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: 1735852
Sex: F
Age: 57
State: OR

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 09/26/2021
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: September 12 starting of shingles. Aching, pain in area, burning, needles where blisters forming. September 21 new case of shingles formed on top of and above already out break of shingles. Aching, pain, burning, needles on blisters. All on back of left back side thigh.

Other Meds: Pantoprazole 40mg, meloxicam 14mg, Atorvastatin 20mg,, what a day no iron women?s vitamin, D3 10mcg, B12, 500mcg, vitamin E 180 mg, Fluticasone Propionate /Salmeter Diskus Inhalalation Powder 250mcg

Current Illness: Throat and chest pain. When walking.

ID: 1735853
Sex: M
Age: 17
State: CA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
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: N/A

Symptom List: Anxiety, Dyspnoea

Symptoms: Client received first dose of COVID-19 pfizer vaccine in left deltoid at 3:22 PM. Vaccinator activated the plunger on the vanish point syringe which made an unusual clicking sound. When vaccinator withdrew syringe from client's arm, the actual vaccine fluid out of the client's arm. Vaccinator believed there was less than 50% of the dose still in the client's arm as a lot of the vaccine squirted out of the client's arm. Vaccinator alerted me of the situation as I was the co-lead of the site. I then notified our clinical care coordinator that gave the CDC guidance of revaccinating the client today if there was less than 50% of the first attempt administered. Client along with parents were notified of the situation and client was in agreement of revaccination.

Other Meds: N/A

Current Illness: N/A

ID: 1735854
Sex: M
Age: 4
State: FL

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/26/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: He had blood drawn, urine sample, MRI, and EEG

Allergies: Just seasonal allergies

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

Symptoms: My son had, DTAP, Polio, MMR, Flu, Varicella, He had a seizure later that evening and the following day. Spent 2 nights in the hospital and was monitored by EEG and had an MRI done.

Other Meds: Xyzal allergy

Current Illness: none

ID: 1735855
Sex: M
Age: 37
State: AZ

Vax Date: 09/17/2021
Onset Date: 09/21/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: Cat scan

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Grand Mal Seizure on 9/21/2021; 4 pm

Other Meds: None

Current Illness: None

ID: 1735856
Sex: F
Age: 46
State: OH

Vax Date: 09/17/2021
Onset Date: 09/20/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: CT head in ER Day 3; ENT visit Day 3; Blood work Day 4; Family Dr visit day 5

Allergies: None

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

Symptoms: Headache day 1; Swollen axillary lymph nodes and in neck near clavicle day 2; Severe nose bleed which required being transported to ER day 3; Severe nose bleed Day 7; Severe nose bleed Day 8; Rash on lift side of face and neck Day 4.

Other Meds: Metro gel

Current Illness: None

ID: 1735857
Sex: M
Age: 63
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735858
Sex: F
Age: 69
State: IL

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

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

Lab Data: unkown

Allergies: Codeine

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient fainted approximately less than 5 minutes after dose, Patient regained consciousness within 60 seconds and was taken by ambulance for observations. Patient stated nervousness with needles after event

Other Meds: N/A

Current Illness: Unkown

ID: 1735859
Sex: F
Age: 31
State: WV

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

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

Lab Data: X-rays at Emergency room, The patient is bruised, but no broken bones

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: Patient got 2nd Pfizer dose on 9-24-21 at 3:27pm Patient sat for 15 minutes in the waiting area and then got up to look around. We heard a loud crash and saw the glasses rack in the OTC area on the floor about 3:45pm. Tech and (tech) went out to pick it up and found the patient under it. She said she felt dizzy and grabbed on to the bar on the glasses rack and pulled it over on top of her. We evaluated the patient, called 911 and provided comfort measures including ice packs (the patient initially said she was very hot) then provided a pillow and blanket when the patient then said she felt cold from the floor. We were careful not to move her until the rescue squad arrived at 4:04 pm. One of the managers on the scene and she filled out code white paper work. The patient was very lucid and responsive and said she felt ok going to the hospital to get checked out.

Other Meds: NONE LISTED AND NONE ON FILE

Current Illness: NONE KNOWN AND NONE LISTED

ID: 1735860
Sex: F
Age: 77
State: CA

Vax Date: 02/18/2021
Onset Date: 02/25/2021
Rec V Date: 09/26/2021
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: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Awoke on 2/25/21 with a severe headache. It started in the back of my neck and went across my head. It lasted for 24 hours. Advil gave only slight relief. Since then I have continued to have headaches. I have had as many as 4 per week, now having one to two per week. I saw my doctor in June and was given Flexeril, Diclofenac , and I see a Physical Therapist. I recently saw a Neurologist who advised it was inflammation caused by the Covid vaccine

Other Meds: Fosomax Metropolol Low dose aspirin Iron Vitamin c

Current Illness: None

ID: 1735861
Sex: F
Age: 75
State: FL

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: 4/21/21 Audilogist Referred by by primary after reporting my tinnitus

Allergies: Penicillin, Sulfa, lidocaine with epi

Symptom List: Diarrhoea, Nasal congestion

Symptoms: This was my second dose. I was sleepy I laid down it felt as though I heard noise but I thought that it was a fever. I can't remember how long afterwards I began to hear noises sound like in my whole head. Went to my dr. She said it was tinnitus. Went to ear Dr He said my hearing was good. Its a constant noise, sometimes I can tune it out then sometimes I can't. But I never had tinnitus before. Its going on 9 months. I ran across this article. So I am reporting this. I do not know if related. Would like to know. Thanks

Other Meds: Vit.C, D3, Fish Oil, Asprin 81mg, centrim sliver multi vit. Calcium with vit. D. , Ginger and green tea, Allegra 180 mg. Prn, fluctuate nasal spray prn

Current Illness: Environmental allergies

ID: 1735862
Sex: F
Age: 46
State: WA

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

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

Lab Data:

Allergies: Cipr0, Amoxicillin, Diamox

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

Symptoms: general malaise 9/25/2021 a few hours after receiving the 2nd shot, starting at 4:00 am 9/26/2021 Fever of 101.4 lasting all day, lethargic, passed out most of the day. It is 4:00 at night now and I still have the fever. With the first shot, I went home and 15 minutes later passed out on the front porch and was not able to get up for 20 hours.

Other Meds: Acetyl-CH, Adaptacrine, Vitamin B-12, vit. D

Current Illness: N/A

ID: 1735863
Sex: F
Age: 93
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1735864
Sex: F
Age: 61
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735865
Sex: F
Age: 49
State: LA

Vax Date: 04/13/2021
Onset Date: 04/17/2021
Rec V Date: 09/26/2021
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: None

Allergies: None

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

Symptoms: Two significant side effects: 1. A break-through menstrual period starting 3-4 days after the second dose 2. Muscle soreness and weakness beginning the day after the second dose near the site of injection and lasting for 5 months In addition, I had severe general weakness, soreness, fever, and nausea for 30 hours, but this was not the reason for reporting.

Other Meds: None

Current Illness: None

Date Died: 07/31/2021

ID: 1735866
Sex: F
Age: 71
State: CA

Vax Date: 04/08/2021
Onset Date: 07/31/2021
Rec V Date: 09/26/2021
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: NKDA

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

Symptoms: Patient fell off edge of bed face forward; ambulance was called. They helped her up off the floor, then assisted her into a chair in the living room. Later that same evening, patient got up and walked into the bathroom to use the toilet. While sitting on the toilet, she fell forward and to the left hitting her head on the side of the bathtub that was positioned to the left of the toilet. Her husband asked if she was okay. She responded, "I hit my head", then she stopped talking and he went for help. Emergency workers attempted CPR, but were unable to recussitate.

Other Meds: gabapentin, vicodin, glipizide ER, xarelto, lisinopril, synthroid, atorvastatin, celecoxib, Vit D3, B12, CoQ10, Biotin, Glucosamine Hcl with MSM, Calium Citrate Magnesium and Zinc

Current Illness:

ID: 1735867
Sex: M
Age: 57
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735868
Sex: F
Age: 32
State: TN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/26/2021
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: second dose was given on day 21 instead of day 28

Other Meds:

Current Illness:

ID: 1735869
Sex: F
Age: 54
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735870
Sex: F
Age: 45
State: MA

Vax Date: 09/23/2021
Onset Date: 09/23/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: None.

Allergies: Too many food allergies to list individually. Include soybeans, peas, some stone fruits, some berries, and other foods.

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Developed a rash around 5.5 hours after receiving my influenza vaccine. Rash on lower left leg (near ankle and knee), lower right leg (4 spots between ankle and knee), right arm (forearm near wrist and upper arm near shoulder), and abdomen. Small injection site reaction on left arm and pain in left arm. Some locations of the rash were very itchy, others less so. Noticed the rash just before midnight but had been scratching for some time. Self-treated with 10mg of loratadine sometime after midnight. Rash had not gone away by 12:30pm and was concerned it might be hives. I have a history of being hospitalized due to anaphylaxis after accidental ingestion of soymilk so I self-transported by car to the nearest emergency department. PA who saw me recommended I take 2 Benadryl and go to sleep but return if things got worse. I purchased dye-free diphenhydramine capsules at Walgreens and took two 25mg capsules. Rash was gone by the time I woke up. Left arm was still sore.

Other Meds: amlodipine besylate montelukast sodium etonogestrel-ethinyl estradiol vaginal ring Breo Ellipta inhaler loratadine fluticasone proprionate nasal spray probiotics acacia fiber melatonin potassium vitamin D3

Current Illness: None.

ID: 1735871
Sex: M
Age: 57
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735872
Sex: M
Age: 54
State: UT

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 09/26/2021
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: Moderna COVID-19 Vaccine EUA. Aches, chills, fever, nausea, diarreah, numbness in fingertips, tingling or numbness in scalp.

Other Meds: Omeprazole, turmeric supplement, Nature Made TripleFlex Triple Strength + D3, multi-vitamin

Current Illness:

ID: 1735873
Sex: M
Age: 65
State:

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

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1735874
Sex: F
Age: 82
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735875
Sex: M
Age: 38
State: MA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Chills, feeling of being cold without relief

Other Meds: None

Current Illness: None

ID: 1735876
Sex: F
Age: 68
State:

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1735877
Sex: F
Age: 81
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735878
Sex: F
Age: 97
State: SC

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/26/2021
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: WBC was 12.0

Allergies: Cipro Sulfur drugs

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Approximately 7 pm I called Mother on phone and she was very incoherent . Nurse checked her vitals and said normal. I was afraid of a stroke so told them to call EMS. They took her to ER. Gave fluids, temp elevated.. kept her overnight as she was still confused. Sounded normal the next day but they admitted her for 2 more days as her temp was elevated and gave antibiotics. Drs thought reactions were from the Moderna booster shot.

Other Meds: BP meds Anxiety tab for sleeping Statin Aspirin

Current Illness: None

ID: 1735879
Sex: M
Age: 29
State: IA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: No medical tests

Allergies: No known allergy

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Immediately after vaccine reported dizziness, sweating, blurred vision, nausea, lump in throat, tingling in hands and arms. This lasted approximately 15 minutes. Provided with water and encouraged slow deep breaths. Ride was called for patient unable to drive home. The next day patient reported slight fever, fatigue, tingling in hands/arms. Also reported chills, muscle ache, joint pain. The patient reported that he slept for majority of next day. Also reported severe headache next day and felt pressure in the back of the head. Pt returned to pharmacy 1 week later and reported he was feeling better but still had some pressure/tingling in hands/arms, muscle pain/pressure, headache.

Other Meds: None

Current Illness: none

ID: 1735880
Sex: F
Age: 83
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735881
Sex: M
Age: 44
State: FL

Vax Date: 04/10/2021
Onset Date: 05/01/2021
Rec V Date: 09/26/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Nausea

Symptoms: Ringing in the ears.

Other Meds: None

Current Illness: None

ID: 1735882
Sex: F
Age: 66
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735883
Sex: F
Age: 69
State: NC

Vax Date: 08/22/2021
Onset Date: 08/24/2021
Rec V Date: 09/26/2021
Hospital: Y

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

Lab Data: MRI, blood work, hydration, Pain meds,

Allergies: Sulfa drugs

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

Symptoms: Intense headache, chills, very tired, dizzy, was hospitalized due to epic migraine caused by vaccine booster

Other Meds: Clonazepam, quetiapine, amitriptyline, Prozac, vitamin d3, B12, acetaminophen

Current Illness: None

ID: 1735884
Sex: M
Age: 56
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735885
Sex: F
Age: 33
State:

Vax Date: 09/02/2021
Onset Date: 09/06/2021
Rec V Date: 09/26/2021
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: N/A

Symptom List: Tremor

Symptoms: Chest pain Heat racing Headache Nausea Dizziness Abdominal discomfort Allergies Sweating Tired Forgetful

Other Meds: Cymbalta

Current Illness: N/A

ID: 1735886
Sex: M
Age: 51
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735887
Sex: U
Age: 56
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735888
Sex: M
Age: 27
State: WI

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/26/2021
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: No known allergies

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

Symptoms: Patient received 2nd dose of Pfizer vaccine 14 days after 1st dose instead of earliest possible day (day 17). Pt did not experience any adverse events from the vaccine after the dose that we are aware of.

Other Meds: Unknown

Current Illness: Unknown

ID: 1735889
Sex: M
Age: 60
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735890
Sex: F
Age: 51
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735891
Sex: M
Age: 67
State: AL

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/26/2021
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: None

Allergies: Slight problems with dairy, shellfish, & peanuts

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: 8/26/21 10:00 PM - tired 10:10 - Chills, go to bed 10:30 - 98.6 11:00 - 100.5 11:25 - 101.7 11:30 Chills stopped 8/27/21 12:00 AM - 102.7 1:30 - 102.3 4:15 - 101.1 Daytime ~100.8 sleeping most of the day 6:15 PM - 102.2 8/28/21 12:15 AM - 102.8 muscle and joint aching begins 3:15 100.9 7:30 100.3 8:15 liquid diarrhea 10:30 - 99.8 11:00 - 99.5 11:30 last episode of diarrhea 3:15 PM - 98.4 10:45 normal 97.7 temperature 8/29/21 Normal BM - all symptoms subsided

Other Meds: Nadolol 10mg @ 2/day Aspirin 83 @ 1/day Vitamin C 500 mg @ 2/day Vitamin D 2,000 iu @ 1/day Vitamin E 400 iu @ 1/day

Current Illness: None

ID: 1735892
Sex: M
Age: 72
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735893
Sex: M
Age: 21
State: NY

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 09/26/2021
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: Fever, slight delirium, body aches, muscle soreness, fatigue, mental fog

Other Meds:

Current Illness:

ID: 1735894
Sex: M
Age: 70
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/26/2021
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: 1735895
Sex: F
Age: 42
State: TN

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: NKA

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

Symptoms: 1st day: injection site soreness, arm soreness, headache 2nd day: severe arm, shoulder, and back soreness, fatigue 3rd day: left axillary lymph node swelling, right submandibular lymph node swelling, fatigue

Other Meds: LoLoEstrin Fe, Flonase, probiotic, vitamin C supplement

Current Illness: flu-like symptoms 14 days prior (tested negative for COVID twice during illness)

ID: 1735896
Sex: M
Age: 54
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735897
Sex: F
Age: 29
State: WI

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

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

Lab Data: None

Allergies: No Known Allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient received 2nd dose of Pfizer vaccine 14 days after 1st dose instead of the earliest possible day (day 17). No adverse reaction occurred that we are aware of.

Other Meds: Unknown

Current Illness: Unknown

ID: 1735898
Sex: U
Age: 81
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/26/2021
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: 1735899
Sex: M
Age: 82
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1735900
Sex: F
Age: 81
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1735901
Sex: F
Age: 50
State:

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