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: 1731470
Sex: M
Age: 47
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731471
Sex: F
Age: 82
State: TN

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: RASH ABOUT 2 HOURS AFTER VACCINE, TOOK HYDROXYZINE AND FELT BETTER. NO ISSUES TODAY

Other Meds:

Current Illness: SKIN ISSUES TRYING VARIOUS REMEDIES WITH DR, BUT THIS WAS A RASH NOT HER USUAL BUMPS

ID: 1731472
Sex: F
Age: 72
State: WA

Vax Date: 03/23/2021
Onset Date: 04/13/2021
Rec V Date: 09/24/2021
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: 7/22/2021 Echocardiogram results showed leaking heart valves and tachycardia; 8/6//2021 Stress test came back ok.

Allergies: Eggs; Barley; Corn; Soy; Potato food allergies; not to take steroids due to her eye issues.

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

Symptoms: Tachycardia-Irregular heart activity during anesthesia. The surgery I was having was a cataract surgery. I wore a heart monitor for a week to confirm this starting on May 14th Up to and over 180 beats were recorded. My cardiologist told me he believes this is from sleep apnea, which I have not had the testing done for this yet.

Other Meds: Vitamin B12; Vita D; Vita C; I Caps

Current Illness: None

ID: 1731473
Sex: U
Age: 57
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: 1731474
Sex: F
Age: 84
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: 1731475
Sex: M
Age: 65
State: FL

Vax Date: 04/16/2021
Onset Date: 04/24/2021
Rec V Date: 09/24/2021
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: Doctor performed visual exam and diagnosed Bell?s Palsy. No other test(s) required.

Allergies: No known allergies

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

Symptoms: Afflicted with Bell?s Palsy. Paralysis on left side of face. Still paralyzed to date (9/24/2021)

Other Meds: Atorvastatin 40mg, 1 daily Diclofenac 50mg, 1 daily Paroxetine HTL 20mg, 1 daily

Current Illness: None

ID: 1731476
Sex: M
Age: 59
State:

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/24/2021
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 came for his 3rd booster Pfizer shot, he filled the covid19-immunization consent form+ the attestation form for additional dose eligibility. He didn't have his Covid card with him, we still gave him the 3rd shot per his form(Pfizer) and he came next day so we can fill the card 3rd dose and that's when we found out that he had Moderna not Pfizer.

Other Meds:

Current Illness:

ID: 1731477
Sex: F
Age: 53
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731478
Sex: F
Age: 55
State: MT

Vax Date: 04/22/2021
Onset Date: 08/29/2021
Rec V Date: 09/24/2021
Hospital: Y

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: Diagnosed and Hospitalized with COVID

Other Meds:

Current Illness:

ID: 1731479
Sex: F
Age: 29
State: CO

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: None.

Allergies: Peanuts, Bactrim.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I got my first dose of the Moderna vaccine on 2/24/2021. About a week later, I woke up one morning with my right arm burning at the injection site. I then got out of bed and saw that there was a rash there. It was a burning rash that had some itching; it almost felt like shingles. I saw a doctor at Medical Offices, and he though it was what is commonly called "COVID arm." He gave me a steroid cream to put on it, and it went away in 2-3 days. I got my second dose on 3/24/2021. Immediately after the shot, there was a welt at the injection site. They had me wait for 30 minutes afterwards at the pharmacy to make sure I didn't have an anaphylactic reaction. They checked my arm before I left to see if the swelling had gone down, which it had. I had no more problems afterwards.

Other Meds: Albuterol.

Current Illness: None.

ID: 1731480
Sex: F
Age: 69
State: RI

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: X-ray; Ultra sound; blood work

Allergies: SOFIA

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

Symptoms: I had body and joint ache that went away in 24 hours. About 2 weeks later, it came back. I began wake up at nights with server lower back pain. Then it would go away within an hour. I also had groin pain. I went to the doctor about this. He thought it might be a hip ligament. He did an X-ray on my back and said I had arthritis in my back. I also went to my OBGYN about my groin pain. They did a ultrasound. They also did blood work, which was normal.

Other Meds: LIVONIA

Current Illness:

ID: 1731481
Sex: M
Age: 74
State: VA

Vax Date: 01/20/2021
Onset Date: 09/06/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Antigen test provided. Positive.

Allergies: Halidol

Symptom List: Rash, Urticaria

Symptoms: Tested positive to COVID 9/6. Cough, congestion, and low grade fever noted few days prior.

Other Meds: Multiple medications.

Current Illness: Recovering from sepsis, kidney stone stint placed, hospitalized from mid July until sept 4th

ID: 1731482
Sex: U
Age: 57
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731483
Sex: M
Age: 60
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731484
Sex: M
Age: 82
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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 vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731485
Sex: F
Age: 75
State: CT

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 09/24/2021
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: n/a

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

Symptoms: A booster third dose was administered to patient, but Moderna is not currently approved for third dose booster for patients. It is listed Moderna that a third dose may be given if the patient is immunocompromised. The patient has COPD so is immunocompromised, so the third was given based off that information. The patient was called on 9/24/21 at noon, and she reported that she felt fine and had no side effects. The doctor's office was informed that the patient received the third dose and that the patient has not experienced any side effects

Other Meds: n/a

Current Illness: COPD

ID: 1731486
Sex: F
Age: 58
State: NY

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: NONE

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

Symptoms: PATIENT STATES THAT AFTER HER SECOND MODERNA COVID VACCINE DOSE, SHE DEVELOPED A BIG, RED SPOT AT THE AREA OF INJECTION. THE PATIENT WAS DIAGNOSED WITH CELLULITIS.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1731487
Sex: F
Age: 71
State:

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Sudden onset of severe bilateral tinnitus that has not resolved.

Other Meds: None

Current Illness: None

ID: 1731488
Sex: F
Age: 81
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731489
Sex: U
Age: 73
State:

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/24/2021
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: 1731490
Sex: F
Age: 90
State: FL

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: NONE

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

Symptoms: Pt was given a dose of Moderna vaccine that was intended for another resident. The pt had previously received 3 doses of Pfizer vaccine (1/18/21, 2/8/21, 9/16/21). No additional adverse effects noted.

Other Meds: ERTAPENEM 1GM, FUROSEMIDE 40MG, POTASSIUM CL 20MEQ, QUETIAPINE 300MG, SENNA 8.6MG, CREON 12000U, METOPROLOL 25MG,

Current Illness: UTI

ID: 1731491
Sex: M
Age: 56
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

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

Other Meds:

Current Illness:

ID: 1731492
Sex: M
Age: 57
State: GA

Vax Date: 03/31/2021
Onset Date: 08/22/2021
Rec V Date: 09/24/2021
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: PUI was in the hospital with pneumonia when he tested positive. Patient is fully vaccinated.

Other Meds:

Current Illness:

ID: 1731493
Sex: F
Age: 52
State: NJ

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/24/2021
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: No known

Symptom List: Injection site pain, Pain

Symptoms: Ever since my first dose of my vaccination my left hand is stiff in the early morning hours, I wake up about 4 AM It takes a while for my hand to be able to move comfortably.

Other Meds: N/A

Current Illness: No

ID: 1731494
Sex: F
Age: 85
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: 1731495
Sex: F
Age: 44
State: IL

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/24/2021
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: none

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

Symptoms: Sore arm, chills/aches, lack of energy (very tired all the time), no treatment yet

Other Meds: none

Current Illness: none

ID: 1731496
Sex: U
Age: 69
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731497
Sex: F
Age: 76
State: IA

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

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

Lab Data:

Allergies: UNKNOWN

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: ***PATIENT DID NOT HAVE AN ADVERSE EFFECT, BUT RECIEVED A 4TH DOSE OF PFIZER VACCINE ON 9/8/21****

Other Meds: UNKNOWN, PATIENT DOES NOT USE OUR PHARMACY

Current Illness:

ID: 1731498
Sex: M
Age: 39
State: NY

Vax Date: 01/26/2021
Onset Date: 01/30/2021
Rec V Date: 09/24/2021
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: Quinton, Lorabid, peanuts, shellfish, fish

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

Symptoms: Developed left sided neuropathy/burning followed the next day by right sided neuropathy/burning. Right foot maintained this neuropathy sensation for several days followed by numbness that will turn to burning sensation with continuous pressure. Treated with Aleve with temporary relief of burning but continued numb sensation. This sensation has now increased with worsening burning sensations.

Other Meds: Breo Ellipta, Albuterol MDI PRN

Current Illness:

ID: 1731499
Sex: M
Age: 16
State: MT

Vax Date: 06/18/2021
Onset Date: 09/19/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Hospitalized and diagnosed with COVID

Other Meds:

Current Illness:

ID: 1731500
Sex: M
Age: 52
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731501
Sex: F
Age: 48
State: AZ

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Severe headache - persistent x 3 weeks - started after 3rd dose of covid19 shot, persistent back pain/myalgias, and feels her whole body is swollen x 3 weeks. Not improving. Has been taking ibuprofen, naproxen, acetaminophen for pain x 3 weeks w/o improvement.

Other Meds: Acetaminophen, Metformin, Naproxen, pantoprazole

Current Illness: None

ID: 1731502
Sex: F
Age: 79
State: WI

Vax Date: 03/01/2021
Onset Date: 09/13/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data:

Allergies: acarbose, morphine, lisinopril

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

Symptoms: Pt received full vaccination series for the Moderna COVID-19 vaccine. Pt subsequently still became ill with covid and needed treatment. She began having symptoms of COVID on 9/9/2021 and tested positive for the virus on 9/13/2021. Pt presented 9/16/2021 to outside ED, transferred here due to lack of closer facilities that could both treat COVID and had inpatient dialysis. Discharged from this hospital on 9/22/2021.

Other Meds: amlodipine, aspirin, atorvastatin, calcium acetate, cefadroxil, clopidogrel, dexamethasone, docusate sodium, doxazosin, famotidine, furosemide, insulin glargine, losartan, metoprolol tartrate, neosporin topical, vitamin D.

Current Illness:

ID: 1731503
Sex: M
Age: 78
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731504
Sex: F
Age: 54
State: VA

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Erythema, Pruritus

Symptoms: PATIENT COMPLAINED OF HEADACHE & HAVING DIZZINESS; I CALLED FOR EMERGENCY SERVICE; I PASSED THE CARE ONTO THE PARAMEDICS

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1731505
Sex: F
Age: 71
State: NY

Vax Date: 03/22/2021
Onset Date: 07/14/2021
Rec V Date: 09/24/2021
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: MRI Head

Allergies: N/A

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

Symptoms: My arm was a little sore. I got a funny headache in mid July that I could control with enough medicine. The headaches wouldn't go away and it started lasting so long. I called my doctor and she sent me for and MRI and the results came back fine. My MD is sending me now to a headache clinic to see if they can assist with the headaches. I started drinking a lot of water and taking Motrin but the headaches never fully go away.

Other Meds: Gabapentin; atorvastatin; meloxicam; fish oil; vitamin B12; lansoprazole

Current Illness: N/A

ID: 1731506
Sex: M
Age: 26
State: KY

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: NKA

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

Symptoms: Turned red, unresponsive, dizziness, passed out, difficulty walking, turned pale, excessive sweating, and shaking and headache. He was seated given water and elevated legs. Color returned but dizziness and headache lasted throughout the day.

Other Meds: None

Current Illness: None

ID: 1731507
Sex: F
Age: 65
State: IL

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: Labs were done and CT SCAN was done in the ED August 21, 2021 everything came back negative.

Allergies: Darvocet and Codeine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I received my 2nd COVID-19 vaccine on 3/21/2021. I had the normal 24 hour pain in the location of my vaccine. (Left arm same as the first vaccine (2/28/21). But this time it continued to hurt. I started working out with a personal trainer July hoping to get some relieve from the pain. She advise me to ice the area because I could not do the exercises it hurt to bad. I applied an ice pack to the area, it swelled up the size of an egg it still hurts.

Other Meds: All vitamins and prescriptions were stopped

Current Illness: None

ID: 1731508
Sex: M
Age: 64
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731509
Sex: U
Age: 58
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731510
Sex: M
Age: 44
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731511
Sex: F
Age: 38
State:

Vax Date: 07/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/24/2021
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: PATIENT HAD COVID VACCINE Dose 1 date: 07/16/2021, Dose 2 date: 08/14/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1731512
Sex: M
Age: 61
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: 1731513
Sex: F
Age: 47
State: CA

Vax Date: 04/07/2021
Onset Date: 05/14/2021
Rec V Date: 09/24/2021
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: None

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

Symptoms: Inconsistent periods. Menstrual bleeding for 3 weeks. Then following month heaving menstrual bleeding. Then following month missed period. Then following month period lasted for 1 week.

Other Meds: Blisovi 24 Fe (Birth Control)

Current Illness: None

ID: 1731514
Sex: M
Age: 72
State: CA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731515
Sex: F
Age: 66
State: PA

Vax Date: 07/22/2021
Onset Date: 07/24/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: None

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I had fever, body aches, sore throat for 5 day. Developed pain in upper right stomach area and heart burn. After 2 weeks I developed petechiae over the bicep of left arm and on both shins. The heart burn and pain in stomach continued to get worse, and itching on the skin of the upper stomach had started. On Aug 24, I woke with a sore throat at 1 AM. I woke again at 6 AM with shin of my right leg hot, and a red spot 14mm in size. I had aches all over my body, and pain in my neck, under arms, in groin. It was extremely painful to stand. I could not find medical help until Aug 25, 2021. The spot on my leg had gotten bigger and painful. I was diagnosed with Cellulitis. I started a course of Bactrim DS . On Day 10 of antibiotics 9/4/2021, i woke covered in a rash all over my body. I could not get medical assistance. I stopped antibiotics, started to take Benadryl for 5 days. I was finally able to see my MD on 9/10. The rash for the antibiotics finally disappeared on 9/15/21. In the mean time, the petechiae, the stomach skin itching, and Cellulitus resolved. I'm finally feeling better, 2 months later

Other Meds: Vitamin C, D

Current Illness: None

ID: 1731516
Sex: F
Age: 38
State: AL

Vax Date: 04/30/2021
Onset Date: 05/18/2021
Rec V Date: 09/24/2021
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: Audio Test - Left ear was affected; Clicking ear test - further test required - Rotatory Chair testing VNG -confirmed from Meniere's disease.

Allergies: Penicillin

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

Symptoms: I had on 18 May2021 congestion and drainage, fluid pressing and went to urgent care on 20May2021 for pain in the left ear, they said I had an ear infection. 20th and 30th of May went to ER again. Referral to ENT on 2 Jun2021. Diagnosed with Meniere's disease. End of Jun2021, Another test where they spin your car VNG. Changed diet and on medication and less salt. Vertigo in May2021 can be very severe and limited ability to drive and hearing loss and intense feeling of left ear.

Other Meds: VITA FUSION multi vitamin

Current Illness: No

ID: 1731517
Sex: F
Age: 38
State: NH

Vax Date: 08/10/2021
Onset Date: 08/21/2021
Rec V Date: 09/24/2021
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: Latex, Gentamycin, Penicillin, Adhesives, peanuts

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Unexplained rash (treatment non-responsive). Rash began days after 2nd Moderna vaccine and have gotten worse. Rash spread from groin, to flank, to back

Other Meds: None

Current Illness: None

ID: 1731518
Sex: U
Age: 64
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1731519
Sex: M
Age: 46
State: CA

Vax Date: 01/21/2021
Onset Date: 09/17/2021
Rec V Date: 09/24/2021
Hospital:

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

Lab Data: None.

Allergies: NKA

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

Symptoms: Reporting second dose prior to recommended time frame. First Dose was documented as 12/29/2020, second dose was 01/21/2021, indicating early second dose.

Other Meds: N/A

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am