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: 1732033
Sex: M
Age: 46
State: MO

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 of mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732034
Sex: M
Age: 43
State: TX

Vax Date: 09/17/2021
Onset Date: 09/18/2021
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: N/A

Allergies: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: I have sores on my lips and inside of my mouth lower jaw bottom lip.

Other Meds: Suboxone 8/2 mg X3 daily Lyrica 75 mg 1-2 @ bedtime Cyclobenzaprine 10mg X1 at bedtime

Current Illness: N/A

ID: 1732035
Sex: F
Age: 45
State: MO

Vax Date: 03/06/2021
Onset Date: 08/01/2021
Rec V Date: 09/24/2021
Hospital: Y

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: SARS-CoV-2 PCR positive on 07/25/2021. This was 6 days prior to admission to the hospital.

Allergies: NKDA

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

Symptoms: Patient presents to the emergency department with cough, body aches from being fatigue, shortness of breath, flank pain, chest pain, a score throat, left ear pain, dizziness, and loss of taste or smell.

Other Meds: Guaifenesin, Levothyroxine, and multivitamin

Current Illness: Patient presented to the emergency room with an ear infection: acute otitis media and was on Augmentin.

ID: 1732036
Sex: F
Age: 58
State: NC

Vax Date: 08/01/2021
Onset Date: 08/15/2021
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: None

Allergies: No

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Ear is hard to hear from and there is a thumping like somebody is tapping on my eardrum with a q-tip or something and it by yarn or if I raise up or sit down it thumps and it does it every day not continually but it doesn't at least a dozen times a day .am taking antibiotics for a wound on foot and hope ear will clear up.. it has in the past week went down to about five or six times a day so it is reducing and I'm hoping it will go away.

Other Meds: Lisinopril, Lantus, homolog, Lyrica, jarvians, cipro

Current Illness: Diabetic, Lupus, hbp,

ID: 1732037
Sex: M
Age: 87
State: MO

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 of mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732038
Sex: M
Age: 63
State: RI

Vax Date: 08/24/2021
Onset Date: 08/25/2021
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:

Allergies: None

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

Symptoms: Fever 102F; headache; extreme fatigue; nausea; loss of appetite.

Other Meds: Losartan, Atorvastatin, Vitamin D, Zinc

Current Illness: None

ID: 1732039
Sex: F
Age: 42
State: OK

Vax Date: 03/23/2021
Onset Date: 04/07/2021
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: blood test

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I starting jaw pain and inflammation. My doctor determined that it was musculoskeletal pain. I started having tendonitis in my right elbow.

Other Meds:

Current Illness:

ID: 1732040
Sex: M
Age: 69
State: MO

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 of mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1732041
Sex: F
Age: 79
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: Abdominal pain, Chills, Sleep disorder

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

Other Meds:

Current Illness:

ID: 1732042
Sex: F
Age: 57
State: PA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: she had no reaction

Other Meds:

Current Illness:

ID: 1732043
Sex: F
Age: 87
State: AZ

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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: none

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

Symptoms: Patient received fluzone HD at 9:30AM on 9/22/21. Experienced redness and swelling at injection site that was 2 inches in diameter. 24 hr later had uncontrolled vomiting and diarrhea and chills. Pt called ambulance and was assessed by EMS, but was not taken to hospital. She called today and said symptoms had improved to some degree.

Other Meds: Lisinopril 20mg daily, levothyroxine 75mcg daily, vitamin D3 2,000IU, atenolol 100mg daily, clonidine 0.1mg half tab daily, furosemide 40mg daily, pravastatin 40mg daily, aspirin 81mg daily

Current Illness: none

ID: 1732044
Sex: F
Age: 40
State:

Vax Date: 09/01/2021
Onset Date: 09/17/2021
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:

Allergies: NA

Symptom List: Rash, Urticaria

Symptoms: Congestion Runny nose Fatigue/lethargy Slower to recover/fight off illness

Other Meds: NA

Current Illness: NA

ID: 1732045
Sex: M
Age: 66
State: MO

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 of mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1732046
Sex: F
Age: 78
State: ID

Vax Date: 02/09/2021
Onset Date: 08/21/2021
Rec V Date: 09/24/2021
Hospital: Y

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: Pt was fully vaccinated 2 weeks after the last dose of Moderna Covid vaccine given. Pt was subsequently diagnosed with COVID on 08/17/2021 and then admitted to the hospital for treatment on 08/21/2021.

Other Meds:

Current Illness:

ID: 1732047
Sex: M
Age: 12
State: UT

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: LA

Lab Data: EKG obtained 9/23 notable for diffuse ST elevation, initial troponin of 13.55 and CRP of 1.8. Normal chest x-ray. Follow-up troponins 9/23 were 18.15 and 11.14. Troponins from 9/24 were11.63 and 17.53. Infectious workup notable for negative respiratory film array (includes COVID, Parainfluenza 1-4, rhinovirus, adenovirus, RSV, Chlamydia pneumoniae, Coronavirus 229E/HKU1/NL63, OC43, Bordatella Pertussis, Human Metapneumovirus), negative HIV antigen/antibody , negative Hepatitis A/B/C serologies, negative CMB/EBV serologies, Varicella only with positive IgG, parvovirus only with positive IgG, negative RPR, and negative enterovirus serum PCR. Pending tests include COVID spike IgG, COVID nucleocapsid IGG, HSV serum PCR, enterovirus stool culture, enterovirus nasopharyngeal swab PCR, serum HHV6 PCR, and serum adenovirus PCR. Cardiac MRI pending.

Allergies: amoxicillin, penicillin

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

Symptoms: Fatigue, diffuse myalgias on day 1 after vaccination, progressing to chest pain on exertion the following day. He continues to have mild chest pain today (day 4)

Other Meds: None

Current Illness: None

ID: 1732048
Sex: F
Age: 84
State: MO

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error: Mixed series of mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1732049
Sex: M
Age: 87
State: MO

Vax Date: 03/26/2021
Onset Date: 08/04/2021
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: SARS-CoV-2 PCR positive 8/11/2021

Allergies: Norco

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

Symptoms: Patient was hospitalized 8/4/2021 with hypoglycemia, altered mental status and acute renal failure. On 8/11/2021, patient was cleared for discharge to nursing home. Routine SARS-CoV-2 PCR screen for clearance / admission to nursing home came back positive. No signs/symptoms of COVID-19; rather an incidental finding.

Other Meds: acetaminophen albuterol allopurinol apixaban aspirin atorvastatin carvedilol Coenzyme Q10 Cyanocobalamin escitalopram furosemide glimepiride insulin aspart, w/Niacinamide Insulin Glargine LORazepam melatonin metFORMIN metOLazone nitroG

Current Illness: none

ID: 1732050
Sex: F
Age: 78
State: GA

Vax Date: 08/26/2021
Onset Date: 08/29/2021
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: Took rapid COVID-19 test two days running after 3 days of reaction.

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Aches in all joints; diarrhea; nausea; shortness of breath. Absolutely no energy.

Other Meds: Synthroid

Current Illness: None

ID: 1732051
Sex: F
Age: 54
State: PA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
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: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: The same day around 10 pm that I received the shot I felt nerve loss in my face below my nose. 34 days later, I felt more nerve loss in my face around 3:15 pm same location as before. I went to the dr. the next week and she thought it would most likely go away. It has not. It has gotten worse. I now have an appointment with an oral surgeon and neurologist because of this vaccine I received.

Other Meds: Talz

Current Illness: None

ID: 1732052
Sex: F
Age: 34
State: MI

Vax Date: 09/02/2021
Onset Date: 09/16/2021
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: EKG, chest X-ray, full blood panel (9/18), thryoid and autoimmune screening (9/20).

Allergies: None

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

Symptoms: Tightness and pressure in chest from top of shoulder to lower rib cage. Isolated to left-side. Also dizziness and diarrhea. Tingling and numbness in left arm and leg.

Other Meds: Flonase

Current Illness: None

ID: 1732053
Sex: M
Age: 64
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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:

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: 1732054
Sex: F
Age: 45
State: WA

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: Dr diagnosed as shingles even though patient has never been exposed to chickenpox and has never had the vaccine. Blood work shows no antibodies for chickenpox tested in June 2021.

Allergies: Sulfa, iron, chloraprep, acetaminophen

Symptom List: Unevaluable event

Symptoms: Severe rash and blisters on roof of mouth and throat.

Other Meds: Tramadol, hydroxychloroquine, levothyroxine, B12 inj

Current Illness: None

ID: 1732055
Sex: M
Age: 64
State: MO

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

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

Other Meds:

Current Illness:

ID: 1732056
Sex: M
Age: 56
State: ID

Vax Date: 09/14/2021
Onset Date: 09/20/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: CXR, labs

Allergies: morphine, keflex, contrast, clonidine, ambien

Symptom List: Injection site pain, Pain

Symptoms: Shortness of breath, admitted and treated for acute on chronic HFrEF.

Other Meds: albuterol 90 mcg/actuation inhaler Inhale 2 puffs into the lungs every 4 (four) hours as needed for Wheezing. aspirin 81 MG EC tablet Take 1 tablet (81 mg total) by mouth Daily. atorvaSTATin 80 MG tablet Take 0.5 tablets (40 mg total) b

Current Illness: Admit 9/8/21 for dissecting VA aneurysm on the right which embolized to his PCA, and MRI findings of incomplete flow void is probably just a manifestation of retrograde flow to right VA. No radiographic evidence, nor s/s of acute ischemia. Additionally, the patient was noted to have reduced renal function, worse than his baseline, during this stay

ID: 1732057
Sex: M
Age: 74
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 1732058
Sex: F
Age: 50
State: NC

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: The patient received a second dose of the Johnson and Johnson and vaccine even though it isn't approved.

Other Meds:

Current Illness:

ID: 1732059
Sex: M
Age: 56
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 1732060
Sex: F
Age: 69
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1732061
Sex: F
Age: 50
State: OH

Vax Date: 12/29/2020
Onset Date: 12/30/2020
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: none

Allergies: PCN and keflex: hives

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

Symptoms: I am a physician. I am fairly certain that I had myositis. The day after my injection, I developed SEVERE muscle pain to the point I required assistance getting out of bed. It was mostly in the legs and arms. This lasted about 4 days. I am a regular runner. My endurance dramatically dropped (running 8 miles to being unable to run three miles without frequent stops. The second injection was similar, but I had more sever muscle pain and fever lasting about 1 week. My endurance took another dive. I developed muscle tremors whenever I held a contraction in my muscle. Even driving my car, my leg muscles would shake with my foot on the gas pedal for any length of time. This lasted about 3 months. My second shot was in January. It was not until July that I started to feel like my strength had returned.

Other Meds: Wellbutrin XL 300 mg a day Prozac 20 mg a day

Current Illness: none

ID: 1732062
Sex: F
Age: 83
State: MO

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: Nausea

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

Other Meds:

Current Illness:

ID: 1732063
Sex: F
Age: 52
State: IL

Vax Date: 03/03/2021
Onset Date: 08/25/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: Lung X-ray, Blood Oxygen Test, Covid.

Allergies: Penicillin; bees; oranges.

Symptom List: Injection site pain

Symptoms: About 3 AM I woke up and couldn't breathe. It was very difficult to breathe and I thought I was having an asthma attack so I took my rescue inhaler and it didn't work so I waited about 10 minutes and tried again and it still didn't work. I called my husband and he took me to the ER and they put me on 12 liters of oxygen because oxygen was down so low, and then they tested me for covid (negative) and they did an X-ray of lungs and said it was pneumonia, and they put me in a room and I stayed there for 5 days so my oxygen gradually came down and I was able to get off oxygen by the fifth day. During that time I had multiple breathing treatments (2x a day in hospital) and then I also got antibiotics and my regular medicine as well and then I was able to go completely off of the oxygen the 4th afternoon. They kept me for the 24 hours to evaluate and make sure everything was clear and I was able to get out the next day and then I was given instructions to follow up with my PCP which I did the next week and he diagnosed me with Bronchitis. He gave me Levaquin and put me on a steroid pack (meprednisone pack 4 mg) and codeine for the deep cough, and levofloxacin 500 mg (antibiotics) and so I finished that up and it took me awhile. I notice sometimes my chest is tighter than normal but that's it.

Other Meds: Adderall; levothyroxine; venlafaxine XR; alprazolam; albuterol nebulizer; montelukast; EpiPen; Symbicort; Diovan; sitagliptin; amitriptyline; escitalopram; bupropion SR; gabapentin

Current Illness: None.

ID: 1732064
Sex: M
Age: 59
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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 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: 1732065
Sex: F
Age: 27
State: CA

Vax Date: 09/24/2021
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: RA

Lab Data: n/a

Allergies: None

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

Symptoms: On Friday, September 24, 2021 patient came to vaccination POD for the second COVID-19 Pfizer dose. Upon arrival, the lead nurse was called to assess client as she stated she had an allergic reaction after her first Pfizer dose (batch/lot# EW0168) she received on August 29, 2021. After her first Pfizer dose, client stated she broke out in a itchy rash on her arms and legs the next day after vaccination that lasted for a day and would "come and go" for the next three weeks. Client denied going to MD and stated she took Zyrtec on days rash appeared that helped with the itchiness and redness. The lead nurse escalated to the vaccine operations leadership, who consulted with the county MD. Per county MD, administration approved. Advised client to get her second dose of Pfizer COVID-19 vaccine with 30-minute observation. Client vaccinated with COVID-19 Pfizer vaccine (batch/lot# FF8839), left arm, at 12:54 pm. Client was educated by lead nurse on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client also encouraged to sign-up on V-safe. Client experienced no adverse reaction while waiting in observation area and left vaccination site with a steady gait at 1:35 pm.

Other Meds: Zyrtec, Claritin

Current Illness: None

ID: 1732066
Sex: F
Age: 77
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 1732067
Sex: M
Age: 31
State: FL

Vax Date: 09/18/2021
Onset Date: 09/18/2021
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: Multiple EKGs came out normal taking blood pressure and heart rate came out abnormal

Allergies: Yes, food allergies almonds , cashews, coconut , kiwi. I?m allergic to latex

Symptom List: Erythema, Pruritus

Symptoms: Approximately a minute to three minutes I started having burning sensation in both arms and legs and next having ringing in my ears and started to get dizzy and feel like I?m going to pass out. Sat down became very pale and started sweating profusely. Approximately 15 to 20 minutes symptoms has decreased but felt very fatigue. Went to the fire department approximately 30 minutes after symptoms decrease and fire apartment was unable to clarify why I had these symptoms The following day 9/19/2021 when doing light activities I had chest pain 5/10 pain and shortness of breath and thought fatigue and lightheaded. Went to the fire apartment had slight elevation of blood pressure and heart rate. Three days 9/20/2021 I was on a stationary bicycle with light resistance I had chest pain and shortness of breath and felt dizzy and ringing in the ears blood pressure was 177/86. Went to the fire department the Fire department took my blood pressure it was 164/83 and heart rate was 112bpm. They EKG came out normal. Still having chest pains shortness of breath and fatigue with normal activities and with any slight exertion blood pressure goes up and increase chest pain. I have seen allergy doctor that recommended the Covid vaccine and he referred me to a cardiac doctor. ?Allergy doctor ?stated that I had a reaction and does not recommend me having second dose.

Other Meds: N/a

Current Illness: N/a

ID: 1732068
Sex: M
Age: 52
State: KS

Vax Date: 04/25/2021
Onset Date: 04/26/2021
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:

Allergies:

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

Symptoms: Student administered first shot as RN and then realized it had no vaccine in it/then administered second shot with actual vaccine in it. Student was working with RN who also did not report to floor supervisors or any management staff. Patient was in observation area and saw RN and questioned her about incident. RN then found other RN's and explained what had happened, Patient/son were concerned it had been a dirty needle and or wrong medication,

Other Meds:

Current Illness:

ID: 1732069
Sex: M
Age: 89
State:

Vax Date: 05/21/2021
Onset Date: 09/23/2021
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: LA

Lab Data:

Allergies:

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

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: 1732070
Sex: F
Age: 21
State: MA

Vax Date: 09/14/2021
Onset Date: 09/22/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Heart palpitations (22nd; midnight as well and 23rd). Felt quite dizzy (like fainting). Unsure if it's because of the vaccine.

Other Meds: Hair, Skin & Nail Vitamin; Lutein; Zeaxanthin

Current Illness:

ID: 1732071
Sex: F
Age: 67
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: 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: 1732072
Sex: M
Age: 64
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 1732073
Sex: M
Age: 72
State: MO

Vax Date: 02/26/2021
Onset Date: 08/08/2021
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: SARS-CoV-2 PCR test detected 8/8/2021

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: Patient presented with an syncopal episode. During admission, patient stated that he was feeling sick for the past few days with chills, nasal congestion, and generalized weakness. The patient was discharged in good health.

Other Meds: Acetaminophen, escitalopram, guaifenesin, insulin glargine, metformin, methylprednisolone, and Trulicity

Current Illness: None

ID: 1732074
Sex: F
Age: 74
State: WI

Vax Date: 04/29/2021
Onset Date: 09/22/2021
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: lovastatin - headache, myalgia pravastatin - myalgia tranexamic acid - Contraindication to

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

Symptoms: Patient contracted COVID after being fully vaccinated

Other Meds: acetaminophen 650mg q4hr PRN for pain acetaminophen 1000mg TID aspirin 81mg BID Vitamin D3 50,000 IU dicyclomine 20mg QID senna-docusate 9.6mg-50mg flecainide 100mg q12hrs metoprolol Tartrate 12.5mg omeprazole 20mg daily ondansetron 4mg q8h

Current Illness: None documented

ID: 1732075
Sex: M
Age: 28
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 1732076
Sex: M
Age: 47
State: MO

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: 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 of mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732078
Sex: F
Age: 49
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: 1732079
Sex: M
Age: 42
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: 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: 1732080
Sex: F
Age: 18
State: NC

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: None

Allergies: Unknown

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

Symptoms: Patient stated that she felt nauseated almost immediately after the injection followed by ringing in the ears and dizziness. Patient was scared and reported sweating and shaking. Patient was given diphenhydramine liquid to help with possible allergic reaction. Patient began to recover shortly after the diphenhydramine administered.

Other Meds: Unknown

Current Illness: Unknown

ID: 1732081
Sex: M
Age: 49
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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:

Symptom List: Injection site swelling, Limb discomfort

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

Other Meds:

Current Illness:

ID: 1732082
Sex: F
Age: 44
State: ID

Vax Date: 09/04/2021
Onset Date: 09/04/2021
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: CTA head and neck. Brain MRI. Echo. Labs.

Allergies: Benadryl, aspirin, PCN, gabapentin

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

Symptoms: The patient received her third Pfizer vaccination into her left deltoid at 9 AM on the day of admission. At 1 PM on the day of admission she was at work at when she developed left-sided weakness, facial droop, left-sided numbness, left-sided headache, blurry vision, gait instability, slurred speech, word searching. In the ED she was initially evaluated as a code stroke. The CT scanner was down at the time so she proceeded to a brain MRI/A brain. This was negative. She was admitted to the hospitalist service for ongoing evaluation. Neuro exam of the time of admission was inconsistent. Differential included conversion disorder versus migraine. She was eventually able to receive a CTA of the head neck which was negative. Echo is still pending at the time of discharge, although anticipate this will be unremarkable. On the day of discharge the patient has a residual headache but all of her other neurologic deficits have resolved. Ultimately, her symptomatology may be psychosomatic, although it may represent a hyper immune response given the third Covid vaccine dose she received 5 months after her second dose. She will discharge home with no new medications or changes.

Other Meds: acetaminophen 325 MG tablet; albuterol 90 mcg/actuation inhaler Inhale 2 puffs into the lungs every 6 (six) hours as needed for Wheezing; Bismuth subsalicylate 262 mg/15 mL suspension; clindamycin 1 % lotion Apply topically 2 (two) times d

Current Illness:

ID: 1732083
Sex: F
Age: 22
State: NM

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 09/24/2021
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: Xolair- causes unknown reaction Fasenra monoclonal antibody FDAP TB

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

Symptoms: Patient had an anaphylactic reaction to half-dose of the PFizer vaccine within 15 minutes of administration requiring Benadryl 50mg , Epinephrine 0.3mg, and solumedrol 125mg to be given in-facility. Patient then required transfer to another acute-care hospital for a 5 admission and administration of monoclonal antibodies.

Other Meds: Albuterol 90mcg inhaler: 2 puffs PRN Allegra 180mg tablet: 1 tablet daily Dupixent 200mg/1.14mL syringe: 1 unit PRN Metformin ER 500mg tablet: 1 tablet BID Pepcid 40mg tablet: 1 tablet daily Prednisone 20mg tablet: 3 tablets daily Zytrec 1

Current Illness: Non-insulin dependent diabetes mellitus, and eosinophilic mast cell activation

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am