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: 1734524
Sex: F
Age: 38
State: MN

Vax Date: 08/18/2021
Onset Date: 08/27/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: Complement levels pending.

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient presented to ED on 8/28, 10 days after first immunization, with angioedema - right side tongue swelling and difficulty swallowing, itching on arm and buttock. Rash (hives) to abdomen, right arm, right hand, left buttock. Treated with benadryl, EpiPen, famotidine and dexamethasone. Patient symptoms resolved then she had her 2nd dose on 9/16 and presented on 9/25 with right lower lip swelling, abdominal swelling and finger swelling and itching. Treated with benadryl, famotidine, dexamethasone, and montelukast.

Other Meds: glimeperide, metformin, propranolol,

Current Illness: none

ID: 1734525
Sex: F
Age: 60
State: ID

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient reported hives the following day on trunk

Other Meds:

Current Illness:

ID: 1734526
Sex: F
Age: 59
State: MD

Vax Date: 06/13/2021
Onset Date: 08/10/2021
Rec V Date: 09/25/2021
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: Doppler on 8/26/2021 to rule out blood out the results were negative for blood clot. I saw my PCP again on 9/24/2021 to follow up on leg continues to be swollen and painful. Order was given for an X-ray left Knee & prescribed Methyiprednisolone 4 mg 21 tablets to be taken over 6 day period to reduce leg swelling and pain.

Allergies: Eggs disagree with me causes loose bowels

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

Symptoms: 1st Moderna shot given on 5/16/2021 left arm Lot number 036C21A and 2nd Moderna shot given 6/13/2021 in left arm Lot 023C21A; August 10, 2021 I woke up with left leg swelling. I saw my PCP on 8/25/2021 sent for Doppler to rule out blood out. Results were negative for blood clot. I saw my PCP again on 9/24/2021 in follow up orders given for X-ray left Knee & prescribed Methyiprednisolone 4 mg 21 tablets to be taken over 6 day period to reduce leg swelling and pain.

Other Meds: Amlodipine 10 mg x1 daily, Metformin HCL 850 MG x1 morning, Metformin HCL 850 mg x1 at bedtime; Losartan Potassium 50 mg x1 daily, Claritin 10 mg x1 daily, Aspirin 81 mg x1 daily, Iron 65 mg x1 daily, B12 1000 mg x1 daily, D3 2,000 IU x1 a

Current Illness: None

ID: 1734527
Sex: F
Age: 59
State: TX

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

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

Lab Data:

Allergies: Sulfa

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Immediate dizziness at the time of injection that lasted about 20 minutes. Extremely painful injection site with swelling (a lump), redness, and heat. Intermittent muscle pain rotating from thigh to calf, to arms, and so on. Slight headache could be muscle in neck. We are applying ice to the injection site.

Other Meds: None

Current Illness:

ID: 1734528
Sex: F
Age: 31
State: IL

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies: Azithromycin

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

Symptoms: Currently pregnant- 33 weeks 5 days Woke up in a rash all over my butt, armpits, under chest, groin. Most prevalent on my butt cheeks. Extremely itchy

Other Meds: Unisom, b6, vitamin d, lexapro

Current Illness: N/a

ID: 1734529
Sex: F
Age: 64
State: NJ

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 09/25/2021
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: Echocardiogram - 7/27/21: Results - OK, Nuclear Stress Test - 7/30/21 - Results - OK

Allergies: None known

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

Symptoms: Chest tightness and labored breathing, brain fog

Other Meds: Meloxicam 7.5mg, Baclofen 10 mg., Simvastatin 20 mg., Escitalopram 15 mg., Vitamin C 50 mg., Daily Vitamin

Current Illness: None

ID: 1734530
Sex: M
Age: 22
State: OR

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was administered an expired varicella vaccine. He was notified immediately, NP in office that day was notified immediately. Patient's questions were answered and plans to return to office for second dose of vaccines administered that day. He was advised that he may need a third dose of the vaccine.

Other Meds:

Current Illness:

ID: 1734531
Sex: M
Age: 37
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

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

Other Meds:

Current Illness:

ID: 1734532
Sex: F
Age: 60
State: CA

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

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

Lab Data:

Allergies: Acarbose Actifed Cephalexin Cilostazol Codeine Cortisone Depo-Medrol Diazepam Keflex Niacin Norco Precose Pseudoephedrine Bell Peppers Oranges Shellfish

Symptom List: Abdominal pain, Chills, Sleep disorder

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

Other Meds: Acetaminophen Acetaminophen Amiodarone HCl Amitriptyline HCl Aranesp (Billable) Aranesp (Billable) Ascorbic Acid Atorvastatin Calcium Auryxia Covid-19 Pfizer-BioNTech Addl dose Cyanocobalamin Cyclobenzaprine HCl Docusate Sodium Furosemide G

Current Illness:

ID: 1734533
Sex: F
Age: 67
State: WI

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: None as far as I know

Allergies: Sulfa drugs

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient experienced a slight fever relieved with medications, swelling and redness at the site, and soreness at the site of injection

Other Meds: Unknown

Current Illness: Unknown

ID: 1734534
Sex: M
Age: 43
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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 known

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

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

Other Meds: Acetaminophen Aranesp (Billable) Aspirin Calcitriol Covid-19 P

Current Illness:

ID: 1734535
Sex: M
Age: 65
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: None known

Symptom List: Rash, Urticaria

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

Other Meds: Acetaminophen Aranesp (Billable) Auryxia Calcitriol Covid-19 Pfizer-BioNTech Addl dose GlipiZIDE ER Heparin bolus Levothyroxine Sodium Metoprolol Succinate ER Normal Saline Oxygen Toujeo Vit B With C And FE

Current Illness:

ID: 1734536
Sex: M
Age: 52
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734537
Sex: F
Age: 53
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: None known

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

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

Other Meds: Acetaminophen Amiodarone HCl Amlodipine Besylate Atorvastatin Calcium Covid-19 Pfizer-BioNTech Addl dose Furosemide Heparin bolus Heparin hourly Isosorbide Mononitrate Levothyroxine Sodium Lidocaine Lisinopril Normal Saline Omeprazole Oxyge

Current Illness:

ID: 1734538
Sex: F
Age: 40
State:

Vax Date: 09/17/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: No

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

Symptoms: Migraine that lasted for four days starting on Sept 17th. Then Covid Arm - red itchy spot at shot location appeared on Sept 24th. Still have the

Other Meds: Synthroid

Current Illness: None

ID: 1734539
Sex: M
Age: 65
State: CA

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

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

Lab Data:

Allergies: None known

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

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

Other Meds: Acetaminophen Aranesp-Hold ASA Buff (Mag Carb-Al Glyc) Calcitriol Calcium Acetate Calcium Carbonate Antacid Covid-19 Pfizer-BioNTech Addl dose Dialyvite 800 Heparin bolus Normal Saline Oxygen Parsabiv Hold

Current Illness:

ID: 1734540
Sex: M
Age: 71
State: CA

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1734541
Sex: M
Age: 0
State:

Vax Date: 09/12/2021
Onset Date: 09/13/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: Head ultrasound.

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Mother of infant received 2nd dose of Pfizer 9/21. Mother actively breast feeding infant. 24 hours after mother receiving 2nd vaccination, infant had significant bradycardia (drop in heart rate), desaturation ( low oxygen in the blood causing infant to turn blue). Infant was a previous 31 weeker adjusted to 36 weeks and discharge was pending at time mother received 2nd vaccination. After the initial episode, infant required a feeding tube due to feeding difficulties and lethargy. Infant was monitored in NICU with continued episodes of feeding difficulties associated with choking, inability to coordinate suck/swallow/breath, and bradycardic events. Head ultrasound was completed to show multiple cysts/hematomas (blood clots) present on the brain that were not present prior to vaccination. Infant was transferred to higher level of care for neurological evaluation. Due to absence of hematomas prior to vaccination and no evidence of head trauma, and the known vaccination side effects of potential blood clots; this shall be considered an adverse event.

Other Meds: multivitamin

Current Illness:

ID: 1734542
Sex: M
Age: 55
State: CA

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

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

Lab Data:

Allergies: Ampicillin Gentamicin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

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

Other Meds: Acetaminophen Allopurinol Amlodipine Aranesp (Billable) Calcitriol Cinacalcet Hcl Covid-19 Pfizer-BioNTech Addl dose Ezetimibe Gabapentin Heparin bolus Heparin hourly Heparin Lock Heparin Lock Hydralazine HCL Keppra Levetiracetam LiquaCel S

Current Illness:

ID: 1734543
Sex: M
Age: 46
State: CA

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

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: None known

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

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

Other Meds: Acetaminophen Amlodipine Besylate-Valsartan

Current Illness:

ID: 1734544
Sex: F
Age: 75
State: TX

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 09/25/2021
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: Amoxicillin; gadolinium

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

Symptoms: Body aches headache tired dizzy

Other Meds: Multiple vitamin

Current Illness: None

ID: 1734545
Sex: M
Age: 72
State: CA

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

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

Lab Data:

Allergies: None known

Symptom List: Unevaluable event

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

Other Meds: Acetaminophen Amlodipine Besylate Aranesp (Billable) Aspirin

Current Illness:

ID: 1734546
Sex: M
Age: 68
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1734547
Sex: F
Age: 65
State: CA

Vax Date: 09/24/2021
Onset Date:
Rec V Date: 09/25/2021
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: Dilaudid Vancomycin

Symptom List: Injection site pain, Pain

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

Other Meds: Acetaminophen Aranesp (Billable) Aranesp (Billable) Aspir-81; Auryxia Calcitriol Colace Covid-19 Pfizer-BioNTech Addl dose Escitalopram Oxalate Furosemide Gabapentin Heparin bolus Insulin Glargine Insuli

Current Illness:

ID: 1734548
Sex: M
Age: 89
State: IL

Vax Date: 02/03/2021
Onset Date: 08/01/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: Creatinine level was 1.8 in December 2020 and went up to 2.53 in August 2021. Highest creatinine level was 2.99 on 9/16/2021. Now creatinine level is starting to come down, currently 2.46

Allergies: none

Symptom List: Injection site pain, Menorrhagia

Symptoms: Acute kidney injury diagnosed in August 2021, many tests were performed and Nephrologist has not been able to determine a cause for the AKI.

Other Meds: Lisinopril, calcium, vitamin D

Current Illness:

ID: 1734549
Sex: M
Age: 43
State: CA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: Feraheme

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

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

Other Meds: Aranesp (Billable) Aranesp (Billable) Aranesp (Billable)

Current Illness:

ID: 1734550
Sex: F
Age: 77
State: IL

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: None

Allergies: Molds, trees, animals, strawberries

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 7:00 pm: Sneezing, blowing nose frequently, cold and sweaty at the same time overnight, slight headache in morning, By 7:00 am, symptoms receded to nothing except loss of appetite.

Other Meds: Vitamin D, Tylenol

Current Illness: None

ID: 1734551
Sex: F
Age: 56
State: CO

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Was given at other facility

Other Meds: Multivitamins

Current Illness: None

ID: 1734552
Sex: F
Age: 44
State: IL

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: pencillian, sulfa

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

Symptoms: Rapid heart rate (140 - 165), full body hives

Other Meds: none

Current Illness: none

ID: 1734553
Sex: M
Age: 66
State: MD

Vax Date: 01/18/2021
Onset Date: 02/26/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: WBC = 16,000

Allergies: none

Symptom List: Nausea

Symptoms: ELEVATED WBCs, brown spots on body, red eyes, WBCs attacked my eyes. continue to see eye doctor for chronic uveitis, WBCs in the eyes, edema in the eyes eye drops combigan, prednisone, atropine, bromsite

Other Meds: amlodipine/benazepril, gabapentin, metformin hcl er, lipitor, multivitamins, vidtamin d,

Current Illness: diabetes 2, GERD, hypertension, anemia, hyperlipemia, alphathallesemia

ID: 1734554
Sex: F
Age: 56
State:

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734555
Sex: M
Age: 46
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734556
Sex: F
Age: 63
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734557
Sex: F
Age: 43
State: AZ

Vax Date: 09/01/2021
Onset Date: 09/11/2021
Rec V Date: 09/25/2021
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: Macrobid, Clavulanic acid

Symptom List: Tremor

Symptoms: Raised maculopapular rash, burning, plaques starting on upper extremities, eventually spreading to the legs, then to the trunk. Plaques eventually coalesced together forming larger plaques and raised macules. Started on the inner arms, then was noted on the outer thighs, which spread to the buttock, then up the back. As plaques began to heal, new raised papules and plaques would surface in other areas of the body. Plaques and raised papules caused Itching, burning, bleeding, which caused scratching so bad there was bruising and bleeding noted around the affected areas. Resolved with time, 14 days, and antihistamine as needed.

Other Meds: None

Current Illness: None

ID: 1734558
Sex: F
Age: 50
State: NC

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: None

Allergies: No

Symptom List: Erythema, Pruritus

Symptoms: Lose of use in left arm Rash since the injection Severe neck pain Loss of sleep

Other Meds: None

Current Illness: Budd-Chirari Syndrome

ID: 1734559
Sex: F
Age: 71
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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 mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734560
Sex: M
Age: 49
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734561
Sex: M
Age: 67
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734562
Sex: M
Age: 20
State: IN

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
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: N/A

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

Symptoms: fatigue, extreme weakness, migraine, nausea

Other Meds: N/A

Current Illness: N/A

ID: 1734563
Sex: M
Age: 58
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734564
Sex: F
Age: 68
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734565
Sex: F
Age: 51
State: DE

Vax Date: 09/21/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
Hospital:

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

Lab Data: Took a rapid COVID-19 nasal swab which was negative.

Allergies: None

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

Symptoms: Received flu shot mid-morning 9/21, woke morning 9/23 with tension-like headache, vertigo/seasick type of feeling, nausea and vomiting which lasted majority of the day. Symptoms resolved by next morning.

Other Meds: Irbesarten 300mg Daily - I take in the evening.

Current Illness: None

ID: 1734566
Sex: M
Age: 68
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734567
Sex: M
Age: 50
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734568
Sex: F
Age: 85
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734569
Sex: M
Age: 52
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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: 1734570
Sex: M
Age: 62
State:

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1734571
Sex: F
Age: 62
State: CT

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 09/25/2021
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: Basic Metabolic panel 9/23/21 CBC auto differential 9/23/21 Hepatic function panel 9/23/21 Lipase 9/23/21 all tests in normal range

Allergies: Clarimithomycin Effexor epinephrine cortisone

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Awoke am after vaccination with fever, extreme body aches and nausea. Took tylenol/advil every 4-5 hours but fever kept climbing to 103.4 by 4 pm on 9/23/21. Extreme nausea with dry heaves as unable to eat or drink at that point. Dr. advised me to go to ER for treatment. Spent 4+ hours in ER and was given IV fluids, toradol via IV, and Zofran via IV. Today is 9/25 (3 days after injection) and still running a low grade fever of 99 (my normal body temp is 97.5) and feeling unwell. Also have LARGE red, hot and very swollen area on arm where injection was given which has grown in size since yesterday.

Other Meds: metoprolol 25 mg pantaprazole 40mg low dose aspirin zyrtec amitriptyline 10 mg

Current Illness: none

ID: 1734572
Sex: F
Age: 27
State: OH

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

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

Lab Data: N/A

Allergies: Reglan

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

Symptoms: Fever around 100.1 Body aches/chills Nausea and vomiting Headache Left arm achy after injection.

Other Meds: Buspirone Sertraline Seroquel Hydroxine Lamictal

Current Illness: Upper respiratory infection

ID: 1734573
Sex: M
Age: 30
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/25/2021
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