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: 1737410
Sex: F
Age: 34
State: TX

Vax Date: 08/19/2021
Onset Date: 08/30/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: obgyn and hcg level with ultrasounds 8/30 through 9/17

Allergies: Na

Symptom List: Dysphagia, Epiglottitis

Symptoms: Was in 1st trimester pregnant and began bleeding shortly after and ended up miscarrying approx 3 weeks later. Embryo stopped developing after shot

Other Meds: Viread 300mg

Current Illness: Na

ID: 1737411
Sex: F
Age: 72
State: WV

Vax Date: 02/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Since I had to crawl to the bathroom throughout the night, on March 13 two weeks later I experienced momentary extreme right knee pain and again could not put weight on that knee for about 36 hours. Xrays showed spurring in both knees. Spent 3 subsequent months in physical therapy.

Allergies: Highly sensitive to medications when taken so I rarely take medications

Symptom List: Anxiety, Dyspnoea

Symptoms: After the second vaccine:Severe total body pain for 4 hours beginning 8 hours after the second vaccine, weakness in the legs so severe that I could not stand, vomiting, nausea, diarrhea , chills, profuse sweating, heartache, total fatigue. After the first vaccine: extreme fatigue and two days after the first vaccine swollen glands for a two days. After about a week a felt back to normal after the second vaccine.

Other Meds: Vitamin D3 Centrum for women 50 and over Fish Oil capsule Zinc Garlic supplements

Current Illness: None

ID: 1737412
Sex: M
Age: 65
State: KY

Vax Date: 03/09/2021
Onset Date: 09/15/2021
Rec V Date: 09/27/2021
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: Covid positive house hold member

Other Meds:

Current Illness:

ID: 1737413
Sex: F
Age: 68
State: CA

Vax Date: 06/25/2021
Onset Date: 09/20/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: COVID test - Saturday - It wasn't the rapid. Negative result - medical center

Allergies: Codeine; Zolpidem; Citalopram; Diazepam; Epinephrine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Extreme Fatigue - I wasn't well; I couldn't do my normal activities; my neck bothered me and caused headaches. I have also experienced dizziness and a little nausea - it's an equilibrium thing as if I've been drinking. It gets kind of scary, like I'm going to drop. Because of the Cushings, I have, it may be causing my body to deal with more than I can. Worse of it 04:00 am last Monday - my headache was so bad I had to stand up. Any pressure on the neck exacerbates my headache. At 04:00 am I couldn't take it right away but a little later it was 101.7 degree fever -it would climb and break and for three days (had chills with it); and then it seemed like I was having Menopausal hot flashes where I don't feel feverish but just break out in a sweat. I'm doing that right now. (The worst days were up to the first 72 hours after 04:00 am). I am going to see an Orthopedic surgeon for necks (in case my symptoms are not from the vaccine) on October 5 (postponed to this because I have a fever) - this is for my neck and head. The headaches get scary - it seems like they get so bad. I had two years ago - a brain tumor removed - that's what Cushing can do. They removed it successfully - the endocrine system try to recover and the adrenals are fighting (so the dizziness and the faint is what might be happening in response to that). The headache and the neck - these symptoms have me highly suspicious. Last night, it was scary, it's as if I'm walking on a boat, like I've been drinking, my balance got so off and I got nauseous and my head is killing me and my bowels are loose and make me feel kind of sick on Thursday - and got Tested.

Other Meds: Vit D; Lutein; Excedrin Migraine tablets - maybe 1/2 of one five days a week

Current Illness: no

ID: 1737414
Sex: M
Age: 69
State: MN

Vax Date: 03/26/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Hospitalization weakness and shortness of breath.

Other Meds:

Current Illness:

ID: 1737415
Sex: F
Age: 67
State: NY

Vax Date: 04/30/2021
Onset Date: 05/05/2021
Rec V Date: 09/27/2021
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: Stress test. 8/24/2021. Echocardiogram 8/30/2021

Allergies:

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

Symptoms: Shortness of breath. Heaviness/ pressure in chest

Other Meds: Rosuvstatin, ramipril,aspirin

Current Illness:

ID: 1737416
Sex: F
Age: 69
State: TX

Vax Date: 09/21/2021
Onset Date: 09/23/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: CTPE.

Allergies: Erythromycin.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Large multiple pulmonary emboli with hypoxic respiratory failure.

Other Meds: Albuterol Sulfate HFA Inhalation. Flexeril Oral. Flonase Nasal. Lopressor Oral. MetFORMIN HCl Oral. Synthroid Oral. Zantac Oral. Zofran Oral.

Current Illness:

ID: 1737417
Sex: F
Age: 49
State: CA

Vax Date: 03/19/2021
Onset Date: 03/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: ultrasound, all kinds of tests to check if infection, miscarriage etc.

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: abnormal bleeding for 22 days.

Other Meds: none

Current Illness: none

ID: 1737418
Sex: M
Age: 77
State: CA

Vax Date: 09/24/2021
Onset Date: 09/26/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies: lithium

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: GI BLEED

Other Meds: Omeprazole Tablet Delayed Release 20 MG Give 1 tablet by mouth two times a day for Upper GI BLeed Pharmacy On Hold 9/26/2021 17:00 9/26/2021 Tums Tablet Chewable 500 MG (Calcium Carbonate Antacid) Give 2 tablet by mouth every 6 hours as

Current Illness: none

ID: 1737419
Sex: M
Age: 50
State: MD

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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Dose was given too early after the previous dose.

Other Meds: No

Current Illness:

ID: 1737420
Sex: F
Age: 41
State: ID

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: No medical test or lab reports related.

Allergies: No allergies.

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

Symptoms: I was unable to perform daily activities. I couldn't sleep and it was hard to move and walk as well. I also ran a fever of 100.08.

Other Meds: Yes I was taking 50mg tab of a med and 180mg of FEXOSONADINE.

Current Illness: No other illnesses.

ID: 1737421
Sex: F
Age: 27
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/27/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: EKG, blood work full panel. I did have low potassium, chest x-ray came back normal. COVID and a flu test both came back negative.

Allergies: Penicillin

Symptom List: Rash, Urticaria

Symptoms: I'm due November 22, I got my vaccine when I hit my 3rd trimester. I got tachycardia that afternoon it lasted 3 days, I got light headed and nauseated, I felt weak. I still been having chest pain on and off. They monitored me for an afternoon about 5 hours in labor and Delivery.

Other Meds: Metoprolol; prenatal vitamin; vitamin D; baby aspirin; antibiotic

Current Illness: Sinus infection

ID: 1737422
Sex: F
Age: 32
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: Moderna COVID-19 Vaccine EUA Patient received Moderna Vaccines on 1/8/2021 and 2/2/2021 at Allergy & Asthma. Patient presented to Vaccination Clinic - on 9/10/2021, and received a Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1737423
Sex: M
Age: 15
State: MN

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/27/2021
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: Gave Moderna to a child

Other Meds:

Current Illness:

ID: 1737424
Sex: M
Age: 0
State: TX

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: Patient broke out in hives.

Other Meds: Erythromycin Ointment

Current Illness: Conjunctivitis of left eye

ID: 1737425
Sex: F
Age: 12
State: NE

Vax Date: 08/31/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: Patient had a stroke on left cerebral stroke on 9/24/21. She is an otherwise healthy child and no existing cardiac, neurologic, or hematologic causes were identified during her hospitalization. She did have some hypercoagulation labs pending at time of discharge from the hospital.

Other Meds: none

Current Illness: upper respiratory infection- virus unknown

ID: 1737426
Sex: F
Age: 69
State: MA

Vax Date: 03/10/2021
Onset Date: 04/02/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 04/02/2021: COVID-positive test, CT chest found multifocal pneumonia

Allergies: NKDA

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

Symptoms: Patient admitted to hospital for altered mental status, was fully vaccinated for COVID. Course complicated by COVID+ multifocal pneumonia, profound metabolic acidosis, AKI, and a CT A/P , CVVH to HD. Patient was discharged to rehab.

Other Meds: albuterol, fluticasone inhaler, ibuprofen

Current Illness: unknown

ID: 1737427
Sex: F
Age: 59
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: 1737428
Sex: M
Age: 23
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: 1737429
Sex: M
Age: 68
State: KY

Vax Date: 03/17/2021
Onset Date: 09/16/2021
Rec V Date: 09/27/2021
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: Covid positive church contact

Other Meds:

Current Illness:

ID: 1737430
Sex: M
Age: 53
State: MN

Vax Date: 02/21/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital: Y

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: Hospitalization for trauma and COVID positive on screening

Other Meds:

Current Illness:

ID: 1737431
Sex: F
Age: 66
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Unevaluable event

Symptoms: pt sat down 10 minutes after shot. when she got up to talk to her husband she felt lightheaded and fainted. she was flat on the ground . after a few minutes she came to , opened her eyes, she was coherant , still lightheaded, headache and bump on her head . paramedicts took her to hospital

Other Meds: no

Current Illness: no

ID: 1737432
Sex: M
Age: 71
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: 1737433
Sex: F
Age: 49
State: CA

Vax Date: 09/20/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: not yet, scheduled on 10/1/2021 -- > ultrasound + OBGYN appointment

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: abnormal bleeding (my period was not due for another 12 days)

Other Meds: n/A

Current Illness: N/A

ID: 1737434
Sex: M
Age: 39
State: GA

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: 9/21 - Urgent Care

Allergies: Amoxicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Day 1 - 4:100-102.4 degree fever; Day 5 -10: Exaustion feeling, not feeling like self, back pain and felt like other systems were effected (possibly liver and kidneys); Day 6 - 7 - semen had very dark color, not normal; Day 11 - ear ache started; Day 13 - ear ache, face rash; Day 15 - went to doctor and said the vaccine caused shingles outbreak; Day 16 - brownish specks in semen, semen dark colored and not normal; Day 21 - still dealing with shingles outbreak and severe ear pain

Other Meds: N/A

Current Illness: N/A

ID: 1737435
Sex: F
Age: 69
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: 1737436
Sex: M
Age: 25
State: NC

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: Intense muscle pain in arms and legs still ongoing after 3 days, along with fatigue and joint pain.

Other Meds: Aderral Lamictal Bupropion Xanax Cymbalta

Current Illness: None

ID: 1737437
Sex: F
Age: 66
State: CA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 24 hours after receiving my Covid booster shot, I started to get large red itchy blotches on my left back starting near the back of the armpit area to the top of my tailbone. The next day I also noticed both my wrists had the same red itchy blotches. I took some over the counter antihistamine and used topical hydrocortisone cream. On day three, the red blotches and itchy skin appear to be clearing up.

Other Meds: Calcium, vitamin D+K

Current Illness: None

ID: 1737438
Sex: F
Age: 63
State: KY

Vax Date: 02/02/2021
Onset Date: 02/21/2021
Rec V Date: 09/27/2021
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: NA

Allergies: tetanus toxoid, TB skin test, iodine, sulfa, gentamycin, preservatives, bee stings, multiple trees

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

Symptoms: Approximately 5 hours after initial dosage began to have scratchy throat with constant clearing and closing feeling. ( same as with bee stings) immediately took 3- 25mg Benadryl, had epi pen on hand but didn't have to use. Went away within 30min-1 hour. Spoke with PCP but no visit necessary.

Other Meds: Benadryl nightly,

Current Illness: positive covid 12/28/2021

ID: 1737439
Sex: M
Age: 67
State: MN

Vax Date: 01/04/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Hospitalization being treated for anaphylaxis and covid screening positive.

Other Meds:

Current Illness:

ID: 1737441
Sex: F
Age: 64
State: IN

Vax Date: 01/06/2021
Onset Date: 01/06/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: Blood Tests to look for anemia, oxygen levels.

Allergies: Codeine; Bactrim; Peanuts; Corn; Melons; Seasonal allergies; I have to use laundry detergent that is all clear but I don't know what it is from the laundry detergent; I have to be careful with soaps as well because I get a rash.

Symptom List: Injection site pain

Symptoms: After the 2nd dose around 8 PM on 01/06/2021 I had some side effects that were expected like achiness and headache for a couple of days and also tiredness that lasted for 30 days. It was an extreme tiredness and most days I would come home early from work and just go to bed. I just felt very incredibly tired but not sleepy. My doctor said if it lasted more than a month than they would look to see if it was anything else. I also got a tremendous pain in arm where I got vaccine and that night I was drawing and doing some artwork and all of a sudden I got a horrible pain in left arm from fingertips to the shoulder and that's when everything else started. The next day the arm pain was gone.

Other Meds: Zyrtec D; Flonase; Tylenol every night.

Current Illness: None.

ID: 1737443
Sex: F
Age: 59
State: NY

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/27/2021
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: Levaquin, penicillin , bactrim

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

Symptoms: Headache, rash to arm , light headedness, mental fogginess - resolved with rest , Benadryl , tylenol

Other Meds:

Current Illness:

ID: 1737444
Sex: M
Age: 68
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: 1737445
Sex: F
Age: 65
State: AR

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 09/27/2021
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: My hair started to shed in June, and I am still occurring. I am still having hard time concentrating. I am still having brain fog. I am still having issues thinking and everything. I am seeing a neurologist this week. I feel like I am having static in my ear. It almost is like the noise from the TV.

Other Meds: abnodapin tusapene neurontin

Current Illness:

ID: 1737446
Sex: F
Age: 41
State: NY

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
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: aspirin, penicillin, morphine

Symptom List: Erythema, Pruritus

Symptoms: Her arm became swollen, her head hurts so bad til it is making her ear hurt, nausea and feel weak.

Other Meds: fetanell, docsozoane,

Current Illness: cancer

ID: 1737447
Sex: F
Age: 37
State: OR

Vax Date: 02/25/2021
Onset Date: 08/01/2021
Rec V Date: 09/27/2021
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: none

Allergies: NKA

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

Symptoms: Four months after I got my second shot, I was diagnosed with Shingles on my R forehead extending over the R eye and R temple

Other Meds: sertraline 75 mg po QD

Current Illness: None

ID: 1737448
Sex: M
Age: 50
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: 1737449
Sex: F
Age: 82
State: TX

Vax Date: 05/13/2021
Onset Date: 06/07/2021
Rec V Date: 09/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Pt has had multiple hospitalizations since event including rehabilitation and a stay in skilled nursing care, pt is now on home hospice.

Allergies: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient suffered a severe stroke 25 days post vaccination of dose 2 of moderna covid vaccination. Pt is now on hospice.

Other Meds: Synthroid

Current Illness: Hypothyroidism

ID: 1737450
Sex: F
Age: 49
State: AR

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 09/27/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: arm swelling, rash at site of injecion , treatment _ tylenol and cold compress

Other Meds: proair, flovent

Current Illness: copd

ID: 1737451
Sex: M
Age: 18
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: patient had a syncopal episode while sitting in chair, fell backward striking back of head on ground, pt. states he did not eat breakfast

Other Meds:

Current Illness:

ID: 1737452
Sex: F
Age: 35
State: NY

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/27/2021
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:

Symptom List: Pain in extremity

Symptoms: Within 15 minutes of receiving vaccine, c/o tingliing in right upper extremity. Hand strength equal, color pink and warm. Overall color pink, and denies any other symptom.

Other Meds: Unknown

Current Illness: NKA

ID: 1737453
Sex: F
Age: 63
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1737454
Sex: M
Age: 65
State: MA

Vax Date: 03/22/2021
Onset Date: 04/05/2021
Rec V Date: 09/27/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: COVID-19 positive date 4/5/21.

Allergies: Varencline and statins-hmg-coa reductase inhibitors

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

Symptoms: Patient was admitted on 4/5/21 and was fully vaccinated for COVID-19. During admission, patient was managed/treated for COPD and a COVID-19 infection. Patient was discharged from on 4/10/2021

Other Meds: Prescriptions prior to admission: acetaminophen albuterol amoldapine aspirin atorbastin advair duoneb levothyroxine omeprazole zoloft

Current Illness: History of COPD

ID: 1737455
Sex: F
Age: 22
State: WA

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: The patient felt like there was "hair in her throat". The patient stated that she feels this way when she has issues with allergies. This occurred around 20 minutes after vaccination. 25mg of Benadryl was administered orally. The patient was feeling good and released. She was instructed to take another 25mg of Benadryl at home in 4-6 hours if she needed. She was also instructed to tell provider about this reaction before receiving her second dose of the Pfizer vaccine.

Other Meds:

Current Illness:

ID: 1737456
Sex: M
Age: 69
State: TN

Vax Date: 09/27/2021
Onset Date: 09/24/2021
Rec V Date: 09/27/2021
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: There was an opened unlabeled vial of Moderna in the fridge. There had not been any mentions on the group chat of an open Moderna vial (as when we open each vial we let everyone in the chat know) . I grabbed the open vial along with an unopened vial of Moderna and proceeded to the Covid clinic. There were 7 doses of this vaccine given to patients. As of 9/27 we were off on our counts and now realize that the vial that was used on 9/24 to those 7 patients was an expired vial. The vial had originally been opened on 9/23 by RN. These 7 patients have been located and will be contacted once recommendations from agency are reviewed.

Other Meds:

Current Illness:

ID: 1737458
Sex: M
Age: 20
State: VA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/27/2021
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: unknown

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient stated that within 3 minutes he started to feel faint and his heart started racing. he started to sweat and passed out in floor. Gash on eyebrow

Other Meds: unknown

Current Illness: unknown

ID: 1737459
Sex: F
Age: 19
State: MN

Vax Date: 06/21/2021
Onset Date: 06/22/2021
Rec V Date: 09/27/2021
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: Bloodwork at primary care clinic. Primary care referred me to neurologist. EEG and MRI of brain both had normal results. Seeking appointment now with ENT.

Allergies: amoxicillin

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

Symptoms: Day after first vaccine, fainted. Periodic dizziness. Urgent care diagnosed vasovagal syncope. 2nd dose 7/12/21 Immediately after 2nd dose, dizziness, odd noises in ear, nystagmus, later Dr. determined it was vertigo. September 27 still experiencing vertigo multiple times per day.

Other Meds: citalopram 20mg

Current Illness: None

ID: 1737460
Sex: F
Age: 47
State: AZ

Vax Date: 02/16/2021
Onset Date: 02/25/2021
Rec V Date: 09/27/2021
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: No issues immediately after injection. A week later, injection site was red, hard/swollen, hot to touch and spreading. I do have photograph of the angry arm. Went to health center, she thought it was cellulitis, was prescribed antibiotics. Site was marked with a sharpie to monitor spread. Revisited health center a 3/2/21 for follow up, still warm to touch, but much better. On 3/8/21, did read the article on Delayed Large Local Reactions to mRNA-1273 by doctor, et al. With that research information, I was ready for the second shot (3/16/21). Once the injection site started to turn pink, I took Benedryl and did not have angry Moderna arm as the first injection. Much more soreness and fatigue the second time around though.

Other Meds:

Current Illness:

ID: 1737461
Sex: M
Age: 88
State: IL

Vax Date: 03/11/2021
Onset Date: 09/10/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: 9/10/21 COVID19: Positive 9/14/21 chest xray: Patchy airspace disease most consistent with COVID-19 pneumonia. 9/20/21 chest xray: No acute cardiopulmonary disease 9/23/21 US: Neg for DVT 9/23/21 CTA chest: Multifocal atypical pneumonia described above. Consider COVID-19.

Allergies: Simvastatin

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

Symptoms: diagnosed with COVID-19 on last Friday on September 10. His wife also has it. Was sent from home because of increasing tiredness, generalized weakness and confusion. Apparently, he was saturating only 89% on room air at home but here he is saturating in the upper 90s. The patient is quite hard of hearing and appears to be a poor historian. He denied any headache, dizziness, chest pain. Says occasionally cough but does not bring up any sputum. Denies any shortness of breath. No nausea, vomiting, or diarrhea. His lab work however shows a sodium of 112 with a baseline being around 132. His potassium was 3.2. Creatinine is normal at 1.1. The patient also history of hypothyroidism, but for some reason I do not see any Synthroid on his medication list and his TSH is slightly high at 4.77 and a free T4 is a pending as we speak. Chest x-ray shows some patchy right-sided opacity, possible COVID-19 related pneumonia and the patient was started on Rocephin and Zithromax and then the hospitalist service was called for admission. A nephrology consult was also obtained; and because the patient has a change in mental status with a sodium of 112 he has been started on 3% normal saline to be given 25 mL/h x10 hours only which is 250 mL, and we will do BMP and sodium q.4 hours. The etiology of his sudden and acute hyponatremia is unclear. Patient denies drinking large amounts of water and is on not on any new medications. I have stopped his hydrochlorothiazide for now also because he is hyponatremic. Will put him on seizure and fall precautions. On 9/24/24: Temp 102 - improving Most likely secondary to chronic prostatitis Procalcitonin 0.12, CRP 105 Flomax Keep Foley at discharge, Urology outpatient follow-up Blood Culture pending Urine culture no growth (was on antibiotic) Chest x-ray no new findings Was on ceftriaxone and azithromycin Antibiotic changed Zosyn and Levaquin Currently continuing Levaquin Occasional spikes can be secondary to chronic prostatitis needs long-term antibiotics. Discharged on 9/25/21

Other Meds: Amlodipine, aspirin, tylenol PM ES, hydrochlorothiazinde, ibuprofen PRN, lisinopril, metoprolol tartrate, multivitamin, saw palmetto

Current Illness:

ID: 1737462
Sex: M
Age: 62
State: CA

Vax Date: 09/21/2021
Onset Date: 09/25/2021
Rec V Date: 09/27/2021
Hospital: Y

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

Lab Data: Trop Echo Cardiac Cath

Allergies: n/a

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

Symptoms: Acute myocarditis vs stress induced cardiomyopathy 3 days after 3rd dose (booster dose) of Pfizer vaccine.

Other Meds: n/a

Current Illness: n/a

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am