17/2021
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: Swab; Covid test- positive.

Allergies: I have a lot of intolerances to medications: Lidocaine with Epinephrine, Steroids, Tylox, Cymbalta, Gabapentin. I am allergic to Sulfa; Compazine, Vraylar; Latuda.

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

Symptoms: It started itching. The itching was really intense. I was at a funeral and I was wearing long sleeves and I was 2 hours away and I did not really see it until hours later. When I saw my foot there were 6 blisters. They had open but they were just like a simple opened blister. The next morning I had shingles on the inside of my thighs but they were much smaller but they spread from there. The ones on my foot got progressively worse over the week. By day 3 I went to the doctor because my foot was swelling up twice its size. It was extremely painful. They were oozing. It was almost impossible to walk. My doctor took a picture and sent it to a dermatologist. She confirmed it was shingles. She did a swab for bacteria and virus and gave me an antiviral which I took for a week. 2 of the blisters were really deep. One was on top on my ankle. The others oozed and started to oozed less and crust over within 9 days. The scabs persisted for quite a while especially the deep one. I still have scars on my foot. The shingles on my thigh kept spreading over a week but then they went away. I still have scars in there. I started having COVID symptoms on 07/25/2021. I had orthostatic hypotension, I was feeling really faint and I had a bad headache and neck ache. My asthma was a little worse. I had a bad smell. Extremely fatigued. I could not do anything. I had nausea and diarrhea. My ears were ringing. I talked to my doctor and she recommended a COVID test. I went for the test and it came back positive. I went to the doctor when the symptoms persisted and they just told me to rest and drink a lot of water and electrolytes.

Other Meds: Iron; Lamictal; Zoloft; Synthroid

Current Illness: None

ID: 1708785
Sex: F
Age: 65
State: KS

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: 1040 BP 108/70; O2 93%. 1050 BP 110/72; O2 97%; Pulse 54.

Allergies: Toradol

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Felt faint and light headed. Warm and clammy. No hives or shortness of breath. Carries an epi pen for Toradol allergy. At 1110 Good color, conversational, Awake. and alert.

Other Meds: Unsure

Current Illness: No

ID: 1708786
Sex: M
Age: 86
State: IL

Vax Date: 05/05/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: Patient tested positive for COVID on 9/15/2021 via PCR.

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Patient tested positive for COVID on 9/15/2021 via PCR.

Other Meds: No active home medications noted in patient's record

Current Illness: Coronary artery disease

ID: 1708788
Sex: F
Age: 47
State: CA

Vax Date: 03/17/2021
Onset Date: 04/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None

Allergies: N/A

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: My menstrual cycle has changed: I've experienced a lot of cramping and passing of small blood clots. I've been taking Advil to deal with the cramping.

Other Meds: N/A

Current Illness: None

ID: 1708789
Sex: F
Age: 68
State: KS

Vax Date: 04/07/2021
Onset Date: 04/07/2021
Rec V Date: 09/17/2021
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: Allergic to diazide

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient states she had severe anxiety prior to Covid vaccine today and prior to today. Husband checked her BS at home and glucose monitor read 92. Vitals taken: 02 97%, HR 85. At 1012 patient states she feels back to normal and appears well. Patient given water and a snack.

Other Meds:

Current Illness:

ID: 1708790
Sex: M
Age: 32
State: MI

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Patient received vaccine that was stored in the freezer for 19 days prior to moving to the refrigerator.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708791
Sex: F
Age: 34
State: CA

Vax Date: 03/19/2021
Onset Date: 03/21/2021
Rec V Date: 09/17/2021
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: 2 days after shot 1 on March 19, 2021, I began experiencing very bad clogged ducts. I am a lactating/breastfeeding mother. They mostly occurred on the left breast, closest to the injection site. I had 1-2 bad clogs a week that would take 2-3 days to resolve, and this lasted for 5 weeks until I received the second Covid-19 dose. No particular treatment helped (I tried all recommended methods to relieve a clogged duct), just time and continuous breastfeeding. 2 days after receiving my second dose on April 23, 2021, the clogs worsened. Again, mostly the left breast, but occasionally on the right breast as well. They were almost continuous with only 12-24 hours of relief in between for 4-5 weeks after my second injection. After about a 5 week period after the second injection, the clogs lessened and eventually I no longer experienced regular recurring clogs. No particular treatment helped (I tried all recommended methods to relieve a clogged duct), just time and continuous breastfeeding. In total, the recurring bad clogs lasted about 11-12 weeks from the time of first vaccination.

Other Meds: Pre-natal vitamin, sunflower lecithin

Current Illness: none

ID: 1708792
Sex: F
Age: 58
State: TX

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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 - I met with the Doctor via virtual visit. The red reaction was still visible but not to the original start of the reaction. I did take 2 photos on my mobile.

Allergies: Penicillin

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

Symptoms: I am reporting on dose #2 however for dose #1 I had a red circle the size of a 50 cent coin around the injection with no other issues. For dose #2 my left upper arm turned major red the next day and grew in size over progressive days to a minimum size like a pizza slice and bigger and was HOT to the touch and felt itchy. The reaction was my main concern I monitored. Meanwhile, I dealt with traditional flu side effects with major tiredness on the 3rd day, major night sweating, blah feelings, and by Thurs. shaky and light-headedness. I also experienced muscle pain in my underarm and breast area on the left arm where the dose was given. Treatments included sleep when I could get it, started a Tylenol and Ibuprofen on Tues-9/13/21 with a benedryl also started afterwards per Pharmacist with follow up to Doctor at 4:30p per direction which occurred on Thurs, 9/16/21 where I was prescribed Azithromyci 250mg 6-pak and Pendnisone 20mg (up to 5 tablets as needed) to address the allergic reaction and bacterial infection. I have been informed I am not a candidate for the booster and will be collecting acknowledgement from my pharmacist.

Other Meds: Vitamins: Omega3 Fish 1400mg x 1, Co-Q 10 100 mg x 1; D3 2000BU x 2; C 500mg x 2' Calcium Citrate Magnesium and Zinc x 2; baby aspirin

Current Illness: none

ID: 1708793
Sex: F
Age: 39
State: MN

Vax Date: 02/03/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: Tested positive for COVID 9/16/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1708794
Sex: F
Age: 42
State: WI

Vax Date: 04/23/2021
Onset Date: 09/14/2021
Rec V Date: 09/17/2021
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: No known allergies

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

Symptoms: Patient contracted COVID after being fully diagnosed on 9/14/2021 with Shortness of breath and sore throat.

Other Meds: Ascorbic acid; Calcium and Vitamin D; Cholecalciferol; Multivitamin; Treximet

Current Illness: None documented

ID: 1708795
Sex: F
Age: 55
State: ID

Vax Date: 01/11/2021
Onset Date: 01/30/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: 2/2/21 CBC - normal 2/3/21 Ultrasound of neck showed prominent left-sided lymph nodes with abnormally thickened cortices. Reactive lymph nodes favored. 2/18/21 Mammogram - normal 2/25/21 CT chest, abdomen, pelvis - Prominent but nonenlarged left axillary and subpectoral lymph nodes. Mildly prominent but nonenlarged left supraclavicular lymph nodes. Renal cyst 3/29/21 EGD - showed mild esophagitis

Allergies: mild hayfever

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

Symptoms: There was a hard lump in my supraclavicular lymph node on the left side after my 2nd dose of the vaccine. I also had a great deal of pain and swelling on the underside of my upper left arm and axilla for a week after the injection of the 2nd dose. The lump in lymph node was painless and the size of a marble.

Other Meds: Hydrochlorothiazide 25 mg daily Loratidine 10 mg daily prn

Current Illness: none

ID: 1708796
Sex: F
Age: 63
State: KS

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 09/17/2021
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: Patient reports reactions to multiple antibiotics previously

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

Symptoms: Patient reports of not feeling well, clammy, dizziness, and ringing in ears. Patient has had reactions to antibiotics previously. Patient reports of above symptoms and was placed on a cot, given water, and cool packs. Patient's symptoms improved without further treatment.

Other Meds:

Current Illness:

ID: 1708797
Sex: M
Age: 37
State: WI

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient passed out, seizure like activity less than 30 seconds, approximately 15 seconds, patient diaphoretic and clammy.

Other Meds:

Current Illness:

ID: 1708798
Sex: F
Age: 38
State: OR

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: tests related to infection in Ovarian tube

Allergies: Olive oil, Clindamycin; almond oil and red onions

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Lightheaded right after the vaccine - they made sure I ate and drank some fluids before they let me go back to work. I had headaches and feeling gross for several days. My health kept getting worse after that. It wasn't headaches, but no energy, mood changes. I seemed to have problems with short term memory and issues with sleeping. I was more accident prone. During ER visit on the 23rd for infection - my abdominal infection where it abscessed into my right ovarian tube. And they didn't give me an answer me as to why it happened. They treated. They did IV medicine and drained the area and had a bag on the outside of abdomen (for two weeks, at home) to drain for several weeks any excess fluid that was there to help dry out the abscess. They did a CT imaging to see where it drained into to make sure it wasn't intestinal. They could tell it didn't drain into the intestine but just into the ovarian tube and they didn't know why or how I had gotten an infection there. It was e-coli and it didn't make sense that I would have e-coli there or that I would be exposed to it to the extent that that would happen. I've been off work since towards the end of July and to now still. I keep falling and bruising myself. I fell outside my apt. and put down my hand and broke my finger - it was a dislocated break where they had to do surgery and put pins in it - this was August 10th when it broke. But it further broke about a week later - and it broke to the point where I had to go in to ER and they sent me to hand specialist that's when I had to have surgery. Have had one post surgery visit so far for hand. Still experiencing fatigue and problems with sleeping; problems with short-term memory and having problems with accidents - where I get bruises when I am moving around. Recently I have issues with remembering to eat and drink fluids. For the most part, it's just trying to remember to eat and drink fluids - I have had intestinal surgeries in the past so it is easy for me to get dehydrated. I do have family that checks in on me. I see primary care doctor beginning of October for follow up and will see other specialists to try to figure out what is going.

Other Meds: zoloft; Seroquel; allergy pill - Cetirizine; multi-vitamin in the morning; Topiramate; UTI preventer - Methenamine Mandelate; Vit C; Vit D;

Current Illness: End of January, I had intestinal surgery - it was repairing function to my intestine.

ID: 1708799
Sex: F
Age: 71
State: OH

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient is stating that she is experiencing slight hearing loss. No mention of ringing in the ears. She can hear, but not very well. Discussed with patient's husband and told him I would do some further research into this in addition to filling out the VAERS report. She will also contact her primary care.

Other Meds:

Current Illness:

ID: 1708800
Sex: M
Age: 27
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: Patient had previously received first dose Moderna under the name in the immunization registry. Patient unable to get second dose Moderna and received Janssen instead.

Other Meds:

Current Illness:

ID: 1708801
Sex: F
Age: 64
State: CA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None

Allergies: Vancomycin, Penicillin, Fioricet, neoprene

Symptom List: Unevaluable event

Symptoms: Fever, nausea, headache, injection site/arm pain

Other Meds: levothyroxine, atorvastatin, duloxetine, progesterone, Spiriva Respimat inhalation spray, PreserVision AREDS 2, Gobiotix Probiotic

Current Illness: None

ID: 1708802
Sex: U
Age: 59
State: GA

Vax Date: 04/01/2021
Onset Date: 08/29/2021
Rec V Date: 09/17/2021
Hospital: Y

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: Patient husband provided all information except email address He stated his wife has been at Hospital since the 09/01/21 for covid and is still having symptom but is doing much better

Other Meds:

Current Illness:

ID: 1708803
Sex: F
Age: 16
State: TX

Vax Date: 08/03/2021
Onset Date:
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

Symptom List: Injection site pain, Pain

Symptoms: No adverse event, patient was given to a 16 year old. Moderna is only approved for ages 18 and older

Other Meds: n/a

Current Illness: n/a

ID: 1708804
Sex: M
Age: 34
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: Patient fainted, chipped tooth, and cut his lip.

Other Meds:

Current Illness:

ID: 1708805
Sex: M
Age: 28
State:

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: covid 19-negative

Allergies:

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

Symptoms: sore, fever, skin hurt, chills, congestion, sore throat, cant smell or taste

Other Meds:

Current Illness:

ID: 1708806
Sex: M
Age: 64
State: MT

Vax Date: 03/22/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital: Y

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: Diagnosed and hospitalized with COVID while vaccinated

Other Meds:

Current Illness:

ID: 1708807
Sex: F
Age: 61
State: OR

Vax Date: 03/31/2021
Onset Date: 06/29/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Patient had previously received the Janssen (J&J) vaccine on 3/31/2021. This violates the EUA for both vaccine parameters.

Allergies: Flaxseed; Vicodin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: She has not experienced any fever, cough, or shortness of breath, and did get the Johnson & Johnson Covid vaccine, but has seen where the single vaccine is not effective against the delta strain and would like to get a Maderna booster.

Other Meds: None

Current Illness: None

ID: 1708809
Sex: M
Age: 71
State: NY

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: Resident was sent to the ER for evaluation.

Allergies: ceftriaxone; pentazocine-naloxone; Stadol; Talwin

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

Symptoms: At approximately 5:45 pm, staff found patient in an active seizure. His vitals were BP 163/73, SP02 98% Temp 96.9 and RR 16. Patient was given keppra as ordered and noted to have L sided weakness to arms and legs which resolved. Later that evening Patient then had an elevated temperature and was given 1 dose of Apap. The patient continued to have elevated temperature with shivering, increasing pain, lethargy and inability to swallow. His temperature was 102.8.

Other Meds:

Current Illness: other seizures

ID: 1708810
Sex: M
Age: 64
State: AZ

Vax Date: 03/11/2021
Onset Date: 04/07/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Nausea

Symptoms: Yes, Covid rash on lower legs, and arms of a severity 7-8 from January 2021. I was covid 19 positive from mid January 2021 through early February 2021. The rash continued from Feb 2021 through March 2021 a severity of 6-7. The first Madera shot I received was at clinic on March 11, 2021. Two weeks later my Covid rash spread to low ankles feet and toes. The severity was 8-9 and toes were getting progressively worse until they started bleeding and soaking my socks that about 3" to 5" was puss and blood stained. On 4/07/2021, I sought emergency help at clinic in which they gave me Prednisone. The rash subsided within three days taking the Prednisone but my toes especially large t

Other Meds: none

Current Illness: N/A

ID: 1708811
Sex: M
Age: 17
State: IL

Vax Date: 08/18/2021
Onset Date: 08/01/2021
Rec V Date: 09/17/2021
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: No adverse event(s) to report. Vaccine was given to a a 17 year old due to incorrect calculation of age by staff.

Other Meds:

Current Illness:

ID: 1708812
Sex: M
Age: 34
State: MI

Vax Date: 03/29/2021
Onset Date: 04/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Have not gone to hospital yet

Allergies: none known

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

Symptoms: - After 13 hrs of receiving 2nd dose: body aches, chills, shaking, severe headache, dizziness - After a couple of weeks of 2nd dose through present day: daily headaches, primarily in afternoon - From 4-5 months after 2nd dose through present day: chest pain/ache

Other Meds: none

Current Illness: none

ID: 1708813
Sex: F
Age: 85
State: NY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None.

Allergies: no

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

Symptoms: Pfizer vaccine was diluted with Normal Saline 0.9% Bacterostatic, which is not recommended. Reported to CDC and Pfizer, recommendation was to repeat affected dose. Patient was notified and all questions answered. Patient has received their repeat dose on 9/15/21.

Other Meds: unk

Current Illness: unk

ID: 1708814
Sex: F
Age: 77
State: VA

Vax Date: 07/29/2021
Onset Date: 08/19/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies: Sulfa-Drugs

Symptom List: Tremor

Symptoms: Pt. states that after receiving the 1st dose Shingrix 07/29/2021, started experiencing symptoms 08/19/2021 developing rash along back side and under side. Primary visit 09/01/2021, Diagnosed with Shingles. Still experiencing symptoms.

Other Meds: Ledothyroxin, Potassium, Chloride, Simdaspatin, Desdenlafaxin

Current Illness: N/A

ID: 1708815
Sex: M
Age: 33
State: CA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: N/a.

Allergies: Nkda

Symptom List: Erythema, Pruritus

Symptoms: Second dosage was administered one week prior to the recommended time. No adverse reactions.

Other Meds: Na

Current Illness: No

ID: 1708816
Sex: M
Age: 82
State: OH

Vax Date: 02/12/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
Hospital: Y

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: 9/16 Blood culture positive for ESBL E. coli. Scr: 1.81 Potassium: 5.4 UA: WBC too numerous to count, many bacteria

Allergies: sulfa antibiotics, Vimovo

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

Symptoms: Patient is being admitted for COVID-19, symptom onset approximately 1 week PTA. Patient also with Bacteremia. Patient is receiving meropenem and dexamethasone.

Other Meds: Zinc sulfate, trazodone, timolol ophthalmic solution, potassium chloride ER tablets, multivitamin, methocarbamol, latanoprost ophthalmic solution, Duoneb, furosemide, ferrous sulfate, divalproex DR, atorvastatin, aspirin, amiodarone

Current Illness:

ID: 1708817
Sex: F
Age: 44
State: KS

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: BP 125/60; O2 98%; Pulse 64; Stayed for 30 minutes.

Allergies: Levaquin; Cymbalta; Trintellix

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

Symptoms: Felt like her throat was closing up. Water was offered and 15 minutes later she reported that she felt better.

Other Meds: Fentanyl, Percocet, Lorazepam, Paroxetine, Chlorpromazine, Lithium, Estradiol, Chantix, Pravastatin, TOVIAZ

Current Illness: None

ID: 1708818
Sex: F
Age: 66
State: MN

Vax Date: 03/15/2021
Onset Date: 07/30/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: EKG occasional irregular heart beat, my potassium levels were slightly elevated

Allergies: Sulfa; tetracycline

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On 07/30/2021 - I went into A-fib, it lasted about 45 minutes, my heart rate was 177. I went to the urgent care, it was back in sinus rhythm. The urgent room sent me to the ER by ambulance -- blood work, EKG, they set me up on machines. On 08/092021 - 08/13/2021 - I had to wear a heart monitor for 2 weeks -- I had a irregular heart rate at least 600 or 700 times during those 2 weeks. It is the first and only time I have had A-fib and that lasted 45 minutes, that I am aware of. I am continuing to do treatments for A-fib.

Other Meds: Bupropion; Vitamin D-3; naltrexone; omega 3 fatty acid; biotin; Metrogel .75%

Current Illness: No

ID: 1708819
Sex: F
Age: 17
State: MI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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: NKDA

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

Symptoms: Patient received vaccine that was stored in the freezer for 19 days prior to moving to the refrigerator.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708820
Sex: F
Age: 26
State: WA

Vax Date: 08/28/2021
Onset Date: 08/30/2021
Rec V Date: 09/17/2021
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: None.

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

Symptoms: On 08/30/21, I noticed brief moments (a few seconds) of extreme dizziness in the middle of the night when I wake up to move my head in a different position. This morning/currently on 09/17/21, I am experiencing extreme dizziness when my head is moved whether I am laying down or standing, but it is persistent and won?t go away. I am also very nauseous from these episodes.

Other Meds: None.

Current Illness: None.

ID: 1708821
Sex: F
Age: 38
State: LA

Vax Date: 08/20/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient came in for her 2nd dose and said her arm has shooting pain down to her wrist when I asked how her 1st dose went. She said it started after she got her 1st dose.

Other Meds:

Current Illness:

Date Died: 09/15/2021

ID: 1708822
Sex: M
Age: 74
State: MI

Vax Date: 03/18/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies: Ranexa [Ranolazine]

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

Symptoms: Hospitalization (9.10.21) --- > patient deceased (9.15.21) due to COVID-19 pneumonia; COVID-19 positive 9.10.21; fully vaccinated Date of Death: 9/15/21 Time of Death: 1:29 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus Discharge Disposition: expired DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19 HOSPITAL COURSE: 74 yo male presented with the complaint of fever and weakness. He had been admitted on 9/6/21 with fever and weakness and had tested negative for covid. He had a UTI and was discharged home on the 8th. He returned 2 days later and was positive for covid and had hypoxia with CXR findings. He was admitted for the treatment of covid pneumonia dn started on dexamethasone. Over the course of his stay his baseline dementia was worse with note sun downing and associated agitation. He did not like having oxygen on or pulse ox monitoring. Family stayed with him which did not help. They decided to change his goals of care and talked to hospice. He was changed to comfort care and passed away with his family at bedside. (at admission: HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male who presents today with fever and weakness . Recently discharged 9/8/2021 with febrile illness meeting sepsis criteria with elevated lactic, wbc, fever . Started with empiric abx With zosyn. Infectious work up neg for covid, film array , cxr, blood and urine cultures neg . Op urine culture growing serratia. He improved clinically and was dc to complete x2 more days cipro. Per wife still having low grade fever on dc . He progressively became more generally weak . continued with higher fever and chills taking tylenol for relief. With fever and weakness brought back in to ed where tested pos for covid 19 . In ed lactic elevated initially then trended down . Per wife he has become more and more wean . Still able to stand and walk to bathroom . Notes increasing urine incontinence now utilizing depends. No co chest pain and really has not been sob significantly . Minimally cough. No dysuria other wise . No diarrhea . No co ha vision changes. Notes progressive decline in cognitive function over last several months. occasionally wit hand tremors . No other sz like movements .)

Other Meds: adapalene (DIFFERIN) 0.1 % gel Ascorbic Acid (VITAMIN C PO) aspirin 81 MG chewable tablet atorvastatin (LIPITOR) 80 MG tablet B Complex-C (SUPER B COMPLEX PO) benzonatate (TESSALON) 100 MG capsule Cholecalciferol (VITAMIN D3) 2000 UNITS TAB

Current Illness: Hospital admission 9.6.21 - 9.8.21: diagnosis - SIRS; hypomagnesemia; recent UTI (COVID negative during this hospitalization) Worsened and COVID-19 positive 9.10.21

ID: 1708824
Sex: M
Age: 80
State: FL

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None.

Allergies:

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

Symptoms: The patient's arm is red and swollen.

Other Meds: Alprazolam, Folic Acid, Metformin, Allopurinol, Omeprazole, Carvedilol, Meloxicam, Lisinopril

Current Illness: Cancer

ID: 1708825
Sex: F
Age: 40
State:

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: HUMIRA

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: onset of facial numbness and tingling with difficulty swallowing.

Other Meds:

Current Illness:

ID: 1708826
Sex: F
Age: 63
State: TX

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: BP: 130/70; HR: 75; O2: 97%. BP: 120/70; HR: 72; O2: 97%.

Allergies: Tylenol

Symptom List: Vomiting

Symptoms: Patient stated that she has a history of allergic reactions to acetaminophen. Patient wanted to be monitored for an additional 15 minutes due to concern of possible allergic reaction.

Other Meds: Metformin

Current Illness: N/A

ID: 1708827
Sex: F
Age: 44
State: MN

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: Body aches, chills and joint and muscle pain started about 12 hours post injection. Fever between 102 and 103 for the next two days. Treated symptoms with ibuprofen.

Other Meds: Vitamin D, daily vitamin.

Current Illness:

ID: 1708828
Sex: F
Age: 58
State: NY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/17/2021
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: None.

Allergies: No

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

Symptoms: Pfizer vaccine was diluted with Normal Saline 0.9% Bacterostatic, which is not recommended. Reported to CDC and Pfizer, recommendation was to repeat affected dose. Patient was notified and all questions answered. Patient has received their repeat dose on 9/15/21.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708829
Sex: F
Age: 16
State: CA

Vax Date: 08/19/2021
Onset Date: 09/16/2021
Rec V Date: 09/17/2021
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: N/A

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient was mistakenly given Moderna Covid Vaccine. It was noticed by staff when patient was called for scheduling of second dose. Mom informed of med error and stated that patient developed the following symptoms after having received the first dose of the vaccine: fever (102 F), chills, headache, cough, runny nose for a couple of days after administration.

Other Meds: N/A

Current Illness: N/A

ID: 1708830
Sex: M
Age: 45
State: MI

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient received vaccine that was stored in the freezer for 19 days prior to moving to the refrigerator.

Other Meds: Lipitor, Timolol, Xalatan

Current Illness: Unknown

Date Died: 09/12/2021

ID: 1708831
Sex: F
Age: 74
State: MT

Vax Date: 01/22/2021
Onset Date: 09/03/2021
Rec V Date: 09/17/2021
Hospital: Y

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: Diagnosed, hospitalized and expired with COVID 19- fully vaccinated

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am