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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1741147
Sex: M
Age: 70
State:

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: 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: 1741148
Sex: F
Age: 67
State: CT

Vax Date: 03/26/2021
Onset Date: 07/19/2021
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: Went to the clinic for a Covid test which was negative

Allergies: propranolol, phenytoin

Symptom List: Anxiety, Dyspnoea

Symptoms: Sore throat, runny nose, headache, cough

Other Meds: lamotrigine, frovatriptan, multivitamin, omega 3, Allegra, vitamin d, magnesium

Current Illness:

ID: 1741149
Sex: M
Age: 46
State: CA

Vax Date: 08/20/2021
Onset Date: 08/26/2021
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: blood work

Allergies: morphine and morphine related products

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

Symptoms: I began having a itchy, painful bumps on my heel of my foot and my fingers. It spread to my whole body. I went to the doctor about this. They did blood work, which came back normal.

Other Meds:

Current Illness:

ID: 1741150
Sex: F
Age: 58
State: IL

Vax Date: 08/26/2021
Onset Date: 09/23/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies: Codeine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 9/23/21 - presented to the emergency department with weakness, dizziness, nausea. CT showed large pericardial effusion and pleural effusion. Taken to OR for emergent pericardial window complicated by AF RVR and transient hypotension. Patient intubated and admitted to ICU. Further diagnoses: Cardiac tamponade, obstructive shock, anemia. 9/24: R pleural drain placed. 9/25: extubated 9/28: continues to be hospitalized and is improving.

Other Meds:

Current Illness:

ID: 1741151
Sex: M
Age: 78
State:

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:

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

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1741152
Sex: F
Age: 33
State: NC

Vax Date: 03/17/2021
Onset Date: 03/31/2021
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: sulfates and penicillins. gluten

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

Symptoms: All PCOS symptoms went crazy and hormones off the charts. Acne came back from 1 active breakout per week to about 5-7 per day. Anxiety came back in full force.

Other Meds: inositol probiotic

Current Illness: n/a

ID: 1741153
Sex: M
Age: 58
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: 1741154
Sex: F
Age: 63
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

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

Other Meds:

Current Illness:

ID: 1741155
Sex: F
Age: 50
State: AL

Vax Date: 09/11/2021
Onset Date: 09/11/2021
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: Knee drained

Allergies: Epinephrine, NSAIDS, Sudafed, Clindamycin, Keflex, Lorcet, Lortab, Liquid red dye, Steroids, Cefprozil, Cyclabenzaprine, Prednisone

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Breathing changed (was more labored) for about 48 hours. Inside of my nose felt swollen, my tongue felt swollen, my lips were tingly, and my finger tips were tingly for about 4 hours. Left side of my body hurts from the top of my head to the tips of my toes. For about 4 days I could not tough my neck because the pain was so intense. I had a hard time eating because my jaw hurt to chew. My rib cage hurts to breathe. Can't lay on my left side because the pain is so severe. On day 7 my knee swelled up and had to be drained. Can't bend my knee because the swelling is so much. After a week the swelling has started to go down, but still swollen and very concerning. I have felt feverish everyday but only had a fever the first two days. I get waves of feeling weak and dizzy every day.

Other Meds: Singular, Magnesium with zinc and vitamin D3

Current Illness: None

ID: 1741156
Sex: F
Age: 80
State:

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1741157
Sex: F
Age: 57
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: 1741158
Sex: F
Age: 49
State: TN

Vax Date: 08/27/2021
Onset Date: 09/13/2021
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: 9/17/21 and 9/24/21 dr visits

Allergies: Bees, penicillin and niacin

Symptom List: Rash, Urticaria

Symptoms: Sore arm, general fatigue at first and 2nd injection. Broke out in first ever Shingles condition on 9/13/21

Other Meds: None

Current Illness: None

ID: 1741159
Sex: M
Age: 63
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: 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: 1741160
Sex: F
Age: 64
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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741161
Sex: F
Age: 27
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: PATIENT STATED PRIOR TO RECIEVING VACCINE THAT SHE HAD BROKE OUT IN A RASH WITH THE FIRST DOSE. ALSO HAD BEEN ON MENTRAL CYCLE SINCE LAST FIRST DOSE. NOTIFIED MD. STATED TO HAVE HER WAIT 30 MINUTES TO GIVE VACCINE. ALSO WANTED PATIENT TO FOLLOW UP WITH GYNOCOLOGIST, THAT THE MENSTRAL CYCLE WAS NOT A SIDE EFFECT OF VACCINE. GAVE VACCINE. PATIENT BROKE OUT IN HIVES AND WAS ITCHING. NOTIFIED MD AGAIN. SATED TO TAKE BENEGRYL AFTER LEAVING WORK, WHICH HER SHIFT WAS ABOUT TO END. AND IF SWELLING DEVELOPED AROUND NECK MOUTH AREA TO GO TO THE ER. VS: HR89, RR 20, BP 128/78.

Other Meds:

Current Illness:

ID: 1741162
Sex: F
Age: 84
State: PA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: No adverse event occurred, reporting vaccine administration error. Customer was given Booster Shot of Pfizer too early. Circled 3rd Dose on intake form, but later indicated this was booster they were seeking. Patient was unaware of 3rd dose/immunocompromised requirements and that there was a difference in timing. Patient did not meet criteria for 3rd dose, only booster. Last dose 4-7-21, would be due 6 months after (10/7/21), was administered early on 9/28/21.

Other Meds:

Current Illness:

ID: 1741163
Sex: M
Age: 47
State: CA

Vax Date: 09/17/2021
Onset Date: 09/24/2021
Rec V Date: 09/28/2021
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: morphine and morphine related products

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

Symptoms: On the 24th, I noticed the same itchy, painful bumps on my hand. It spread to my whole body. They are still there.

Other Meds: amoxicillin

Current Illness:

ID: 1741164
Sex: M
Age: 52
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1741165
Sex: F
Age: 16
State: NC

Vax Date: 08/28/2021
Onset Date: 08/29/2021
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: DOCTOR Orthoganalist DOCTOR for Healing

Allergies: no

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Nose Bleeds . Facial Rash . Red blotchy skin. Lump in neck on the right side Sore throat . Extreme fatique .

Other Meds: no

Current Illness: no

ID: 1741166
Sex: M
Age:
State: CA

Vax Date:
Onset Date:
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: Blood test, urinary test, and prostate test. Test came out negative.

Allergies: Seasonal allergies

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

Symptoms: 03/22/2021 within three hours of the vaccination Dose 1, flu like symptoms. Dose 2, experienced at 03:00 AM severe headaches and body aches, progressively experienced exhaustion and fatigue. It was a struggle to complete daily activities. Was unable to continue with normal exercise routine. Prescribed an Inflammatory drug Meloxicam helped with pain and reduced inflammation. Bladder frequently emptying, was put on a medication.

Other Meds: Vitamin D; Multi-Vitamin; Xanax

Current Illness: No

ID: 1741167
Sex: F
Age: 88
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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741168
Sex: M
Age: 12
State: MD

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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: None

Symptom List: Unevaluable event

Symptoms: Child was given the incorrect vaccination. He was previously given Pfizer for his first vaccine. Confusion, weak, vomiting, unable to sleep. He has to go back for observation on Monday 10/04/2021.

Other Meds: None

Current Illness: None

ID: 1741169
Sex: F
Age: 28
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741170
Sex: M
Age: 69
State: TN

Vax Date: 03/29/2021
Onset Date: 09/03/2021
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: Catherization Covid test- negative BPAP

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: On September 3, 2021 I had trouble breathing so my wife sent me to the hospital. They then sent me to the ICU and the doctors said my lungs had filled up with water. They put a catheter on me and put 2 stents in my heart. They said that I did not have a heart attack or a stroke. On October7,2021 I have a doctors appointment.

Other Meds:

Current Illness:

ID: 1741171
Sex: F
Age: 49
State: CT

Vax Date: 04/28/2021
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: SYR
Vax Site: LA

Lab Data: I had an x-ray. going for blood work. the x-ray did not show too much. I am seeking physical therapy this week for a few weeks.

Allergies: SULFA

Symptom List: Injection site pain, Menorrhagia

Symptoms: extreme pain and paralysis. Still have severe back pain in my lumbar area. Inflamation

Other Meds: no

Current Illness: no

ID: 1741172
Sex: F
Age: 48
State: WA

Vax Date: 09/03/2021
Onset Date: 09/21/2021
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: Sept 24 had bloodwork done and Sept 27 had pelvic and transvaginal ultra sounds.

Allergies: None

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

Symptoms: I have been in menopause for over 2 years,and on Sept. 21 began bleeding. Heavy at first with cramps,and now Sept. 28 I still have cramps and spotting.

Other Meds: Humira, paxil,turmeric, D3,calcium,zinc,C,multi vitamin

Current Illness: Inflammation behind right eye

ID: 1741173
Sex: M
Age: 87
State: PA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: No adverse event occurred, reporting vaccine administration error. Customer was given Booster Shot of Pfizer too early. Circled 3rd Dose on intake form, but later indicated this was booster they were seeking. Patient's representative was unaware of 3rd dose/immunocompromised requirements and that there was a difference in timing. Patient did not meet criteria for 3rd dose, only booster. Last dose 4-7-21, would be due 6 months after (10/7/21), was administered early on 9/28/21.

Other Meds:

Current Illness:

ID: 1741174
Sex: M
Age: 83
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1741175
Sex: F
Age: 53
State: MA

Vax Date: 06/03/2021
Onset Date: 06/25/2021
Rec V Date: 09/28/2021
Hospital: Y

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: none

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

Symptoms: High fever (103), intense headache that required narcotics to ease the pain, body aches, chills, Covid toe

Other Meds: vitamin D, vitamin C, probiotic

Current Illness: none

ID: 1741176
Sex: F
Age: 62
State:

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:

Symptom List: Nausea

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1741177
Sex: M
Age: 74
State: AL

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: No tests given.

Allergies: No

Symptom List: Injection site pain

Symptoms: Sore thoat, head ace, tempertuer, tried/sleepy

Other Meds: Telmisartan 80mg, Hydrochlorothiazide 25mg, Atorvastatin 20mg, Bayer low dose 81mg, Ocavite.

Current Illness: None

ID: 1741178
Sex: F
Age: 36
State: MI

Vax Date: 09/01/2021
Onset Date: 09/22/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: experiencing shortness of breath, fatigue, muscle pain, headache, fever, body aches, chills, fatigue, chest pain

Other Meds:

Current Illness:

ID: 1741179
Sex: M
Age: 69
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: 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: 1741180
Sex: M
Age: 74
State: MN

Vax Date: 03/25/2021
Onset Date: 03/25/2021
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: Heart monitor (worn 1 week; waiting on results)

Allergies: No

Symptom List: Tremor

Symptoms: I experienced minor heart palpitations right way after 2nd dose. It has gotten progressively worse; I'm under doctors care. Some days I have no palpitations but sometimes I wake up in the middle of the night with palpitations.

Other Meds: No

Current Illness: No

ID: 1741181
Sex: F
Age: 72
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: 1741182
Sex: F
Age: 72
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/28/2021
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: 1741183
Sex: F
Age: 50
State: WI

Vax Date: 09/02/2021
Onset Date: 09/02/2021
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: None

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

Symptoms: Spotting that turned to heavy bleeding and clotting for 3 days. Very sore, to the point of being uncomfortable, lower back kidney area.

Other Meds: None

Current Illness: None

ID: 1741184
Sex: M
Age: 55
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: 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: 1741185
Sex: M
Age: 38
State:

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: 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: 1741186
Sex: F
Age: 53
State: TN

Vax Date: 08/02/2021
Onset Date: 08/03/2021
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: EGGS, MILK, LATEX, GLUE FOR MEDICAL USE , SULFUR, KIWI, WHITE GRAPES, WHITE BEANS, TROPICAL FRUITS, OAK , MAKE UP , ETC..

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

Symptoms: Received vaccine on 8/2/2021. Woke up 8/3/2021 and noticed a rash that was all over my left arm that itched and burned. my face was puffy and my upper and lower extremities were swollen. I had a head ache for 4 days. I had took Advil and ibuprofen to assist with the Headache and Nausea( A feeling I cannot explain) overall fatigue and motion sickness. The pain meds did not help. I did not want to over take meds so I tolerated the headache and other discomfort until it subsided 8/6/2021 . Rash continued for 2 weeks afterwards. No creams or ointments helped it. Rash were pimple like ,with white blistery heads ,that became hard on the top.

Other Meds: ADVIL FOR PAIN AT INJECTION SITE. NIGHT MEDS. ZOPIDEM, LORAZAPAM, AMITRIPTOLINE THE NIGHT BEFORE.

Current Illness: NONE

ID: 1741187
Sex: F
Age: 51
State: NC

Vax Date: 08/01/2021
Onset Date: 08/25/2021
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: Neurology assessment. experiencing severe dizziness, ear fullness, numbness tongue and hands, numb tongue, light headed, exhausted, fatigue, muscle aches, burning feet, pain in feet when walking, hands ache,hands burn, burning around lips, difficulty concentrating, blurriness eyes, mild sensitivity to light and burning. I have some digestive issues with intermittent diarhea and nausea due to the dizziness and vertigo. The vertigo especially when driving and any continuous motion.

Allergies: Codeine, Demorol, Citrus fruits, pinapple

Symptom List: Pain in extremity

Symptoms: Right arm injection. Immediately my hands. feet, and tongue completely numb. I could not feel my hands, feet, tongue. I felt dizzy and woozy and all of sudden I was sharing I was not feeling right. I shared I could not breathe. I was hyperventilating and kept sharing I did not feel right. I was treated as if i was having a panic attack. I kept saying I cannot breath and utilized my inhaler because I have asthma and took 2 puffs. This did not make a difference. I was given 2 doses of ativan and the 2nd dose I do not remember leaving and being taken home.

Other Meds: Multi-vitamin

Current Illness: None

ID: 1741189
Sex: M
Age: 60
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: 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: 1741190
Sex: M
Age: 68
State: NH

Vax Date: 09/25/2021
Onset Date: 09/28/2021
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: NKA

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

Symptoms: Dizziness

Other Meds: Losartan 100 mg qd HCTZ 25 mg qd ASA 81 mg qd Testosterone Gel 1.62% two pumps qd Flu vacine Quad 20-21 09/22/2021

Current Illness:

ID: 1741191
Sex: M
Age: 59
State:

Vax Date: 03/03/2021
Onset Date: 09/22/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Breakthrough case. PCR test on 9/27/2021

Other Meds:

Current Illness:

ID: 1741192
Sex: F
Age: 66
State:

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: 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: 09/25/2021

ID: 1741193
Sex: F
Age: 98
State: OH

Vax Date: 09/24/2021
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: NA

Allergies: NKA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: resident passed away, no signs or symptoms present

Other Meds: Xanax, Remeron, Zoloft, Ibuprofen, Risperdal, Tramadol, Depakote, Lisinopril, Melatonin, Miralax, Omeprazole, Oxybutrin, Norvasc

Current Illness: shoulder pain and redness

ID: 1741194
Sex: F
Age: 46
State: CA

Vax Date: 08/17/2021
Onset Date: 08/18/2021
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: MRI brian (normal) and spine - Moderate degenerative spondyloarthropathy without central canal or foraminal stenosis. Multilevel disc osteophyte complex protrusions impressing upon the ventral thecal sac of the mid cervical cord , CT head normal (no stroke) , labs CBC w/ diff normal, troponin, Mg, calcium , chem 7 , D dimer, TSH, normal. PT 11.6 , APTT 33. 8/31/21 covid 19 IGG , IGM positive . -Hgb A1c, RPR, HIV negative

Allergies: none

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

Symptoms: the following day: chills, rigors, headache, nausea, vomiting, fatigue. Took 1 gram Tylenol one week later: 8/24/2021 4;10 pm left foot tingling, numbness and persistent numbness and tingling left arm and called 911 /ambulance with numbness and tingling left face and lip/head and went to ER with CT head/MRI normal and no stroke, Diagnosed ? complex migraine . continued until now headache cocktail given in ER wihtout relief. Neurology consult. worse with Depakote one dose , Continued symptoms when due for 2nd covid 19 dose and worsening left leg numbness 7 hours later.

Other Meds: Co-Q, fish oil

Current Illness: no

ID: 1741195
Sex: F
Age: 71
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: 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: 1741196
Sex: M
Age: 52
State:

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:

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

Symptoms: ADMINISTRATION ERROR MIXED SERIES mRNA VACCINE PFIZER AND MODERNA.

Other Meds:

Current Illness:

ID: 1741197
Sex: F
Age: 65
State: NY

Vax Date: 03/25/2021
Onset Date: 03/26/2021
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:

Allergies: PCN, clindamycin, amlodipine. nifedipine, morphine, codeine, Darvon, darvocet

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

Symptoms: The day after the vaccine injection, 3/26/21 I had pain in my right arm from my shoulder to my elbow. It did not go away or seem to get better the next day and I called my providers office and spoke with the provider on call who stated it was probably from the vaccine and to give it a few days. The problem persisted and became worse with the pain going from my right should to my wrist and often causing me to wake up at during the night. It was a constant ache and increased when I used my arm with activity such as using the vacuum, cleaning, cooking, typing. At times I felt that my arm was so weak that i could not hold my coffee cup comfortably. I saw my provider again in April and told her about the pain. I started phsysical therapy (PT) in May and had 4 sessions. PT gave me exercises and I was instructed to use my are as I normally would. The pain continues to this day and NSAIDS did not seem to work.

Other Meds: Calcium/magnesium occuvite COQ-10

Current Illness: na

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am