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: 1727082
Sex: M
Age: 16
State: CA

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: Cardio Chest with Blood test EKG and a Chest X-ray

Allergies: No

Symptom List: Dysphagia, Epiglottitis

Symptoms: 24 hrs. after Dose 2 on 09/02/2021 had left arm was numb and lymph nodes swollen and neck stiffness, gave Motrin. Took a week to feel better but the lymph node has remained consistent. Three weeks 09/20/2021 Patient awoke with lymph on left side of body and arm felt discomfort in his left side of neck and body and three weeks still lymph Monday morning sharp pain before 6am could not move and not able to take deep breaths and had EMT come to the house took to Hospital and check with heart issue and full ex-ray and major inflammation in his body and hour later he has been feeling better and still not recovered.

Other Meds: No

Current Illness: No

ID: 1727083
Sex: M
Age: 65
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727084
Sex: M
Age: 37
State: NE

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
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: Patient stated they had not been previously vaccinated for Covid-19 and attested to that on their consent form. After giving the shot and patient left, we were attempting to bill it to insurance and it rejected with a code of "second dose in series not covered" I called and asked him if he for sure had not gotten a covid vaccine in the past and he stated he had not. I said I would get back to him. I then looked him up on the Immunization Registry and he has gotten 3 Pfizer doses and 1 Moderna vaccine at other locations. I have tried to called him to discuss with him the fact that he should not be seeking further vaccination and has exceeded the recommended doses for covid-19 and he has not returned my call as of 9/23/21 at 5:15 pm. His covid vaccination history is as follows: Pfizer 1 of 3 3/18/21 Pfizer 2 of 3 4/8/21 Pfizer 3 of 3 8/20/21 Moderna 1 of 1 9/18/21

Other Meds:

Current Illness:

ID: 1727085
Sex: F
Age: 70
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727086
Sex: F
Age: 79
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine pfizer and moderna

Other Meds:

Current Illness:

ID: 1727087
Sex: F
Age: 57
State: AR

Vax Date: 09/08/2021
Onset Date: 09/21/2021
Rec V Date: 09/23/2021
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: AREA UNDER ARM IS RED AND SWOLLEN --APPEARS TO BE SWOLLEN LYMPH NODE SPOKE TO DR --SHE IS USING HOT COMPRESSES AT THE INJECTION SITE AND LYMPH NODE AREA DR RECOMMENDED NOT GETTING MULTIPLE VACCINES AT THE SAME TIME IN THE FUTURE.

Other Meds:

Current Illness:

ID: 1727088
Sex: F
Age: 48
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727089
Sex: M
Age: 61
State: AZ

Vax Date: 03/31/2021
Onset Date: 04/15/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies: Pellicilin

Symptom List: Pharyngeal swelling

Symptoms: Ear ringing, especially in mornings.

Other Meds: Antorvastatin 10 mg on Mon, Wed, & Fri.

Current Illness: None

ID: 1727090
Sex: F
Age: 70
State: KS

Vax Date: 03/23/2021
Onset Date: 08/17/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: Saturday 8/21/2021 COVID test, it was positive result on the 22nd. I called my doctor to make sure I was doing everything to do. I asked about the monoclonal antibody. We did a computer conference.

Allergies: Morphine (sick to stomach)

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: It felt like a summer cold. And then I did eventually lose my sense of taste and smell. That was it. It lasted about 12 -14 days. I am back to normal now. I was tired. One day I had a fever of 100.2. I think I took ibuprofen that day. No other treatment. I monitored my temperature and oxygen every day. My oxygen was never abnormal. I have all my energy back. I have my sense of taste and smell back. This was during peach season. I never lost the taste of the peach.

Other Meds: Multivitamin; vit C; vit D3; vit E; COQ10; ginkgo biloba; glucosamine; omega 3 fish oil; Citracal; I take a cream for my face Tretinoin; Prolia

Current Illness: No

ID: 1727091
Sex: F
Age: 48
State: KY

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: unknown

Allergies: no known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: patient woke up at 3:30 a.m. the next morning with arm red and swollen. went to emergency room where she was diagnosis with petechiae and allergic reaction according to doctor that treated her at emergency room and expected it to be from pfizer covid vaccine since she had never had a reaction to a flu vaccine. patient was given steroids and benadryl

Other Meds: unknown

Current Illness: none known

ID: 1727092
Sex: F
Age: 43
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727093
Sex: F
Age: 53
State: IA

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/23/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: none

Allergies: eggs

Symptom List: Rash, Urticaria

Symptoms: severe diarrhea for 12 hours

Other Meds: sertraline, iron, multi - vitamin, fiber

Current Illness: none

ID: 1727094
Sex: F
Age: 15
State: NM

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/23/2021
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: N/A

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

Symptoms: PREGNANT ESTAMATED DUE DATE 01/06/2022 PATIENT IS ALSO UNDER 18 YEARS OLD AT TIME OF VACCINATION

Other Meds: PRENATAL VITAMINS

Current Illness: N/A

ID: 1727095
Sex: F
Age: 60
State: CA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 09/23/2021
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: Some allergies with some nuts.

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

Symptoms: Within 2 hours after injection, large blood vessel in eye broke. Lasted about 4 days. Never had this happen before.

Other Meds: Levothyroxine, vitamins

Current Illness: none

ID: 1727096
Sex: M
Age: 73
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727097
Sex: M
Age: 24
State: CO

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: None available

Allergies: N/A

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

Symptoms: No adverse responses to vaccine at this time. First vaccine was received on 08/30/21. The second vaccine was received 09/23/2021 by RN. Currently this person in not exhibiting any adverse effects, no necessary treatment at this time, but will continue to monitor for a positive patient outcome.

Other Meds: N/A

Current Illness: N/A

ID: 1727098
Sex: M
Age: 59
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727099
Sex: F
Age: 35
State: TX

Vax Date: 03/23/2021
Onset Date: 08/17/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: 8/20/2021 Scrape Biopsy

Allergies: TDP shot(2mo old)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 8/17/2021 Shingles on the right side all over torso back and front and arm. Anti-Viral. It is ongoing and took three weeks to improve.

Other Meds: D3

Current Illness: None

ID: 1727100
Sex: M
Age: 59
State: PA

Vax Date: 08/11/2021
Onset Date: 09/02/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: rash all over face/body, leaves and comes back, face swollen

Other Meds: high blood pressure meds, blood thinner

Current Illness:

ID: 1727101
Sex: M
Age: 60
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727102
Sex: F
Age: 77
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727103
Sex: M
Age: 47
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
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: NKDA

Symptom List: Unevaluable event

Symptoms: At approximately 1300 client (DOB: 03/12/1974) received 1st dose COVID Janssen vaccine (lot #1821286) in the R arm. Immediately after receiving the vaccine, the client asked vaccinator if he could sit with her for his observation. He advised the client to sit in the observation area and educated client that he would be directly observed by an RN. he walked client across the room to observation, advised him to sit in the zero gravity chair, provided water, and notified observer, RN that the client was feeling anxious about receiving the vaccine. Client layed back in zero-gravity chair and drank water. At 1306 client reported to RN that he was feeling slight tingling in his arms and began to get teary eyed. RN took client's vitals at 1307 with BP of 124/80 in L arm laying down, HR 88, O2 99, and RR 18. RN auscultated lung sounds which were clear bilaterally and heart rate which was normal. Lead RN assessed client who presented A&O x4, skin warm and dry, grip strong and equal, and cap refill under two seconds. Lead RN provided ice pack for client's R arm and held ice pack at the site of injection. At 1311 the client reported that he has "severe anxiety" and was contemplating outside the building if he was going to move forward with getting vaccinated for 20 minutes. Client is taking Zoloft 25mg twice daily for anxiety and reported that he took 25mg this morning and ate a bowl of cereal at 0900. Client has NKDA and no chronic health conditions. At 1315 client reported that he has a "fear of needles" and gets" faint with needles". Client also reported a history of vasovagal reactions. At 1316 client reported feeling "chest achiness" on the L side but reported that he experiences this feeling of chest aching on a daily basis as a result of his anxiety. Client denied chest pain, SOB, swelling, and trouble swallowing. At 1316 client vitals were taken by RN with BP of 124/80 laying down on the L arm, HR 84, O2 98, and RR 18. At 1319 client stated that he has "impending doom syndrome". Lead RN educated that client's vitals were all within normal range. Client denied dizziness, chest pain, numbness, trouble swallowing, changes in vision, slurred speech, and shortness of breathe. At 1324 client reported he was "feeling better" and the tingling in his arms was improving. Client denied chest achiness. At 1332 vitals were taken by RN with BP of 110/72 laying down in the L arm, HR 73, O2 98, and RR 16. Client reported that he drove himself to the vaccination site. At 1343 RN educated on covid program, when to follow up with his PCP, and ER Precautions. At 1345 vitals were taken by RN with BP of 110/80 in the L arm laying down, HR 72, O2 98, and RR 16. At 1403 the client stood up and RN assessed an even, symmetrical, and steady gait. Client left the vaccine site at 1404 and drove himself.

Other Meds: Zoloft, 25mg 2x Daily

Current Illness: None

ID: 1727104
Sex: M
Age: 49
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727105
Sex: M
Age: 66
State:

Vax Date: 09/22/2021
Onset Date:
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727106
Sex: F
Age: 73
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727107
Sex: F
Age: 47
State: KS

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 09/23/2021
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: Patient reports long list of medication allergies Patient reports history of "very sick with flu vaccine." States "I no longer take them."

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

Symptoms: RN observed patient holding head. Patient reporting frontal HA "mild" at this time. Also reporting dizziness. Wheelchair for patient to EMS room for patient to rest on cot. Water provided. Onset of HA approximately 15 minutes into observation. Pt rested - dizziness resolved quickly within a few minutes, Discharged at 1610 after escorting to BR.

Other Meds:

Current Illness:

ID: 1727108
Sex: F
Age: 23
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
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: N/A

Allergies: NONE

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient had received 1st dose of the vaccine on the left arm. Ensured no allergies prior to vaccinations. No known issues prior to vaccination. After vaccine, patient was not complaining, alert, and stood up immediately. Waited around with friend for a couple minutes before fainting in front of patients/ staff. She fell forward and hit her chin. Her chin has a cut and was bleeding through her mask. We called EMS requested help from the paramedics. They came to tend to her and she refused to be taken into the hospital, but will go via her own transportation to get her cut stitched up.

Other Meds: NONE

Current Illness: NONE

Date Died: 08/10/2021

ID: 1727109
Sex: M
Age: 36
State: TX

Vax Date: 04/15/2021
Onset Date: 08/07/2021
Rec V Date: 09/23/2021
Hospital: Y

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

Lab Data: CBC, CMP, PT, PTT, D DIMER, ABG'S, FIBRINOGEN, LFT, MAGNESIUM, LDH, FERRITIN, CRP. Labs concurrent with COVID pneumonia, sepsis, respiratory failure. CT, XRay chest done to assess lung status daily, continues to be concurrent with COVID pneumonia diminishing over stay.

Allergies: No known drug allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: obese 35yoM who presents with acute SOB which was found in the ED due to acute COVID 19. He is diaphoretic, and speaks in only short sentences, frequently expressing varying preference for BPAP or facemask. He received the Moderna vaccine series several months prior, and had been in his usual state of good health prior to the abrupt onset of symptoms. He takes medication for hypertension. DISCHARGE DIAGNOSIS: 1. Acute hypoxic respiratory failure secondary to COVID- 19 pneumonia 2. COVID- 19 pneumonia with super-imposed bacterial pneumonia 3. Sepsis secondary to above on pressor support 4. Obesity with body mass index 57 5. Elevated D-dimer He was started on NRB and BPAP, as well as all COVID therapies of steroids, anticoagulation, Colchicine, and Ivermectin. He was also started on broad spectrum antibiotics for possible super-imposed bacterial pneumonia. His oxygenation worsened and he was intubated on 8/8. His O2 levels remained difficult to control and the AM of 8/9 he was proned with increasing PEEP. His oxygenation improved and he appeared to be overall stabilizing by 8/10. The afternoon of 8/10, he was getting suctioned by RT and was noted to become bradycardic, however, this quickly resolved with Atropine and was attributed to increased vasovagal tone secondary to prone positioning and increased PEEP. He remained HD stable and his O2 remained 90s (Last recorded VS HR 61, RR 24, BP 111/67, and O2 99%). Unfortunately, at approximately 2117 the patient developed an irregular heart rate before going into ventricular tachycardia and then asystole. He was started on medical management as per guidelines and CPR was initiated as soon as possible under the direction of Dr. was never obtained and Dr called at 2150. The patient's family was informed of his passing and all questions were answered. Cause of death appears to be cardiac arrest secondary to ventricular tachycardia secondary to hypoxic respiratory failure secondary to COVID- 19 pneumonia.

Other Meds: hypertension medications

Current Illness: unknown

ID: 1727110
Sex: F
Age: 59
State:

Vax Date: 07/09/2021
Onset Date: 09/20/2021
Rec V Date: 09/23/2021
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:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1727111
Sex: F
Age: 49
State: GA

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Nausea

Symptoms: Patient woke up Saturday morning with hives and a red itchy rash covering her entire body. She states it flares up and goes down when she ices it, then pops up again somewhere else.

Other Meds: none

Current Illness: none

ID: 1727112
Sex: F
Age: 20
State:

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies: Allergies: fruit (Vitamin C)

Symptom List: Injection site pain

Symptoms: 12mins post vaccination, pt c/o of chest heaviness. Pt escorted into triage area. RN noted flushing/sweating. Charge RN, on-site provider notified. @1355 BP 123/85 HR 79 SpO2 100% RR 14 Temp 97.9 . VSS, AOx4. Pt denies N/V, headache, SOB. Pt stated had not eaten prior to vaccination. Pt reclined back in chair and given apple juice per NP recommendation. Pt stated that she had not eaten prior to vaccination. On site provider recommended extended observation. After extended observation (unspecified time period) Patient stated feeling better after finishing 1 cup of apple juice. Per NP, pt stable and d/c to home with friend. Per NP, Pt developed panic w/ self-limiting chest heaviness after IZ. She was eval and found to have normal vital signs, see RN note. Pt spoke in full sentences, lungs were CTAB. Sx resolved after apple juice. ED precautions discussed w/ pt, she v/u. Pt's friend will drive her home. Pt informed she may receive 2nd COVID IZ, no contraindication at this time.

Other Meds: unknown

Current Illness:

ID: 1727113
Sex: F
Age: 71
State:

Vax Date: 09/22/2021
Onset Date:
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727114
Sex: M
Age: 66
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727115
Sex: M
Age: 26
State: CO

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: No medical tests or laboratory tests indicated at this time.

Allergies: N/A

Symptom List: Tremor

Symptoms: No adverse responses to vaccine at this time. First vaccine was received on 08/30/21. The second vaccine was received 09/23/2021 by RN. Currently this person in not exhibiting any adverse effects, no necessary treatment at this time, but will continue to monitor for a positive patient outcome.

Other Meds: N/A

Current Illness: N/A

ID: 1727116
Sex: M
Age: 84
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727117
Sex: M
Age: 41
State: CA

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/23/2021
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 reported

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

Symptoms: Patient states that immediately after the vaccine he had chest pain for approximately 15 minutes and then it resolved without any interventions. The next day he reports he had a sore neck. The sore neck lasted approximately 1 week in duration.

Other Meds: Vitamin B 12 and other supplements. No prescription medications.

Current Illness: None reported.

ID: 1727118
Sex: F
Age: 21
State: LA

Vax Date: 08/30/2021
Onset Date: 09/05/2021
Rec V Date: 09/23/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Six days following the vaccine, I noticed a rash appear near the injection site. The rash started our spotty but became solid. The rash lastly about four days. It was extremely itchy and warm to the touch. I also felt nauseous while the rash was present. When the rash went away, I experienced chest pain for a few days.

Other Meds: Balcoltra- birth control IBS solution- prebiotic supplement

Current Illness: none

ID: 1727119
Sex: F
Age: 56
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727120
Sex: F
Age: 24
State: CA

Vax Date: 09/10/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data: None.

Allergies: Type IV hypersensitivity to thiuram mix

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

Symptoms: Delayed hypersensitive reaction. Welts on injection site, hand of injection side, and on leg opposite from injection site. Itchy, red. 12 day after second shot.

Other Meds: None

Current Illness: None

ID: 1727121
Sex: F
Age: 73
State:

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 09/23/2021
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: Loss of taste and smell, continuing to current day. Weight loss, as a result.

Other Meds:

Current Illness:

ID: 1727122
Sex: F
Age: 56
State: CA

Vax Date: 08/05/2021
Onset Date: 08/07/2021
Rec V Date: 09/23/2021
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: Bee sting, latex, poison oak

Symptom List: Pain in extremity

Symptoms: Fever, malaise cough, congestion and chest tightness started with 36 hours. Two days of extreme fatigue, napping and unable to perform usual daily activities (shower, cooking, self-care) and in bed for most of days 2-4 after receiving vaccine. Arm was sore for about 2 weeks. Fatigue continued to limit activities, required additional sleep and naps for 1 month following vaccine. Cough, chest tightness for 6 weeks. Felt sick and poor energy until 9/20. Cough continues but no mucous since 9/20. First month post vaccine had negative impact on my work performance, alertness and home activities which was clearly related to my mandated vaccine as a healthcare provider.

Other Meds: Estradiol 0.1 mg transdermal patch Progesterone 100 mg oral, daily

Current Illness: N/A

ID: 1727123
Sex: M
Age: 67
State:

Vax Date: 09/22/2021
Onset Date:
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727125
Sex: F
Age: 62
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727126
Sex: M
Age: 78
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727127
Sex: M
Age: 32
State: OR

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/23/2021
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: no

Symptom List: Vomiting

Symptoms: lost of color, felt weak, foggy minded, tired, muscle ache, headaches, fatigue, chills, difficulty breathing, coughing and sore throat

Other Meds: no

Current Illness: no

ID: 1727128
Sex: M
Age: 58
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1727129
Sex: M
Age: 77
State:

Vax Date: 09/22/2021
Onset Date:
Rec V Date: 09/23/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1727130
Sex: F
Age: 27
State: HI

Vax Date: 07/06/2021
Onset Date: 07/26/2021
Rec V Date: 09/23/2021
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: None

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: August menstruation lasting 2 weeks. September menstruation very light bleeding only dark blood, heavy sweets cravings, increase in range of cramps (neck to ankles). Normal menstruation is on time lasting 5-7 days with regular bleeding and moderate abdominal cramps.

Other Meds: Oral contraceptive, Vitamin C, Zinc, Tylenol

Current Illness: None

ID: 1727131
Sex: M
Age: 64
State: FL

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 09/23/2021
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: redness, swelling, warmth around injection site. continuous spreading as of 9/23/21. Antibiotics prescribed for skin infection

Other Meds: tadalafil, dutasteride, phendimetrazine, lisinopril

Current Illness: none

ID: 1727132
Sex: M
Age: 62
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/23/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am