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: 1732343
Sex: F
Age: 42
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: 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: 1732344
Sex: M
Age: 63
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1732345
Sex: M
Age: 69
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1732346
Sex: F
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: 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: 1732347
Sex: M
Age: 61
State: FL

Vax Date: 03/15/2021
Onset Date: 03/15/2021
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: IV; EKG; Blood work.

Allergies: Sulfa; Morphine; Emeril; Vicodin; Prednisone; Victoza; Ciprofloxacin.

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

Symptoms: When I got vaccinated with the 2nd dose at first I was in the normal waiting area, but then they put in the area for people who are known to have an allergic reaction because I told them I had a reaction from the 1st dose. The area was right beside the nursing unit just in case they had to get to me quickly. Shortly after getting the vaccine in the first 15 minutes I started developing dizziness, extreme light headiness, anxiety, shortness of breath, and it was hard for me to balance myself and stay alert. The lady next to me was concerned so she called for a nurse. I had explained to them what was going on and that I was having an allergic type reaction. After that, they then put me into a private room. They didn't give me oxygen until the EMTs arrived. I laid on an examination table until the EMTs came. My blood pressure was high and I couldn't focus very well because my eyesight turned bad even though I was wearing my glasses. When I arrived at the ER, I was put on oxygen. I was put in an observation area for people with cardiac issues. The cardiology team examined me. They said it wasn't an anaphylactic reaction but it was an allergic reaction. They ruled out that I didn't have a stroke or heart attack. They said it could have possibly been from one of the preservative's from the vaccine that caused the reaction but they are not sure. A little over 24 hours I was discharged. It was a frightening and fearful situation. I have never had a reaction as severe like this before.

Other Meds: Metformin; Lisinopril; Amlodipine; Lantus; Benadryl; Vitamins; Antihistamine.

Current Illness:

Date Died: 09/18/2021

ID: 1732348
Sex: F
Age: 83
State: MO

Vax Date: 01/25/2021
Onset Date: 09/16/2021
Rec V Date: 09/24/2021
Hospital: Y

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: unknown

Allergies: unknown

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

Symptoms: unknown

Other Meds: unknown

Current Illness: unknown

ID: 1732349
Sex: M
Age: 63
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

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

Other Meds:

Current Illness:

ID: 1732350
Sex: M
Age: 56
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: 1732351
Sex: F
Age: 42
State: IL

Vax Date: 04/19/2021
Onset Date: 09/23/2021
Rec V Date: 09/24/2021
Hospital: Y

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

Lab Data: 9/24/21 Chest x-ray and CT of abdomen and Pelvis 9/24/21 C Reactive Protein; CBC; Comprehensive Metabolic Panel; Creatinine Clearance; Glucose POC; Hemoglobin A1c; Lipid Panel; Magnesium Level; Lipid Panel; Phosphorus Level; Procalcitonin; 9/23/21 Rapid Coronavirus Molecular; Lipase Level;

Allergies: Medtronidazole; Vancomycin; Lactose; Metformin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Admitted to the hospital with vomiting and abdominal discomfort. Has a minimal cough. Also has generalized weakness, malaise and fatigue. Treatment: Supportive care, no O2 at this time. Continuous pulse oximetry.

Other Meds:

Current Illness: Diabetes; ESRD;

ID: 1732352
Sex: F
Age: 78
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: 1732353
Sex: M
Age: 51
State:

Vax Date: 09/13/2021
Onset Date: 09/19/2021
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: Apples, Cherries

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

Symptoms: Shortness of breath, tightening of chest, irregular heartbeat

Other Meds: none

Current Illness: none

ID: 1732354
Sex: F
Age: 72
State: MT

Vax Date: 08/16/2021
Onset Date: 08/18/2021
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: None

Allergies: Sulfonamides, cumin

Symptom List: Rash, Urticaria

Symptoms: Two days after the vaccine, I had an outbreak of shingles. It was in the same location as previous outbreaks (dermatome T3 or T4, right side), and no worse than usual, but the timing was suspicious.

Other Meds: OTC Wal-ACT (allergies)

Current Illness: None

ID: 1732356
Sex: M
Age: 70
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: 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: 1732357
Sex: M
Age: 49
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: 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 of mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732358
Sex: M
Age: 73
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: 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: 1732359
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: 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: 1732360
Sex: F
Age: 30
State: CA

Vax Date: 08/19/2021
Onset Date: 08/01/2021
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: D-dimer on 8/28/21 came back as unlikely for blood clots but showed inflammation Home Pregnancy Test on 9/20/21 showed negative

Allergies: dairy

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

Symptoms: 8/19/21-8/22/21Headache, fever, chills, body aches, vertigo 8/28/21-8/30/21 Leg muscle Spasms, inflammation 9/9/21-9/24/2021 Missed Period (14 days late and counting) my cycle is usually regular I track it on an app..

Other Meds: ParaGard IUD (non-hormonal)

Current Illness: cold symptoms earlier in the month

ID: 1732361
Sex: M
Age: 50
State: UT

Vax Date: 03/08/2021
Onset Date: 03/09/2021
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: I haven't done any. I didn't know how to report it

Allergies: Milk allergy, gluten sensitivity

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fatigue, all over muscle stiffness and soreness. Before the shot I jogged and walked 7 miles. Now i can't even go a block. Or 1/4 of a block.

Other Meds: Depakote, atorvastatin, krill oil

Current Illness: None

ID: 1732362
Sex: M
Age: 63
State:

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: 1732363
Sex: F
Age: 66
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1732364
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: 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: 1732365
Sex: F
Age: 21
State: ID

Vax Date: 05/07/2021
Onset Date: 05/10/2021
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: Ultrasound, September 15th 2021.

Allergies: Sulfate Wheat Dairy

Symptom List: Unevaluable event

Symptoms: 103 fever day following shot, sick for 2 days after that. 3rd day severe abdominal pain, threw up bile, diarrhea, effects lasted 7 hours, then it was mild stomach pain for a few days. No treatment. August 13 had another episode of severe abdominal pain, throwing up bile, diarrhea, and effects lasted 7 hours with mild stomach pain for a few days. Went to an urgent care, but they wouldn?t see me and said I needed to go to the ER. By the time we got to the ER the pain had subsided (it had been 7 hours) and just went home instead. September 15th had another episode with the same symptoms again lasting 7 hours. Went to doctor but she was unable to give a diagnosis and does not know what the issue might be. While there I had an ultrasound done on my gall bladder, intestines, and pancreas, but everything looked normal.

Other Meds: None

Current Illness: No

ID: 1732366
Sex: F
Age: 52
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

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

Other Meds:

Current Illness:

ID: 1732367
Sex: F
Age: 45
State: TN

Vax Date: 09/09/2021
Onset Date: 09/01/2021
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: Blood pressure exam but unsure of date

Allergies: b-12, iodine, vicodin, sulfa

Symptom List: Injection site pain, Pain

Symptoms: Patient has reported petechiae rash on right arm from administration side to roughly elbow. Patient has also reported newly elevated blood pressure. Currently being treated with prednisone, benadryl, and lisinopril

Other Meds: Propranolol

Current Illness: None

ID: 1732368
Sex: M
Age: 44
State: KS

Vax Date: 05/24/2021
Onset Date: 05/24/2021
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: Patient has history of passing out with needles. Taken to EMS room. Administered vaccine. Patient became very nervous, sweating and feeling nauseated. Assisted to cot. Cold pack applied to back of neck and started talking to distract patient which helped. Feeling better at 1800. He sat up for a few minutes and was feeling much better and was ready to go home. AT 1808 Stood up and walked out.

Other Meds:

Current Illness:

ID: 1732369
Sex: F
Age: 86
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: 1732370
Sex: M
Age: 67
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: 1732371
Sex: F
Age: 73
State: NM

Vax Date: 02/24/2021
Onset Date: 08/11/2021
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: RA

Lab Data: (8/11/2021) Blood Test, MRI, CAT scans

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: (8/11/2021) Mini Stroke, had numb arm and could not verbalize. ER visit and was given MRI & CAT scans. Removed Plavix and issued Lipitor, advised to wait a week before taking aspirin. Cleared by that evening but was kept for observation. Also, memory issues lasted about a week.

Other Meds: Gabapentin, Omeprazole, Lisinopril, Pramipexol, Calcium w/D3, Chamomile

Current Illness: none

ID: 1732372
Sex: M
Age: 57
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: 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: 1732373
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

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

Other Meds:

Current Illness:

ID: 1732374
Sex: M
Age: 64
State: NJ

Vax Date: 09/22/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: n/a

Allergies: sulfa

Symptom List: Injection site pain

Symptoms: this afternoon, began to "itch" discovered rash... like shingles ... below waste line / stomach

Other Meds: B-12; Multiple Vitamin ; Niaoin ; ThyroAdvance; iron ; Vitamin C ; glucosamine with mSM ; ecotrin; nexium

Current Illness: none

ID: 1732375
Sex: F
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: 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: 1732376
Sex: F
Age: 74
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: 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 of mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732377
Sex: M
Age: 61
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: 1732378
Sex: F
Age: 48
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

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

Other Meds:

Current Illness:

ID: 1732379
Sex: F
Age: 51
State: MO

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

Other Meds:

Current Illness:

ID: 1732380
Sex: F
Age: 79
State: KS

Vax Date: 05/06/2021
Onset Date: 05/06/2021
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: Patient felt nauseated after receiving vaccine. Took patient to EMS room for observation during 30 minute wait.

Other Meds:

Current Illness:

ID: 1732381
Sex: M
Age: 61
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: Asthenia, Chills, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1732382
Sex: F
Age: 60
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: 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: 1732383
Sex: M
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: 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 of mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1732384
Sex: F
Age: 66
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: Pain in extremity

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

Other Meds:

Current Illness:

ID: 1732385
Sex: F
Age: 54
State: NC

Vax Date: 01/07/2021
Onset Date: 01/14/2021
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: NA

Allergies: NKDA

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

Symptoms: worsened psoriatic arthritis joint pain which did improve over time but flared again after 2nd vaccine and 3rd booster injection. Has not completely resolved

Other Meds: Xanax 0.5 mg tablet ( Take 1 tablet(s) by oral route , 1 time per day , for 30 days ) losartan 50 mg-hydrochlorothiazide 12.5 mg tablet Humira rosuvastatin 10 mg tablet milk thistle; Fish oil; Co-enzyme Q10; Fiber; Vitamin D; Zinc

Current Illness:

ID: 1732386
Sex: F
Age: 66
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: 1732387
Sex: F
Age: 82
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: 1732388
Sex: M
Age: 59
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

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

Other Meds:

Current Illness:

ID: 1732389
Sex: M
Age: 58
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1732390
Sex: F
Age: 78
State: MD

Vax Date: 03/25/2021
Onset Date: 08/25/2021
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: GI endoscopy and cholenoscopy 2 cm polyp. 08/19/2021 Flu vaccination at pharmacy.

Allergies: Contact Cold medication; PYRIDIUM

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

Symptoms: Joint pain with history of arthritis and degenerative back issue; new health problems with interjection and chest pain with GI. H Pylori infection which Clarithromycin 500mg twice a day/Amoxicillin 500mg twice daily. Cholenoscopy 2 cm polyp/ stain results was rare organism. GI issue was negative issue intergestion and chest pain located on the left side radiant her cardiac enzymes levels with heart test and cardio blockage. 08/19/2021 Flu vaccination at pharmacy.

Other Meds: Simvastatin; SYNTHROID; Indomethacin; hydrologien; amlodipine; potassium chloride; allopurinol; RESTASIS; ANORO ELLIPTA

Current Illness: No

ID: 1732391
Sex: F
Age: 83
State:

Vax Date: 04/08/2021
Onset Date: 04/08/2021
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: IM
Vax Site: LA

Lab Data: Cat scan/MRI for patient's head during second hospital stay after July 4.

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: immediate adverse events: dizziness, nausea, panic, stuttering, sweating, shaking, loss of muscular control continued adverse events: blurry vision, vertigo, continued to stutter, hallucinations, confusion, memory loss, worsening of peripheral neuropathy The above events cause the patient to fall and break a hip. Upon return from the hospital and continuing adverse events, another fall occurred and patient broke the other hip. The first time at the hospital, the staff stated she was diagnosed with pneumonia, whereas she had no symptoms previously of even being ill. Consequently, she remained in the hospital for 3 days in excruciating pain before they would operate while they put the patient on antibiotics.

Other Meds: Amlodipine, Recovery, vitamin C

Current Illness: None

ID: 1732392
Sex: M
Age: 50
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

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

Other Meds:

Current Illness:

ID: 1732393
Sex: F
Age: 50
State: KS

Vax Date: 04/15/2021
Onset Date: 04/15/2021
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: Patient received 2nd dose of vaccine . Waited approximately 15 minutes in observation. Started driving home and felt dizzy. Developed rash on chest. Patient drove back to health department to be seen. Patient stayed in EMS room for approximately 15 minutes. Drank water and had an ice pack on neck. Patient stated she felt better and no longer dizzy.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am