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: 1732137
Sex: F
Age: 36
State: GA

Vax Date: 07/28/2021
Onset Date: 08/03/2021
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: About a week later I started to have spotting that I have not had previously before getting the vaccine. From August 6th to about a week ago I was having light spotting and sometimes the spotting would be heavier than others. I have never experienced that before after receiving my depo shot for birth control. When I went to the doctor she said it was a possible side effect from the depo shot. I had some fatigue when I was spotting for almost a month.

Other Meds: Depo shot (birth control); OTC Tylenol; Ibuprofen

Current Illness:

ID: 1732138
Sex: M
Age: 38
State: ND

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: none

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Vaccine was given on 9/22/21 and vaccine had expired on 9/21/21

Other Meds: Unknown

Current Illness: Unknown

ID: 1732139
Sex: M
Age: 37
State: MI

Vax Date: 09/01/2021
Onset Date: 09/12/2021
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:

Allergies: None

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

Symptoms: Heart pain , chest tightness , headache , joint pain , neck pain , shortness of breath .

Other Meds: None

Current Illness: None

ID: 1732140
Sex: M
Age: 94
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Don't know

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient was to be given Fluzone HD, but was given Pfizer Covid vaccine. Upon discovery of error, patient was informed of what had happened and patient opted to still receive Fluzone HD, which was then administered. Patient was instructed to stay for 15 minutes for observation, in which time, no adverse events occurred.

Other Meds: None

Current Illness: Don't know

ID: 1732141
Sex: M
Age: 47
State: CA

Vax Date: 06/01/2021
Onset Date: 07/05/2021
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: Comprehensive bloodwork; EKG; Chest X-Ray; Nuclear stress test (chemical); Follow-up stress test (treadmill).

Allergies: None

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

Symptoms: Complete loss of cardiovascular fitness approximately one month following second vaccination shot. Racing heart beat not corresponding to physical activity. Shortness of breath not corresponding to physical activity. Exhaustion.

Other Meds: None

Current Illness: None

ID: 1732142
Sex: M
Age: 49
State:

Vax Date: 09/23/2021
Onset Date: 09/23/2021
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:

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

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

Other Meds:

Current Illness:

ID: 1732143
Sex: F
Age: 48
State: SC

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: I have an appointment scheduled on Oct 7th to do labwork to determine the source

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: A few hours after the injection I had tingling and numbness in my left arm and hand. As the day progressed the tingling and numbness also started in my left leg and I had a pain in the left side of my head (above my temple area). I hoped that the next day these side effects would subside, but they have continued and I am now 4 days post injection.

Other Meds: none

Current Illness: none

ID: 1732144
Sex: M
Age: 12
State: WA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: Urgent Care

Allergies: None; sensitivity to dairy

Symptom List: Pharyngeal swelling

Symptoms: Nausea (feeling of needing to throw up); Blurred vision; High pitched ringing noise

Other Meds: Retinae for acne; multi vitamin

Current Illness: None

ID: 1732145
Sex: F
Age:
State: VA

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

Allergies: Aspirin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: It started with sore muscles. Over the next week it spread up to the top of my shoulder and neck. My neck was really really sore. My jaw and mandibular area were really sore too. It took at least 2 a half weeks to fade. My ears felt really awful, especially the right ear. Finally, all that muscle pain went again. My ear still feels really stuffy. I get ringing all the time. During the day it does not bother me so much but at night it does since everything is really quiet. Then my right hip started hurting really badly. It still flares up. I have some tendonitis in my right shoulder. I have a bunion in my right toe that has never bother me but now it is really red and swollen. I have been to the doctor for the ear and I am having an appointment with an audiologist. They have not done any medical tests yet but I think they are doing an x-ray of my hip soon. They did not prescribe any medications either.

Other Meds: Multi vitamin

Current Illness: None

ID: 1732146
Sex: M
Age: 68
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732147
Sex: M
Age: 69
State: MS

Vax Date: 07/21/2021
Onset Date: 07/24/2021
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: none

Allergies: none

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

Symptoms: onset with headache which resolved, then weakness, muscle pain/aches, tingling sensations, fatigue, loss of strength (feels like acute onset of arthritic like pains

Other Meds: Bystolic, Nexium, losartan, ibuprofen,

Current Illness: none

ID: 1732148
Sex: F
Age: 70
State:

Vax Date: 03/24/2021
Onset Date: 09/15/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Rashes, welts, itchiness over body. Looks like covid like rash.

Other Meds:

Current Illness:

ID: 1732149
Sex: M
Age: 49
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: 1732150
Sex: F
Age: 80
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: 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: 1732151
Sex: F
Age: 47
State: IN

Vax Date: 04/06/2021
Onset Date: 05/14/2021
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: None

Allergies: None that I know of

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

Symptoms: Abrupt stop of menstrual and immediate onset of menopause symptoms. Extreme repeated hot flashes, menstrual cycle stopped for four months.

Other Meds: Daily woman's vitamin

Current Illness: None

ID: 1732152
Sex: F
Age: 51
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: 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 mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1732153
Sex: F
Age: 45
State: NY

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

Allergies: Nka

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

Symptoms: Metallic taste in mouth within 20 minutes of receiving the vaccine

Other Meds: None

Current Illness: None

ID: 1732154
Sex: M
Age: 53
State:

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

Other Meds:

Current Illness:

ID: 1732155
Sex: F
Age: 84
State: WI

Vax Date: 02/16/2021
Onset Date: 09/21/2021
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: Penicillins - hives

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient contracted COVID after being fully vaccinated Cough, congestion, sore throat, runny nose

Other Meds: amlodipine 10mg daily Vitamin C 500mg daily aspirin 81mg daily benazepril 40mg daily Vitamin D3 3,000 units daily Chondroitin-glucosamine daily cyanocobalamin 1,000mcg daily doxazosin 4mg daily fluticasone nasal daily iron polysaccharide 15

Current Illness: 1.18.2021 Thyroid nodule

ID: 1732156
Sex: M
Age: 80
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: redness to bil arms

Other Meds:

Current Illness:

ID: 1732157
Sex: F
Age: 66
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: 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: 1732158
Sex: M
Age: 29
State: OK

Vax Date: 09/24/2021
Onset Date:
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: COVID vaccine 1st dose was given on 9/17/2021 and 2nd dose on 9/24/2021

Other Meds:

Current Illness:

ID: 1732159
Sex: M
Age: 47
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732160
Sex: F
Age: 70
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: 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: 1732161
Sex: M
Age: 35
State: IN

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: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: after vaccine at 1640, at 1643, member reported feeling sweaty and faint. b/p was 68/40 with a pulse of 78. noted skin was pale. Advised needed help from facility NP and RN. Transferred member to exam table, laid flat. at 1648 bp of 110/68 with pulse of 76. Provided apple juice and pb crackers. member admitted to not drinking much during last overnight shift, waking up and drinking an energy drink prior to arrival, no food since midnight night before. at 1653 bp of 124/82 pulse 78. Member stayed in center and was assessed every 5 minutes at 1700/1705/1710/1715. Left center at 1720, advised to get food/drink from area fast food to get sugar up. Emergency number was called at start of event, ambulance arrived, member refused transport to local ER.

Other Meds: none

Current Illness: none

ID: 1732162
Sex: F
Age: 76
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732163
Sex: F
Age: 24
State: KS

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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: Patient in observation. Said she felt flushed and light-headed. (Just a little bit light-headed). Took patient back to EMS room and gave her water and a snack. Patient says she had not eaten lunch as yet and felt better after eating.

Other Meds:

Current Illness:

ID: 1732164
Sex: F
Age: 66
State: OK

Vax Date: 01/19/2021
Onset Date: 08/01/2021
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: COVID-19 PCR test and rapid results test.

Allergies: No allergies, but some sensitivity to almonds, pomegranates

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: sore throat, fatigue, muscle aches, headache, nausea, low fever (less than 100); over-the-counter drugs, rest - returned to work after a negative COVID test

Other Meds: Clobetasol, Thyroxine, Advil, generic Zyrtec, famotidine, curcumin, Centrum daily vitamin, probiotic, Glucosamine, Biotin, vegan Omega 3,

Current Illness: I contracted COVID-19 approximately two months prior to vaccination.

ID: 1732165
Sex: M
Age: 83
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: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732166
Sex: M
Age: 55
State: WA

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: Penicillin, cephalexin

Symptom List: Nausea

Symptoms: Dizziness, nausea and periodic light ringing in my right ear.

Other Meds: Benazepril (lotensin)

Current Illness:

ID: 1732167
Sex: F
Age: 63
State: NV

Vax Date: 09/16/2021
Onset Date: 09/18/2021
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: 9/19/2021--echocardiogram. Results clear 9/19/2021--CT scan. Results clear. 9/21/2021--Chest ultrasound. Results unknown. I am still awaiting the spinal tap and the MRI with contrast.

Allergies: Honeybee stings and spinach.

Symptom List: Injection site pain

Symptoms: I got my second Pfizer vaccine on 9/16/2021. On 9/18/2021 at 5:00 PM, I suddenly felt like someone was sitting on top of my head, and it was the worst pain I have ever felt. The person I was talking to on the phone told me I was slurring my words, so I put them on hold and called my work supervisor. My supervisor sent me home early from work, because I couldn't even remember what I was saying to him as I was talking. I couldn't drive, so I called my son to pick me up and take me home. The next morning when I woke up, I still had the headache and felt dizzy and lightheaded. I called Ask a Nurse, and I was advised to go to an urgent care clinic with an MRI; I was also advised not to drive. My husband drove me to an urgent care clinic, but their MRI machine was down. My husband then drove me to Medical Center, where they did an echocardiogram and a CT scan of my brain and admitted me. My doctor told me that they were looking for a possible aneurysm and that I would need to undergo an MRI with contrast and a spinal tap. He also said that it would take 3-4 days to get all the necessary tests done, but since there is a hospital bed shortage and I am immunocompromised, I told him I preferred to do it on an outpatient basis. I then went home. On 9/23/2021, I saw a Dr. who referred me to a neurologist; I am still awaiting a call for an appointment with the neurologist. I still have the headache, but it isn't as severe as before, though it feels like there is something on the back of my head that I keep trying to brush away.

Other Meds: Vitamin D, COQ10 with quinol, aspirin, atorvastatin, famotidine, folic acid, levothyroxine, methotrexate, omeprazole, quetiapine fumarate, sucralfate, oxycodone-acetaminophen, prednisone.

Current Illness: None.

ID: 1732168
Sex: M
Age: 70
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: 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: 1732170
Sex: M
Age: 70
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: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732171
Sex: M
Age: 70
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: 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:

Date Died: 09/04/2021

ID: 1732172
Sex: M
Age: 66
State: OH

Vax Date: 06/30/2021
Onset Date: 08/29/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: 8/25/21 NP swab positive for SARS-CoV-2, negative for influenza A/B 8/28/21 Na 138, K+ 3.8, Cl 96, HCO3 34, BUN 20, Cr 4.0, WBC 4.26, Hgb11.4, Plt 164, CRP 57 CXR Mixed interstitial and airspace opacities, right greater than left primarily in the mid-to-lower lung zones and increased from 08/13/2021 chest radiograph. Moderate right pleural effusion, increased in volume

Allergies: ciprofloxacin hydralazine

Symptom List: Erythema, Pruritus

Symptoms: 8/25/21 Pt was seen by PCP office for cough and loss of taste. Was positive for SARS-CoV-2 8/29/21 He presented to the ED w/ worsening cough and SOB. RA pulse ox was 85%. He was admitted. Hospital course as below. Family did change his care to comfort care and the patient died on 9/4/21 Patient is a 66 year old male with a history of end-stage renal disease requiring hemodialysis, chronic systolic heart failure with LVEF 20%, chronic hypotension, anemia of chronic disease, secondary hyperparathyroidism, DVT who was admitted on August 28 for acute hypoxemic respiratory failure, Covid pneumonia, and fluid volume overload. Nephrology was consulted with management of hemodialysis while hospitalized. Infectious disease was consulted. He was started on IV steroids, IV remdesivir, and daily inflammatory markers. The patient experienced worsening hypoxemia and respiratory failure requiring high flow nasal cannula. He required escalating requirements on high flow nasal cannula and was transferred to the intensive care unit on 9/2/2021. Critical care was consulted for management. Palliative care was consulted for goals of care discussion with no changes in plan of care. On 9/3/2021, the patient deteriorated requiring endotracheal intubation and mechanical ventilation. He was placed in the prone position due to hypoxemia. He developed severe acidosis. Temporary HD catheter was placed. This evening, he had continued acidosis with increasing vasopressor requirements. The case was discussed with nephrology and he was started on CVVHD. There were complications with initiation of CVVHD as multiple filters clotted off after initiation. The patient developed progressive hypotension and shock requiring max dosing of norepinephrine, phenylephrine, vasopressin, epinephrine. He received a total of 6 A of sodium bicarb. The patient's deteriorating condition was discussed with his daughters. He was transitioned to a DNR CCA. The patient expired cessation of vital signs on 9/4/2021 at 1:10am. Discharge Diagnoses: Acute hypoxemic respiratory failure Covid pneumonia ESRD HD dependent Shock Systolic heart failure with LVEF 20% OSA on CPAP

Other Meds: acetaminophen 650mg QID albuterol MDI 2 puffs QID prn SOB ascorbic acid 1000mg daily ASA 81mg daily atorvastatin 20mg daily cat's claw daily folic acid/B complex daily guaifenesin as needed iron sucrose complex 50mg IVP weekly midodrine su

Current Illness: 8/18/21 Recurrent right pleural effusion

ID: 1732173
Sex: F
Age: 57
State: MO

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: Employee given expired flu vaccination. Expiration date of 06/30/21. No signs or symptoms reported thus far.

Other Meds:

Current Illness:

ID: 1732174
Sex: M
Age: 62
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732175
Sex: F
Age: 25
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: NONE

Allergies: NONE

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: THE JANSSEN COVID 19 VACCINE THAT WAS ADMINISTERED TO THIS PATIENT EXPIRED 2 DAYS BEFORE THE ADMINISTRATION DATE. THE BEYOND USE DATE WAS OMITTED ON THE LAST BOX CONTAINING THE VACCINE VIAL. I ASSUMED IT WAS STILL IN DATE WHEN I PULLED THE PRODUCT. EXPIRED VACCINE IS USUALLY NOT STORED IN THAT SPECIFIC REFRIGERATOR. I WAS THE ONLY PHARMACIST AND WE WERE BUSY. THAT SPECIFIC REFRIGERATOR WAS WHERE IN DATE CURRENT VACCINES ARE TYPICALLY STORED.

Other Meds: NOT KNOWN

Current Illness: NONE

ID: 1732176
Sex: M
Age: 36
State: OR

Vax Date: 09/15/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: duloxetine, metoprolol, verapamil

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

Symptoms: Patient's significant other brought him into the hospital because of severe headache and right-sided numbness. Patient had been feeling numb from the right mid forearm distally and from the lower third of the right leg distally since yesterday at 4:30pm. The numbness is described as constant, with no relieving factors, no exacerbating factors. He has waning and waxing episodes. He had difficulty walking because of losing balance today. He has had headache for 2 days, the headache is constant, better with the sumatriptan, exacerbated with loud noises, non-progressive, 10 out of 10 pain level when he came to the ED. Pressure and throbbing-like in nature and localized on the right side of the head. Patient's significant other states that yesterday at approx 5:30pm, she heard a thud sound in the kitchen and found patient lying on the floor responsive. Patient says they opened the refrigerator and then next thing they knew, they woke up lying on the floor. He has been having exertional dyspnea since yesterday. He has been feeling more warm than usual for 1 week but did not check his temperature at home. He has been having chills and shivers from time to time over the past week. He feels dizzy while standing up. He has generalized weakness. He lost 8 lbs unintentionally in the past month.

Other Meds: atorvastatin, cetirizine, vitamin D, pregabalin, sumatriptan, tramadol, Co-Q-10

Current Illness: n/a

ID: 1732177
Sex: F
Age: 29
State:

Vax Date: 08/01/2021
Onset Date: 08/04/2021
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: Woke up shivering uncontrollably for one hour. Wrapped self in blankets then woke up one hour later with night sweats. While awake in the middle of the night, when standing I became nauseous and light headed. The next day I was extremely exhausted and my whole body aches. Every move I made hurt and I had to leave work after 2 hours due to the inability to function at normal capacity secondary to pain and fatigue. Did not feel normal again until 7 PM the next day.

Other Meds:

Current Illness:

ID: 1732178
Sex: F
Age: 62
State: WY

Vax Date: 08/31/2021
Onset Date: 09/01/2021
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: X-ray normal

Allergies: Yes

Symptom List: Pain in extremity

Symptoms: I was extremely tired the first day. The next morning my kidneys were really hurting, especially my left one. It had been damaged in a previous surgery. It has been hurting since the vaccine quite a bit. I went to see my urologist yesterday and he said that if it continued more than a couple of weeks then he would like to do a CAT scan. They did not give me any medications. They did an x-ray on Wednesday, the day before I saw my doctor. The x-ray came back normal.

Other Meds: None

Current Illness: None

ID: 1732180
Sex: F
Age: 65
State: TN

Vax Date: 09/23/2021
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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: PATIENT REPORTS HAVING SWELLING, REDNESS, SORENESS AND SKIN BEING WARM TO THE TOUCH BENEATH THE INJECTION SITE 24 HOURS AFTER INJECTION. SHE ALSO REPORTED BEING FAITGUED AND EXPERIENCING MUSCLE PAIN. PATIENT WILL CONTINUE TO MONITOR REACTION AND SEEK IMMEDIATE MEDICAL HELP IF SYMPTOMS PERSIST OR WORSEN.

Other Meds:

Current Illness:

ID: 1732181
Sex: F
Age: 22
State: GA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
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, Echocardiogram

Allergies: NKDA

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

Symptoms: Pt had CP and shortness of breath , dizziness started 24hr after moderna #1, 2 weeks ago now. Treated with steroids x 2 weeks but still having pain. Worse when lying down - Acute idiopathic pericarditis - Primary

Other Meds: levonorgestrel(Mirena) IUD

Current Illness: unknown

ID: 1732182
Sex: F
Age: 30
State: VA

Vax Date: 09/03/2021
Onset Date: 09/06/2021
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: Foods: Chicken, Eggs, Wheat/Gluten, Soy Medications; Penicillin

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

Symptoms: Woke up early at around 7am feeling itchy, but there was no visible reaction such as rash or a hives or a rash. About 30 minutes later I was having issues taking deep breaths which led to difficulty breathing entirely. Got dressed in about 5 minutes and alerted my father that I needed to go to the hospital because of the breathing difficulty. We arrived at the hospital close to 8am where I was taken back within 2 minutes. Standard bloodwork was ran and I was given a prescription for diphenhydrAMINE 25mg CAP, FAMOTIDINE 40mg TAB, predniSONE 20mg TAB, and an Epipen; as they thought I was having an allergic reaction. Was discharged the same day at roughly 10:40 am

Other Meds:

Current Illness:

ID: 1732183
Sex: M
Age: 70
State: CA

Vax Date: 09/19/2021
Onset Date: 09/21/2021
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: diarea days 3,4 and 5 after injection

Other Meds:

Current Illness:

ID: 1732184
Sex: M
Age: 62
State: IA

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: none at this time

Allergies: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Nurse was administering Covid vaccines at the local Nursing home and their staff was taking this nurse to the residents to administer the vaccine and took this nurse to the wrong resident. Nurse administered the Covid vaccine to the resident and later that evening the Nursing home called our Administrator, and informed her of the incident, taking responsibility for the incident. They had completed all of the paperwork prior vaccines being given.

Other Meds: unknown

Current Illness: not currently ill at time of vaccination

ID: 1732185
Sex: F
Age: 61
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: 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:

Date Died: 09/02/2021

ID: 1732186
Sex: M
Age: 23
State: NC

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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: Paramedics stated he died of heart attack.

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom. That continued off and on all night. Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak. H e went back to bed. We checked on him around lunch time lying on his bed with his phone in his hand. He appeared to be trying to text. I checked on him a few minutes later and he had not moved. I checked and saw he wasn't breathing. At that time he had a heart beat. We called 911 and I started CPR and continued for approx 25 until paramedics arrived. They bagged him and used defibrillator but could not bring him back.

Other Meds: xyzal

Current Illness: none

ID: 1732187
Sex: M
Age: 13
State: CA

Vax Date: 08/25/2021
Onset Date: 09/11/2021
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: SARS-COV-2 (COVID-19) URINALYSIS URINE CULTURE URINALYSIS ELECTROLYTES (SODIUM, POTASSIUM, CHLORIDE, CARBON DIOXIDE) CREATININE BLOOD UREA NITROGEN (BUN) GLUCOSE BLOOD CULTURE EPSTEIN BARR VIRUS ANTIBODY PANEL WHITE BLOOD CELL DIFFERENTIAL ALBUMIN ASPARTATE AMINOTRANSFERASE CBC (COMPLETE BLOOD COUNT) WITH DIFFERENTIAL C-REACTIVE PROTEIN ERYTHROCYTE SEDIMENTATION RATE LIVER FUNCTION PANEL CALCIUM DIRECT BILIRUBIN THROAT CULTURE GROUP A STREPTOCOCCUS SCREEN

Allergies: sesame seeds

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

Symptoms: High Fever, mouth blisters, mouth sores, sore throat

Other Meds: none

Current Illness: none

ID: 1732188
Sex: M
Age: 59
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: 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