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: 1741302
Sex: F
Age: 58
State:

Vax Date: 09/27/2021
Onset Date:
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: 1741303
Sex: M
Age: 31
State: NJ

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: No.

Symptom List: Anxiety, Dyspnoea

Symptoms: 5 hours after shot, fatigue set in and a warm feeling in head. About 1 a.m. that night, now Sunday morning I was awoken with a massive migraine. Felt heavy pressure in head, thought I had a blood clot in paranoia. Ate 4 Tylenol to soothe the massive throbbing headache (one I have never had in my life before, comparable to the worst hangover you could ever have x10). I was well hydrated drinking water and Gatorade through the night. If the Tylenol did not subside the pressure in my brain I would have gone to the Emergency Room that night, that is how severe and unworldy it was for me. Sunday awoke at 10 to see my daughter for my weekly visit. About 1 hour in I call it short and proceed to go home and rest as I had felt extremely exhausted and a massive mental fog over my mind. I hydrated again that a.m. with pedialyte and water. Slept close to 20 hours on Sunday. Monday I woke up feeling a bit off mentally, still with persistent body aches, joints I don't normally ever feel aches in were sore but i took it slow and did not really complete anything that day, called out of work to try to fully recuperate. Tuesday, I wake up feeling no brain fog not really fatigued mentally atleast. I walk into work notice a bit of physical exhaustion from ordinary walk into work, felt warm in a.m. My lunch break began now I had to ascend 4 flights of steps in parking garage which I normally do with ease, except this time I was winded like I did a mild workout. As I'm driving in my car with a.c on I notice I still feel warm, I go home and take my temperature to discover it was at 101.1 f.. I subsequently called out of work for rest of day, took Tylenol and temperature slowly subsiding. Note: I am a 31 year old male (life time of exercise through sports/military/hobby, I currently exercise 4 to 5 times a week. Run on average 4 to 5 miles a week with 30 min weight training. I have no underlying health conditions. Days before vaccine I was feeling healthy as can be, as of right now muscle aches and mild fever persists close to 72 hours post second dose vaccine .

Other Meds: No all supplementation and exercise discontinued 48 hours prior.

Current Illness: No

ID: 1741304
Sex: F
Age: 44
State: TX

Vax Date: 12/19/2020
Onset Date: 12/21/2020
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: MRI head, balance test

Allergies: none

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

Symptoms: 3 days following first Pfizer Covid vaccine, I developed sudden onset of feeling as if I was being thrown but was actually sitting still. This was followed by dizziness and balance issues for 30 minutes to 1 hour. This occured multiple times/week for 4-5 weeks. I was evaluated by my ENT who ordered MRI which was normal. He ordered balance test and I was found to have a "vestibular injury" which he described as often caused by viral infection. Symptoms have gradually lessened in severity and frequency but I do continue to have brief episodes of imbalance. This was very early after vaccinations started and he did not think it related to the vaccine.

Other Meds: Sertraline, Zyrtec, NP thyroid

Current Illness: none

ID: 1741305
Sex: F
Age: 77
State: IN

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: none

Allergies: Penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reported having elevated blood pressure evening of receiving the vaccine. Her BP was 177/82. Patient states she does not have hypertension and usually runs 130/80s. Patient's BP was 140/80 the next morning after vaccination. Instructed patient to continue to monitor BP and if it elevated again then she needed to be seen by ER. Patient was understanding of treatment plan.

Other Meds: n/a

Current Illness: none reporteed

ID: 1741306
Sex: M
Age: 89
State:

Vax Date: 09/27/2021
Onset Date:
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: 1741307
Sex: F
Age: 52
State: TX

Vax Date: 09/21/2021
Onset Date: 09/22/2021
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: Sent this information to my Dr. In a message and he messaged back stating he didn't think it was a vaccine side affect and if I continued headaches they would do lab tests. I know my body and I am confident it was from the vaccine as it occurred within hours of the vaccine and I have never had them before the vaccine.

Allergies: Not allergic to anything. Never had any vaccination reactions until now.

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

Symptoms: Got the Pfizer shot at 12:00 PM on September 21st. Arm so sore immediately afterwards I could barely move it. The next morning September 22, I woke up around 8:30 with my left nostril semi stopped up. Blew my nose, and it was a combination of dried blood and fresh blood. Nose bled off and on all day. Same day, felt cramping like from menstrual cycle, and noticed brown red discharge from vagina from Sept 22 thru Sept 26, 2021. I have been Postmenopausal for over 2 years. Slight headaches on Sept. 21 and 22.

Other Meds: Estradiol, Medroxyprogesterone, Losartan, Duloxetine, Atorvastatin, Asprin, Quercetin, vitamin A, B Complex, D3 Magnesium, Lipsoma Vitamin C, and Stomach Enzymes

Current Illness: None

ID: 1741308
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: 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: 1741309
Sex: M
Age: 31
State: FL

Vax Date: 09/18/2021
Onset Date: 09/20/2021
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: had blood work done, ultra sound and ECG scans. all done on 9/27/2021

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: 3-4 days after shot i had tightness in chest and heart pain. after receiving care from ER i was informed i had developed Pericarditis. swelling of my heart. on 9/27/2021. i have never had any previous health conditions in the past.

Other Meds: None

Current Illness: None

ID: 1741310
Sex: F
Age: 66
State:

Vax Date: 09/27/2021
Onset Date:
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: 1741311
Sex: M
Age: 22
State: OH

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: NKDA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: No adverse reaction. Dose was from an expired vial given by accident. Dose given 9/24/2021 which the vials expiration date was 9/19/2021. This was the 1st dose in the Moderna series of 2.

Other Meds:

Current Illness: HTN, Deafness (1999), migraines, GERD, Bipolar disorder

ID: 1741312
Sex: M
Age: 80
State: NC

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: na

Allergies: na

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

Symptoms: no actual adverse reaction we just administered 0.3 ml of undiluted vaccine. Patient reported no effects.

Other Meds: na

Current Illness: na

ID: 1741313
Sex: M
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: none

Other Meds:

Current Illness:

ID: 1741314
Sex: F
Age: 72
State: WI

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

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

Lab Data: 4/19/2021: Sodium 141, potassium 3.6, BUN 51, creatinine 3.5,. Creatinine 9/4/2020 was 0.8

Allergies: No medication allergies

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

Symptoms: Patient received her first Covid vaccine 2/27/2021 and her second Covid vaccine March 20, 2021. She had no symptoms with her first vaccine but the second 1 she developed chills, fever and body aches. The body aches eventually went away but the chills and fever persisted. She then developed loss of appetite and lack of energy and vomiting. She was admitted to our hospital on 4/19/2021 with acute renal failure requiring dialysis. She had no previous renal insufficiency

Other Meds: Calcium carbonate 600 mg twice daily Diltiazem 120 mg twice daily Folic acid MiraLAX Omeprazole 20 mg daily Potassium chloride 10 micrograms daily Pravastatin 10 mg daily B12 at 1000 mcg daily

Current Illness: Hypertension Hypokalemia Onychomycosis Reflux Depression Paroxysmal supraventricular tachycardia Bradycardia in 2015 History of carpal tunnel release Appendectomy

ID: 1741315
Sex: F
Age: 66
State: CO

Vax Date: 09/11/2021
Onset Date: 09/12/2021
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: None

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

Symptoms: Low grade fever(99.9), fatigue, achy for 24 hrs

Other Meds: Lisinipril 10mg with HCTZ 12.5mg

Current Illness: None

ID: 1741317
Sex: F
Age: 18
State: OH

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: None

Allergies: Unknown

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

Symptoms: At 1350 pt reported to feel cool, clammy, dizzy. Pt sat down. At 13:51 Laid client on cot, more alert, regained color not dizzy. At 14:05 rechecked B/P sitting, BP 82/58, awake, not dizzy, talking, drinking water. Skin warm, naturally dry.

Other Meds: Unknown

Current Illness:

ID: 1741318
Sex: F
Age: 36
State: CA

Vax Date: 09/22/2021
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: none

Allergies: Bee stings

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

Symptoms: Today is day 6 and I am still having body aches, headache, nausea and brain fog.

Other Meds: Procardia, hydrochlorothiazide, zoloft,

Current Illness:

ID: 1741319
Sex: F
Age: 74
State: WI

Vax Date: 04/08/2021
Onset Date: 09/21/2021
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: COVID PCR NP swab positive 9/20/21 Chest CT Angiography 9/21/21: 1. No CT evidence for pulmonary embolism. 2. Stable features of pulmonary arterial hypertension. Stable findings of atherosclerotic change with eccentric mural plaque involving the descending thoracic aorta. 3. Development of bilateral airspace opacities containing internal air bronchograms. Findings are compatible with aspiration versus pneumonia. There is a small left pleural effusion. 4. Coronary artery calcification. 5. Stable appearance to bilateral adrenal masses, more completely evaluated on recent contrast-enhanced MRI of the abdomen. 6. Chronic/stable findings, as detailed in the body the report.

Allergies: Sulfa Antibiotics

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

Symptoms: Patient completed COVID-19 vaccination on 4/8/21. Patient was admitted to reporting hospital on 9/21/21 with COVID-19 pneumonia and hypoxemic respiratory failure. Her primary symptoms are coughing with shortness of breath. Patient does live at a long-term nursing home and tested positive on 9/20/21.

Other Meds: Tylenol 650mg, Zyloprim 100mg, amLODIPine 10mg, Lipitor 40mg, Rocaltrol 0.25 mcg, Coreg 25mg, Apresoline 25mg, Lantus insuluin glargine, Florajen, Melatonin 5mg, Namenda 10mg, Renvela 800mg, vitamin D3 10 mcg, Dulcolax

Current Illness: history of a bladder mass currently under work-up, recent initiation of hemodialysis for CKD, chronic heart failure with preserved ejection fraction, probable obstructive sleep apnea, diabetes, mild dementia, and hypertension.

ID: 1741320
Sex: F
Age: 30
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Intense fever, low blood pressure, fainting (the day after) Fever lasted two days Extreme nauseous and dizziness for a week and a half Severe headaches for 4 weeks

Other Meds: NP thyroid Sertraline

Current Illness: None

ID: 1741321
Sex: M
Age: 68
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741322
Sex: F
Age: 81
State: PA

Vax Date: 09/23/2021
Onset Date: 09/24/2021
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: ER visit - unknown what tests were run

Allergies: iodonated products, sulfa antibiotics, statins, bisacodyl, epinephrine, meperidine, penicillin, bactrim,

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

Symptoms: facility reported event as a seizure - transported by ambulance to ER and released after diagnosis of syncopal event.

Other Meds: PEG 17gm po qd for constipation, senna plus 2 tabs po hs prn constipation, calmoseptine to buttocks prn after each episode of incontinence

Current Illness: none known

ID: 1741323
Sex: F
Age: 57
State: AK

Vax Date: 09/01/2021
Onset Date: 09/02/2021
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: no lab test at that moment obtained, was increased in metoprolol doses up to 3 times a day for symptoms, added Co-B-Complex vitamins daily, for UTI use OTC Phenazopyridine prn and Nitrofurantoin 100 MG bid

Allergies: Penicillin, Mometasone nasal , Mupirocin, Carbamazepine.

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

Symptoms: On the 2nd day developed high fever up to 102 F, sever headache on the back of head with muscle weakness in neck on the right side in particular , on 09/03 day developed UTI for 5 day sever ( had appointment 09/07 with primary), on the 10th day started to experience tingling in both legs from hip down ankle with firing nerve pain ( wasn't able to sleep and rest at night time), at the same time had palpitations in the heart and hard time to control blood pressure( have a log of BP up to 159/85 with HR 94 at rest), 5 days later tingling in legs went down from knees to ankles. at day 28 all symptoms diminished.

Other Meds: Lisinopril, Metoprolol, Folic Acid, Vit B12, Hydroxychloroquine, Percocet PRN, Botox, Famotidine, Ascorbic Acid

Current Illness: Blood pressure, palpitations, R Arthritis , chronic migraine

ID: 1741324
Sex: F
Age: 55
State: WA

Vax Date: 01/21/2021
Onset Date: 03/01/2021
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: pending

Allergies: ecn

Symptom List: Unevaluable event

Symptoms: onset of tiredness and fatigue in March.Onset double vision September 2021 difficulty swallowing September 2021 presumed diagnosis of Myasthenia Gravis test to be done blood work then visit to neurologist

Other Meds: hydroxychloroquine and celebrex vitamins keto foods/ supplements

Current Illness: inflammatory arthritis

ID: 1741325
Sex: M
Age: 41
State: GA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: None

Allergies:

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Rash occurred over neck area. Red, splottchy, raised areas with pruitus. Relieved some with 50mg of Benedryl. +hoarseness, neg SOB, n/v, fever, seizures or LOC. Rash continues to be present on day 8 from vaccine although pruritis has eased up.

Other Meds:

Current Illness: eczema

ID: 1741326
Sex: F
Age: 84
State:

Vax Date: 09/27/2021
Onset Date:
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:

Allergies:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

Date Died: 09/12/2021

ID: 1741327
Sex: M
Age: 89
State: KY

Vax Date: 01/26/2021
Onset Date: 09/12/2021
Rec V Date: 09/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: 90-year-old male history of AFib, on anticoagulation with Eliquis, HTN, dementia, DM type 2, BPH presents with increasing shortness of breath. Previously lived in an assisted living facility, was admitted on 08/23 with confusion and generalized weakness, decreased heart rate. He was treated with IVF hydration, empiric antibiotics with ceftriaxone azithromycin, 2D echocardiogram was performed that demonstrated a preserved EF, he was transferred to a local SNF. He fell upon arrival to the sniff within 24 hours, with a subsequent left proximal humerus fracture, and is pending outpatient orthopedic evaluation. Unfortunately patient tested positive for COVID-19 on 08/31. He is fully vaccinated since January '21. Felt in ED profoundly hypoxic, proBNP elevated >39k, troponin T 262, CXR with bilateral multifocal infiltrates. Initiated on treatment with dexamethasone, Remdesivir, IV diuresis, and supplemental O2. Patient was seen by Cardiology and Pulmonary during hospitalization. They recommended continuing present management as above and reiterated patient has very poor overall prognosis given his multiple comorbidities and frail state. Unfortunately, despite aggressive treatment, at 3:55 a.m. On 09/12/2021, patient passed away. His family was notified of death by nursing staff.

Other Meds:

Current Illness:

ID: 1741328
Sex: F
Age: 31
State: MN

Vax Date: 01/12/2021
Onset Date: 09/18/2021
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: Covid-19 test

Allergies:

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

Symptoms: Employee tested positive for COVID-19 after being fully vaccinated

Other Meds:

Current Illness:

ID: 1741329
Sex: F
Age: 26
State: IN

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: Per reported event - Received 2nd mandated Pfizer injection right deltoid today at 8:30 am at the medical pavillion. Within 30 minutes felt itchy on inside of right upper arm, and then noted red, raised rash. Rash spread across upper chest to upper left arm. 10:30 am Benadryl 50 mg IM left gluteal muscle. 11: 30 am Sent to ED via ambulance for worsening of respiratory symptoms

Other Meds:

Current Illness:

ID: 1741330
Sex: F
Age: 60
State: NY

Vax Date: 03/24/2021
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: Omnicef Kenalog Lidocaine Marcaine raw almonds raw cherried

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: In September i was diagnosed with High Blood pressure and a UTI. Have not had high blood pressure prior to vaccine or UTI. Not sure if these are related to Moderna vaccine or not.

Other Meds: Ursodiol 300 mg 3 times a day Synthroid 150 mg 1 time per day calcium 500 mg 2 times per day d3 2000 mg 1 per day

Current Illness: none

ID: 1741331
Sex: M
Age: 76
State:

Vax Date: 02/13/2021
Onset Date: 02/13/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: none

Other Meds:

Current Illness:

ID: 1741332
Sex: F
Age: 62
State: VA

Vax Date: 01/31/2021
Onset Date: 01/31/2021
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: xray of left knee on 2/17/2021

Allergies: seasonal allergies

Symptom List: Nausea

Symptoms: sore arm near injection site, whole body arthralgia,, muscle aches, fatigue, chills for ~ 36 hours beginning ~ 4-6 hours after the injection. I took 600mg ibuprofen every 5 hours for 36 hours. All symptoms resolved except arthralgia. It never completely resolved. My joints (knees, ankles, left wrist) which had previously been intermittently painful are now never pain free. I am nearly unable to walk from bilateral knee pain

Other Meds: levothyroxine, metoprolol, baby aspirin, vitamins

Current Illness: controlled a-fib and hypothyroidism

ID: 1741333
Sex: M
Age: 32
State:

Vax Date: 09/27/2021
Onset Date:
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 vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1741334
Sex: M
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Date Died: 09/28/2021

ID: 1741335
Sex: M
Age: 87
State: AZ

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: Patient suffered from cardiac arrest and past away due to underlying medical conditions on 9-28-2021.

Other Meds:

Current Illness:

ID: 1741336
Sex: F
Age: 75
State: MI

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:

Symptom List: Tremor

Symptoms: Patient came to emergency room with shortness of breathe, low grade fever, light cough Lipitor, Tylenol, Aprefoline, patient is still in emergency room

Other Meds:

Current Illness:

ID: 1741337
Sex: F
Age: 50
State: FL

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: Similar reaction in the past with other very vaccines

Symptom List: Erythema, Pruritus

Symptoms: Hives in back, arms, abdomen, thigh

Other Meds:

Current Illness:

ID: 1741338
Sex: M
Age: 32
State:

Vax Date: 09/27/2021
Onset Date:
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: 1741339
Sex: M
Age: 69
State: MI

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: PATIENT'S FIRST 2 COVID-19 VACCINES WERE MODERNA, AND PATIENT WAS MISTAKENLY GIVEN PFIZER FOR 3RD DOSE TODAY.

Other Meds:

Current Illness:

ID: 1741340
Sex: M
Age: 77
State: IA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient received the Pfizer Covid vaccine for his 3rd dose. After giving the vaccine, it was realized that he received the Moderna vaccine for his first two doses. Discussed this with patient and he commented that he didn't want to have to wait to receive Moderna for his 3rd dose. Also, he had called the pharmacy the previous day to schedule his Covid vaccine today and he told the pharmacy technician at that time that he had received Pfizer for his first two vaccines.

Other Meds:

Current Illness:

ID: 1741341
Sex: M
Age: 76
State:

Vax Date: 03/08/2021
Onset Date: 03/08/2021
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: none

Other Meds:

Current Illness:

ID: 1741342
Sex: M
Age: 49
State:

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

Other Meds:

Current Illness:

ID: 1741343
Sex: M
Age: 71
State: MO

Vax Date: 03/06/2021
Onset Date: 09/08/2021
Rec V Date: 09/28/2021
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: None

Symptom List: Pain in extremity

Symptoms: Patient received both vaccine doses in early 2020. On 9/8/2021 patient presented with symptoms of COVID-19 and a GI bleed. Patient was eventually intubated during hospital admission more for bleeding issues than respiratory issues. Patient needed multiple trips to IR to fix bleeding. Patient was ultimately transferred on 9/28/2021 from our facility to another hospital. Patient has been waiting for liver transplant for awhile and because of continued bleeding transferred to a higher level of care for hepatobiliary surgery.

Other Meds: Carvedilol, ondansetron ODT, dulaglutide, glipizide, rosuvastatin, olmesartan, clonidine, tamsulosin, amlodipine, apixaban, sildenafil, spironolactone, ergocalciferol

Current Illness: None

ID: 1741344
Sex: M
Age: 72
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: 1741345
Sex: M
Age: 72
State: FL

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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1741346
Sex: F
Age: 32
State: CA

Vax Date: 09/06/2021
Onset Date: 09/15/2021
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: Physical examination by licensed health care provider

Allergies: None

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

Symptoms: Moderate symptoms after administration occurring between 24 hours and 48 hours post administration including fatigue and headache. 8 days post administration, numbness and tingling to right side of face developed. 11 days post administration, right flank pain and itching causing severe discomfort developed. 14 days post administration, sever right ear pain developed including vertigo and hearing loss. 19 days post administration, blistering and painful rash appeared on right flank. Following medical evaluation, etiology was determined to be herpes zoster - shingles outbreak. Blisters also visualized in right ear canal during medical evaluation. Anti-viral therapy initiated.

Other Meds: None

Current Illness: Upper Respiratory Tract Infection one week prior

ID: 1741347
Sex: M
Age: 42
State:

Vax Date: 09/27/2021
Onset Date:
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:

ID: 1741348
Sex: F
Age: 34
State: IN

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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: NKDA

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Numbness in left side of face, arm and entire left leg.

Other Meds: Vitamin D Antibiotic

Current Illness: No

ID: 1741349
Sex: F
Age: 55
State: MI

Vax Date: 04/10/2021
Onset Date: 09/27/2021
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:

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

Symptoms: Per ED Note: Patient is a 56-year-old woman with past medical history significant for diabetes, hypertension, diagnosed with COVID-19 approximately 3 days ago that presents emergency department with worsening shortness of breath. Patient denies any outright chest pain palpitations, unilateral weakness or sensory changes. Patient states that she has had worsening shortness of breath since diagnosis. Patient states everyone in her house has Covid. Patient reports that she was immunized by the fibroids are vaccine completely in April.

Other Meds:

Current Illness:

ID: 1741350
Sex: M
Age: 77
State:

Vax Date: 09/27/2021
Onset Date:
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: 1741351
Sex: M
Age: 75
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: 1741352
Sex: F
Age: 23
State: OH

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: RA

Lab Data:

Allergies:

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

Symptoms: Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Patient stated that she experienced some intermittent pain running up the side of her neck after receiving the Pfizer vaccine. The pain seemed to eventually resolve itself after some time had passed. Upon leaving, I suggested that the patient visit her MD or urget care if the issue did not resole shortly. I followed up with the patient a couple hours later, and she indicated that the pain had resolved itself and it was just a little sore.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am