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: 1740991
Sex: M
Age: 54
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

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

Other Meds:

Current Illness:

ID: 1740992
Sex: F
Age: 52
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1740993
Sex: F
Age: 76
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1740994
Sex: F
Age: 70
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

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

Other Meds:

Current Illness:

ID: 1740995
Sex: M
Age: 56
State: NJ

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: tx Medrol dose pack from 9/22/2021 to 9/27/21 Blood work indicated elevated ESR =52 and cRP=21.5.

Allergies: Contrast Dye Shellfish

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

Symptoms: Fatigue, low grade fever, Malalgia surrounding back, shoulder, elbows, hands, knees, hips and feet, arthralgia, severe am stiffness, difficulty straightening arms and raising arms, difficulty walking, abrupt response to Medrol dose pack 2-3 days after taking pain 80--90% improved. Currently symptoms persist, worse in am and when sleeping prior to steroids unable to sleep due to unretractable sholder and elbow pain.

Other Meds: Baby ASA Claritan Crestor 5 mf Tribenzor 40/10/25

Current Illness: HTN CRI S/P Left Adrenalectomy secondary to Aldosteroadoma

ID: 1740996
Sex: F
Age: 79
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: 1740997
Sex: M
Age: 79
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

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

Other Meds:

Current Illness:

ID: 1740999
Sex: M
Age: 56
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741000
Sex: F
Age: 82
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Abdominal pain, Chills, Sleep disorder

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

Other Meds:

Current Illness:

ID: 1741001
Sex: M
Age: 65
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741002
Sex: F
Age: 70
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741003
Sex: F
Age: 83
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741004
Sex: F
Age: 26
State:

Vax Date: 12/31/2020
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: PATIENT HAD PFIZER COVID VACCINE DOSES ON Dose 1 date: 12/31/2020, Dose 2 date: 01/21/2021. PATIENT TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1741005
Sex: M
Age: 65
State: MI

Vax Date: 02/16/2021
Onset Date: 08/08/2021
Rec V Date: 09/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: SARS-COV-2 (COVID-19) by NAA, Micro: DETECTED (8/12/2021)

Allergies: Potassium-containing compounds, penicillins, tetanus-diphth-acell Pertussis

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

Symptoms: This is a 66 year old male with past medical history of cerebral palsy with spastic quadriplegia, seizure disorder, hypertension, GERD and congestive heart failure who presented from group home to the emergency department for persistent fever for the past few days, patient cannot provide detailed history. Fever of 101 degrees Fahrenheit, shortness of breath, and a dry cough. The patient reportedly had hypoxia with oxygen saturation between 88 and 92 on room air and outpatient workup included a chest x-ray, which showed some diffuse congestion. He was started on doxycycline and diuresed, but his symptoms persisted. The patient had been vaccinated for COVID-19. Chest x-ray showed cardiomegaly with pulmonary vascular congestion. The patient's white blood cell count was 4.9.

Other Meds: Enoxaparin, fluvoxamine, furosemide, gabapentin, quetiapine, valproate

Current Illness:

ID: 1741006
Sex: M
Age: 27
State: NC

Vax Date: 05/06/2021
Onset Date: 05/20/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: all my blood work has come back normal

Allergies: none

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

Symptoms: head pressure behind ears and at base of skull, muscle aches in arms and legs which feel like arthritis, heart palpitations when over exerting myself which makes it hard to exercise. I have tried numerous supplements to get rid of this including glucosamine chondroitin, fish oil, and turmeric.

Other Meds: none

Current Illness: none

ID: 1741007
Sex: F
Age: 48
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741008
Sex: F
Age: 90
State: MI

Vax Date: 04/06/2021
Onset Date: 09/22/2021
Rec V Date: 09/28/2021
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: Positive COVID test. CXR,

Allergies: Morphine

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

Symptoms: Pneumonia, Oxygen desaturated,

Other Meds: amitriptyline , apixaban , atorvastatin, lisinopril , loperami, metFORMIN, metFORMIN , methocarbamol , methocarbamol , tamsulosin , tamsulosin,

Current Illness: No

ID: 1741009
Sex: F
Age: 50
State: FL

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 50 yr of healthy, moderna shot 9/2, 9/3 Local redness. Chest pain 9/10. Hx visit 9/28 w/ Dx of idiopathic pericardial effusion.

Other Meds:

Current Illness: none

ID: 1741010
Sex: F
Age: 80
State: MI

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: seen in Emergency department. Benedryl and Keflex prescribed

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: redness to right arm and anterior chest wall began shortly after vaccine administration and spread to chest wall area within 2 days of vaccine

Other Meds: unknown

Current Illness: dimentia

ID: 1741011
Sex: F
Age: 66
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: 1741012
Sex: F
Age: 96
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741013
Sex: F
Age: 32
State: CO

Vax Date: 09/01/2021
Onset Date: 09/10/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: MRI pending

Allergies: penicillin

Symptom List: Unevaluable event

Symptoms: Poor ROM to right shoulder, pain difficultly performing ADLs. Ibuprofen/Acetamiophen, diclofenac gel, and heating pad

Other Meds: ibuprofen

Current Illness: no

ID: 1741014
Sex: F
Age: 36
State: NY

Vax Date: 09/21/2021
Onset Date: 09/22/2021
Rec V Date: 09/28/2021
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: Headache body aches exhaustion bed bound for 3 days a week later still feel tight joints tired

Other Meds:

Current Illness:

ID: 1741015
Sex: F
Age: 20
State: OR

Vax Date: 05/20/2021
Onset Date: 06/03/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: Acetylcholine Binding Ab - positive (26.9), Acetylcholine Blocking Ab - positive (30), Acetylcholine Modulating Ab - positive (66)

Allergies: NKDA

Symptom List: Injection site pain, Pain

Symptoms: Bilateral facial weakness, weakness of voice with swallowing difficulty. Extensor weakness of right finger. Weakness of upper lip when smiling. C/O oral fatigue, muffled speech, voice fatigue, difficulty using a straw.

Other Meds: Enskyce 0.15 mg- 0.03 mg tablet (OCP), probiotics

Current Illness: not reported

ID: 1741016
Sex: F
Age: 43
State: OR

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: none

Allergies: Bee allergy, Gluten allergy

Symptom List: Injection site pain, Menorrhagia

Symptoms: I woke up at 3 am with terrible head, body and eye pain. My right arm is very sore and cold feeling, and I am extremely tired. (more than normal even in pregnancy). I am currently 10 weeks pregnant, due date is 04/26/2022. My doctor advised a Tylenol regimen, which I began at 8am this morning. Symptoms are lessening, with the Tylenol, but I thought it important to report them.

Other Meds: Levothyroxin, Lelothyronine and prenatal vitamin

Current Illness: none

ID: 1741017
Sex: M
Age: 58
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741018
Sex: F
Age: 84
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741019
Sex: F
Age: 32
State: SC

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Right axillary lymphadenopathy occurred about 24 hours after vaccination, worsened at 36-48 hours, then began to improve over the next 5 days.

Other Meds:

Current Illness:

ID: 1741020
Sex: F
Age: 35
State: WI

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 09/28/2021
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: None

Allergies: sulfa

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

Symptoms: Pain at the injection site <24 hours, fever<24 hours, malaise and fatigue lasting >18 days now Treatment: None Outcome: Pain at site resolved, fever resolved, malaise/fatigue ongoing

Other Meds: Vyvanse, tylenol, aspirin, trazadone, lorazepam

Current Illness: Non COVID viral respiratory illness for starting from about a week prior to vaccination.

ID: 1741021
Sex: F
Age: 35
State: IL

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: Unknown triggers. Allergy testing negative.

Symptom List: Nausea

Symptoms: 45 minutes after injection: Lip and facial swelling. Did not effect the airway. Treated with Zyrtec, Pepcid, and Benadryl. Resolved within 24 hours.

Other Meds: Enoxoparin Zyrtec Pepcid Metformin Synthroid Ritalin Oral contraceptive Caffeine

Current Illness: None

ID: 1741022
Sex: F
Age: 53
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741023
Sex: F
Age: 33
State: MN

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: shellfish latex lavender bee corn

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

Symptoms: pt took benadryl at 9:30 shot at 10:00, 10:13- felt hot. B/p 129/76, p 79 100% 10:20 p 80 98% 129/84 1030: 122/78 P 74, 100%

Other Meds:

Current Illness:

ID: 1741024
Sex: F
Age: 64
State: PA

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
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: None.

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

Symptoms: Upset stomach, diarrhea, nausea.

Other Meds: Famotidine 40 mg, Levothyroxine.

Current Illness:

ID: 1741025
Sex: M
Age: 76
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741026
Sex: F
Age: 67
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: 1741027
Sex: M
Age: 60
State: CA

Vax Date: 02/16/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
Hospital: Y

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: Ct chest pulmonary angiogram 9/24/2021

Allergies: none

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

Symptoms: pulmonary embolism

Other Meds: none

Current Illness: none

ID: 1741028
Sex: M
Age: 37
State: TN

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient received vaccine and stated she was itching really bad and noted scratches on stomach. No visible rash noted. Notified MD. Patient's shift was about to end. MD encouraged patient to go to store to get benegryl. No reports of swelling. Vital signs stable. HR 80, RR 24, BP 154/90. Stated that she was told she had HTN, but never followed up with it.

Other Meds:

Current Illness:

ID: 1741030
Sex: F
Age: 71
State: OH

Vax Date: 03/11/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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:

Allergies: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient developed breakthrough COVID-19 requiring hospitalization.

Other Meds:

Current Illness: N/A

ID: 1741031
Sex: F
Age: 61
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741032
Sex: F
Age: 53
State: AZ

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
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: On 9/25/21, at approximately 10:20am this FNP handed the 0.5ml syringe of the Moderna vaccine to the MA, informing her that it was for the patient requesting her 2nd Moderna. At approximately, 10:45am, MA informed me that she realized she had given the Pfizer vaccine to the patient instead of the Moderna and she had already let the patient leave after waiting 15 mins. The MA stated she verified with the patient her name and that she was there for the "Pfizer" vaccine and the patient replied, "Yes." The MA said, "Maybe the patient didn't hear me well enough." The patient did not show signs/symptoms of adverse reactions following the vaccination administration during the 15 minute wait time. This FNP reached the pharmacy at approximately 11am to report the error and for further guidance. The pharmacist contact the clinical director and stated there is no further action to be taken at the time aside from notifying the patient. Once I arrived back at the pharmacy to drop off the vaccines at approximately 1:15pm, I attempted to reach the patient to inform her of the error. I was unable to reach her and did not feel comfortable leaving a voicemail message due to confidentiality/HIPAA rules.

Other Meds:

Current Illness:

ID: 1741033
Sex: F
Age: 44
State: FL

Vax Date: 09/25/2021
Onset Date: 09/26/2021
Rec V Date: 09/28/2021
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: Morphine

Symptom List: Pain in extremity

Symptoms: Severe hypotension, bradycardia, chest pain, diaphoresis, shortness of air,. I awoke from sleeping because I could not breathe. I am a RN and my husband is a nurse practitioner. I was very symptomatic with chest pain, SOA, diaphoretic. My husband could not feel a radial pulse but was able to auscultate my heart beat with a stethoscope. My blood pressure was only reading 55/46 and my heart rate was 44. I felt as if I was dying. Over the next hour before calling an ambulance, my blood pressure began to come up. The symptoms started to improve and dissipate so we did not call an ambulance but fear if I did not wake up I would have died due to the hypotension. I?m assuming that this would be considered a syncopal episode.

Other Meds: Multi vitamin, zinc, vitamin C, omeprazole, vitamin D,

Current Illness: None

ID: 1741034
Sex: F
Age: 49
State: NC

Vax Date: 03/26/2021
Onset Date: 03/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: CBC normal

Allergies: Sulfa drugs and foods; Peanuts; Pecan; Milk

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

Symptoms: A couple days later I developed crushing fatigue that was so bad I could not do anything. I could not go about my daily routine at all this lasting for a couple weeks. An insect bite on the outer side of my left breast had swollen and empurpled so bad causing my skin to peel. A hard knot developed inside of it and it was super sore. It finally started going down and the purple faded and turned more reddish. The hardening softened a little but was still there. My PCP thought it appeared as a spider bite and states it is a possibility that the ingredients from the vaccine and the toxins from the bite could have exacerbated the effects of the bite and cause the severe fatigue, but she is totally unsure of this.

Other Meds: Wellbutrin; Flaxseed Oil; Claritin; garlic pill; women's multivitamin; Patanase; Ipratropium Bromide; Advil; Cotempla XR ODT

Current Illness: AE from possibly an insect bite

ID: 1741035
Sex: M
Age: 62
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741036
Sex: F
Age: 56
State: ID

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: penicillin

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

Symptoms: Moderna lot number 038B21A expired in facility system on 9/25/2021, and vaccine was given 9/27/21. No expiration on Moderna box or vials

Other Meds: amitriptyline 25 mg, celecoxib 200 mg, estradiol 1 mg, folic acid 1 mg, hydroxychloroquine 200 mg, ipratropium, methotrexate 2.5 mg, omeprazole 40 mg, phentermine 37.5 mg, polyethylene glycol, progesterone micronized

Current Illness: None

ID: 1741037
Sex: F
Age: 73
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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:

Date Died: 09/28/2021

ID: 1741038
Sex: F
Age: 85
State: TN

Vax Date: 02/04/2021
Onset Date: 09/25/2021
Rec V Date: 09/28/2021
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: PT EXPIRED; BREAKTHROUGH CASE OF COVID-19

Other Meds:

Current Illness:

ID: 1741039
Sex: M
Age: 69
State: MO

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741040
Sex: M
Age: 76
State:

Vax Date: 02/05/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hospitalization due to COVID-19 pneumonia.

Other Meds:

Current Illness:

ID: 1741041
Sex: U
Age: 0
State: OH

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data:

Allergies: not applicable

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

Symptoms: When employee opened a new box of Fluad a crystallized particulate was observable in the inside corner of box. Unclear if this was drug or some other sort of debris.

Other Meds: not applicable

Current Illness: not applicable

ID: 1741042
Sex: M
Age: 46
State: NM

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/28/2021
Hospital:

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

Lab Data: none

Allergies: n/a

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

Symptoms: Off and on headaches since receiving the 2nd dose. Pt says that he got sick the day after and headaches have been going on since then

Other Meds: n/a

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am