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: 1741912
Sex: M
Age: 26
State: OR

Vax Date: 09/24/2021
Onset Date: 09/26/2021
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: LA

Lab Data: Blood, urine, chest x-ray to confirm just side effects from shot.

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Body aches for first 36 hours. Sweating, chills, dizziness, vomiting, shakiness, chest tightness, difficulty breathing, hand/arm numbness about 48 hours after receiving shot.

Other Meds:

Current Illness:

ID: 1741913
Sex: M
Age: 36
State: MN

Vax Date: 06/11/2021
Onset Date: 07/26/2021
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: skin biopsy and BMP, LFT, CBC etc

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient is a chemical receiver at work. This could be a possibility for his reaction. He believes it is related to vaccine. I am not fully convinced this is the case but would like to report for a possible cause. He developed skin rash during the last week of July . It started with rash on face and get escalated. His whole body is hot red with diagnose of Erythrodermic skin eruption with skin peeling. He was diagnosed of DVT on Sept 20, 2021.

Other Meds: none

Current Illness: none

ID: 1741914
Sex: F
Age: 83
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: 1741915
Sex: M
Age: 11
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: Dr. contacted 6:15 pm and left message to inform physician.

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient received vaccination at approximately 3:52pm, stood waiting for his sister and mother to receive their immunizations. Collapsed and hit head hard on floor at 3:54pm. 911 call contacted at 3:57pm with EMS en route at 4:00pm. Patient was conscious and breathing immediately after. Patient could move finger/arms and legs. Patient able to verify date and location he was at. EMS arrival at 4:10 pm. Vitals good, vision good, and Blood glucose 97. Hospital transport declined by mother who was with patient the entire time. Ice pack was given by official for bruise on head. No other pain reported by patient. Patient was able to sit up, stand, and walk away on own accord.

Other Meds:

Current Illness: none

ID: 1741916
Sex: M
Age: 67
State: MI

Vax Date: 03/17/2021
Onset Date: 08/23/2021
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: SARS-CoV-2 (COVID-19) and Influenza AB Antigens, POC: SARS CoV 2 DETECTED (8/23/2021)

Allergies:

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

Symptoms: 68 yo male with Hx HTN, alcohol pancreatitis and gout who presented as a level 2 trauma after MVA. Per EMS, pt was traveling on the hwy at hwy speeds when he rear ended another slower vehicle. Patient was tested for COVID-19 and found to be positive, then treated for pneumonia.

Other Meds:

Current Illness:

ID: 1741917
Sex: F
Age: 47
State: NY

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: latex cherries

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

Symptoms: rash, itching, itching in the throat, difficulty swallowing feeling of anxiety

Other Meds: omega 3 turmeric vitamin c zinc vitamin D

Current Illness: Behcet's disease

ID: 1741918
Sex: M
Age: 54
State: MO

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: LA

Lab Data: None

Allergies: Sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Severe headache, joint pain, fatigue, fever with chills 101.1, not responding to Tylenol 1 gram but responding to Ibuprofen 600 mg. It has been over 24 hours now.

Other Meds: None

Current Illness: None

ID: 1741919
Sex: F
Age: 75
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: 1741920
Sex: F
Age: 33
State: WA

Vax Date: 08/22/2021
Onset Date: 08/22/2021
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: 9/28/21 X Rays

Allergies: Amoxicillin Penicillin Aspirin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Severe right shoulder pain starting within a couple hours after injection. Pain is sometimes entire arm, and sometimes only in shoulder. Experiencing sharp pain. Arm experiencing numbness, tingling and pain.

Other Meds: Zyrtec Multivitamin

Current Illness: N/A

ID: 1741921
Sex: F
Age: 48
State: VA

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: No symptoms have been reported. She didn't disclose that she had receive d J&J vaccine on 3/8/2021.

Other Meds:

Current Illness:

ID: 1741922
Sex: F
Age: 26
State: HI

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: SYR
Vax Site: LA

Lab Data:

Allergies: Cephalexin Reaction: Rash

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

Symptoms: Dizziness

Other Meds:

Current Illness:

ID: 1741923
Sex: F
Age: 52
State: NJ

Vax Date: 09/13/2021
Onset Date: 09/14/2021
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: None

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Next day experienced bad pain when opening mouth in jaw area and when biting down (all on right side) , or sneezing. Dull headache right side, joint pain in right pinky finger

Other Meds: Birth control nothethin

Current Illness: None

ID: 1741924
Sex: F
Age: 79
State: NC

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

Lab Data:

Allergies: PCN, Sulfa, Morphine, Levaquin

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

Symptoms: Pain at injection site; left facial discomfort like sinus pressure; frequent urination 48 hours after vaccinations.

Other Meds: Aspirin 81mg, Atorvastatin 40mg, Levothyroxine 88mcg, Protonix 40mg

Current Illness:

ID: 1741925
Sex: M
Age: 78
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: 1741926
Sex: F
Age: 71
State: CA

Vax Date: 02/27/2021
Onset Date: 06/01/2021
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: 8-23-2021 Environmental allergen screening was unremarkable IgE was also unremarkable but 1 can still have normal labs while also having eczema 8-23-2021 I also had a Comprehensive metabolic panel, ALLERGENS, COMMON AEROALLERGEN PANEL, VITAMIN D 25 HYDROXY, CBC WITH DIFFERENTIAL. All of these came back normal or unremarkable.

Allergies: non

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

Symptoms: I had the second Pfizer vaccine in Feb. 2021. At the time I had minimal side affects. I am 71 and retired. At the end of June, I had a serious eczema outbreak. I have NEVER experienced eczema or other skin problems. I have been seeing a dermatologist since July. The outbreak has been impacting my quality of life. After following several prescribed treatments, the problem is a minimal problem now. However, there is still discomfort and new areas of outbreaks. I had had no changes in diet, environment or daily life. Have there been reports of physical affects months after receiving the Pfizer vaccine?

Other Meds: Levthyroxine 25mg,hydroxychloroquine 200mg., venlafaxine HCL ER 75 mg, Atorvastatin 40mg,, ubiquinol 100mg, Emergen-C Immune plus

Current Illness: non

ID: 1741927
Sex: F
Age: 66
State: GA

Vax Date: 08/27/2021
Onset Date: 08/30/2021
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: EKG done on

Allergies:

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

Symptoms: Mild chest pain began 3 days after 1st Covid vaccine administered. Pain has been steady and persistant. Visited doctor on 9/13/21, prescribed ibuprofen, diagnosed with inflammation of chest wall. Pain still persists.

Other Meds: levothyroxin, Centrum Silver, Vitamin C, Calcium, D3

Current Illness:

ID: 1741928
Sex: F
Age: 62
State: MD

Vax Date: 03/29/2021
Onset Date: 09/02/2021
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: I had several blood tests; EKG. They gave me a home heart monitor that I have been wearing since then and I have another week (for 30 days altogether). Still no conclusions as to what is happening.

Allergies: seem to have a new allergy to Reglan - December 2020 - is when I found that out - it caused one of my arms to go numb; mimicked stroke symptoms

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

Symptoms: That day, I was feeling kind of weak. I think I had mild headache - or just pressure in my head really. I could not walk normal. I was walking very slow. I felt very hot just before it started. I apparently fainted for a few minutes. They called an ambulance. I was first taken to the ER at a local hospital and then I was transferred to an Urgent Care. I have talked to my PCD since then and a pulmonologist; cardiologist and a neurologist since then. I will get a stress test in October. Still no conclusion as to what is causing the headaches and fainting. The pressure in my head is what has been ongoing since December 2020. In Dec 2020, I had a very, very bad headache and the Urgent care put me on medication that put me in hospital. On July, 2020 - I felt faint one day and didn't faint but ended up in the Urgent Care for that. I think I had an MRI of my head that time. I had a CT scan of my head and I think they did a did a chest x-ray, too, but not sure. The symptoms seem to be escalating and but still no diagnosis of what it is.

Other Meds: Amlodipine; Sertraline; Vit D3; Alive Multivitamin; Aleve

Current Illness: Ongoing since December 2020 - all my tests keep coming back clear - Something going on with pressure in my head; headaches.

ID: 1741929
Sex: M
Age: 51
State: WA

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: RN gave undiluted Pfizer to patient- the whole vial (6 doses)

Other Meds:

Current Illness:

ID: 1741930
Sex: F
Age: 70
State: TX

Vax Date: 08/16/2021
Onset Date: 08/17/2021
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: none

Allergies: statins

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I never have RA flareups during the heat of summer within 7 days I had 3 major flareups lasting 2 days ea. one affecting my rt leg and rt shoulder, 2nd right leg and left shoulder, 3rd neck. I increased my prednisone to 3mg, took 1 additional Tylenol, ! methocarbinol am/pm to stop reaction, low grade fever up to 100.1, iced affected joints for 3-4 hrs to take out heat. Haven't had any flare ups since returned to 1mg prednisone with 3 days after last flareup. That same week could barely walk even with a walker that I had in house left over from a knee replacement 20 years before. Had to hold onto cabinets walls to get to bathroom. Both legs felt like rubber. Right leg was already moderately compromised from a pull The first week only got out of the house once and it took a great effort to get to the car. I ate at drive through and brought food home for later. 2nd week some better but still hard to walk. 3rd week saw doctor and was walking better but still very weak. Drank protein drinks daily to increase strength. Slowing improved weekly. By 5th week close to back to normal with strength and walking before vaccination. Live alone so very difficult. Other medications include Troujo Max insulin 14units/daily, vitamin D 3,000units/day, calcium/minerals 1500 units day, Hydroxychloraquine 400mg/day Had covid August 2020 tested positive twice but had no symptoms at 60 days also had no antibodies Covid vaccinated mid Feb 2020 and 2 March 2020 Pfizer with no issue.

Other Meds: Prednisone 1mg, Enbrel, Tylenol tid, lostatin, nifedipine,

Current Illness: none

ID: 1741931
Sex: M
Age: 81
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: 1741932
Sex: F
Age: 73
State: FL

Vax Date: 09/07/2021
Onset Date: 09/08/2021
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: 2 ER visits. Electrolytes, Sodium and potassium very low

Allergies: antibiotics penicillin cephalon sporins sulfa blood thinner

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

Symptoms: Trouble standing , trouble using arms and leg . possible Guillain Barre. Cystocele went in and Retocele appaered. incontience

Other Meds: gabapentin, duloxetine, losartan ,simvastatin, zolpidem, Caltrate, oxycodone

Current Illness:

ID: 1741933
Sex: F
Age: 41
State: CA

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: Unevaluable event

Symptoms: patient states homicidal and suicidal thoughts. She has no history of depression or mental illness. "Never felt like this before."

Other Meds:

Current Illness:

ID: 1741934
Sex: F
Age: 75
State: FL

Vax Date: 09/25/2021
Onset Date: 09/26/2021
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: None

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

Symptoms: Fever of 101, chills, muscle pain, lower back pain

Other Meds: Zoloft, vitamin B12, vitaminD, magnesium, statin, vitamin K

Current Illness: Kidney stones, psoriasis

ID: 1741935
Sex: F
Age: 38
State: OH

Vax Date: 09/10/2021
Onset Date: 09/14/2021
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:

Allergies: None known

Symptom List: Injection site pain, Pain

Symptoms: Sore arm immediately following 2nd covid vaccine on 9/10. Headache started up a few days later and has not gone away. Terrible 48 hours of chills, aches beginning on 9/19. Had to leave work early. Improved slightly for a few days and am currently going through another round of chills, aches, and bad headache. Been unable to do normal activities. No energy and fatigued.

Other Meds: Birth control Spironolactone (acne)

Current Illness: None

ID: 1741936
Sex: M
Age: 62
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

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

Other Meds:

Current Illness:

ID: 1741937
Sex: M
Age: 60
State: CA

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741938
Sex: F
Age: 87
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: 1741940
Sex: F
Age: 59
State: PA

Vax Date: 03/13/2021
Onset Date: 04/30/2021
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: RA

Lab Data: I have seen a ENT, took a hearing test, no hearing deficiency at this time. No fluid or blockage in ears. Hissing/Ringing has not stopped. It's driving me crazy! ENT says several patients have Tinnitus after vaccine shots.

Allergies: Fish & Seafood

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Developed Tinnitus after second Moderna COVID-19 shot on 3/13/2021. I laid down on my right side to go to sleep on 3/13/2021 and had sudden onset of hissing/ringing in both ears.

Other Meds: Lisinopril

Current Illness: None

ID: 1741941
Sex: F
Age: 50
State: CA

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: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1741942
Sex: F
Age: 47
State: WA

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: RN gave vial of Pfizer undiluted (6 doses)

Other Meds:

Current Illness:

ID: 1741943
Sex: M
Age: 59
State: CA

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: 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: 1741944
Sex: M
Age: 60
State: CA

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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

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

Other Meds:

Current Illness:

ID: 1741945
Sex: F
Age: 57
State: AZ

Vax Date: 04/11/2021
Onset Date: 06/20/2021
Rec V Date: 09/28/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: EKG, echocardiogram, full blood panel, chest x-rays, CT scans, cardioversion.

Allergies:

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

Symptoms: I was hospitalized, I was put on IV antibiotics for pneumonia, oxygen. Rapid heart rate 174 bpm. Metoprolol, diltiazem, Eliquis. Eventually they put me on pacemaker. I'm on ENTRESTO, NATOPHEROL, warfarin. Since I have been home since the pacemaker I have felt pretty normal.

Other Meds: Levothyroxine; norethindrone; estradiol; vit d; zinc; vit c; calcium; Claritin; Allegra

Current Illness:

ID: 1741946
Sex: M
Age: 80
State: MI

Vax Date: 03/12/2021
Onset Date: 08/24/2021
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: SARS-CoV-2 (COVID-19) and Influenza AB Antigens, POC: SARS CoV 2 DETECTED (8/24/2021)

Allergies: Albuterol, Azithromycin

Symptom List: Tremor

Symptoms: 80-year-old male, who has a number of underlying comorbidities including COPD and renal insufficiency. He was admitted to Hospital after a positive COVID test. He had developed some generalized malaise with myalgias, headache, cough, and loose stool 5 days ago, which had been getting worse and presented for COVID testing after he was recently exposed to multiple sick family members. He has been previously vaccinated. On admission, he had a low-grade fever of 99.3 degrees Fahrenheit. Chest x-ray showed patchy bibasilar interstitial and airspace opacities consistent with an atypical pneumonia. His COVID-19 point of care test was positive. His initial CBC showed a white blood cell count of 5.3, hemoglobin of 11.6 and platelet count of 229,000. He initially was able to maintain normal oxygen saturation on room air, but has since required 2 L of supplemental oxygen for worsening hypoxia. Patient was treated with Remdesivir and Decadron. The patient was discharge on 8/30/2021, but was readmitted on 9/5/2021 for worsening symptoms secondary to bacterial pneumonia.

Other Meds:

Current Illness:

ID: 1741947
Sex: F
Age: 89
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: 1741948
Sex: F
Age: 31
State: GA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: None.

Allergies:

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

Symptoms: Hives covering entire body (not itchy or hurting). They are faded after 3 days. I took Benadryl that night and in the morning they were faded a little.

Other Meds:

Current Illness:

ID: 1741949
Sex: F
Age: 32
State: CA

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: 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: Dizziness, vertigo

Other Meds: Letrozole, lupron

Current Illness:

ID: 1741950
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: 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: 1741951
Sex: M
Age: 45
State: NY

Vax Date: 09/26/2021
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: Hydrocodone

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

Symptoms: Throbbing pain in my left hand, particularly between my thumb and forefinger, and general weakness when grabbing. Gradually getting better.

Other Meds: Timolol eye drops, multivitamin, flu vaccine

Current Illness:

ID: 1741952
Sex: M
Age: 62
State: CA

Vax Date: 05/03/2021
Onset Date: 07/13/2021
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: MRI Brain.

Allergies: none

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

Symptoms: Facial Palsy, patient initially went to ED, was treated with valacyclovir for Bell's Palsy. The patient followed up with us at the clinic, with no improvement. Then after PO steroids improved. Neurology was referred then as well and MRI was negative 09/2021.

Other Meds: entresto, aspirin, abilify, benazepril, coreg, escitalopram, glipizide, simvastatin, lantus, naltrexone

Current Illness:

ID: 1741953
Sex: F
Age: 67
State: OH

Vax Date: 03/29/2021
Onset Date: 04/01/2021
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: Penicillin Sulfa Drugs Keflex Belladonna

Symptom List: Pain in extremity

Symptoms: I laid down for a nap a lil after 5PM. I was laying on my right side and my left cheek started to feel strange. I went to the ER. The doctors told me I was having a TIA (small stroke). They kept me for observation. I was kept overnight for 1 day. The TIA made the left side of my body weak. I had left the ER and went back home. On April 5th Home Health Care had came to my house for physical therapy. About 6 years ago, a pile of boards had fell on my foot and broken my big toe. Eventually the toe healed up, and I didn't have any more swelling after wearing the boot. I had started to walk like normal, but when the physical therapist asked me to do an exercise to rock my feet back and forth, my right foot swelled up to the point that I couldn't walk on it. When the EMT's arrived they took me out and transferred me over to a different hospital, where I was hospitalized for 3 or 4 days. I was sent to Physical Therapy Rehabilitation on April 8th. I left the physical therapy hospital 7 days later. I had additional outpatient physical therapy for 2 months. I wore a brace on my right foot and ankle because the tendons were real stiff and kept swelling. I'm still weak on my left side and when I get out of bed in mornings I am still tired.

Other Meds: Acyclovir 400mg 1xday Remeron 45mg 1xday Lorazepam 1mg 3xday Multivitamin COQ 10 Vitamin D Theraturmin HP 600mg in morning & 1200mg at night time

Current Illness:

ID: 1741954
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: 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: 1741955
Sex: F
Age: 53
State: TX

Vax Date: 03/24/2021
Onset Date: 03/24/2021
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: Not applicable

Allergies: Avelox; amoxicillin; statins; peanuts; eggs; almonds; gluten; mold; cats; grass; yellow onions; red and gold bell peppers; shrimp; and sometimes shellfish.

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

Symptoms: I experienced a severe rash on my whole body, then both arms from my elbow are covered with a red rash, and my face. I went to see my PCP and was referred to a Dermatologist who administered a steroid shot and some topical cream to apply to the affected areas which made my arms react badly to the cream and also my face. She prescribed doxycycline and I will be taking it along with continuing to apply the new topical creams (one for my arms and one for my face) to see if that will relieve my symptoms.

Other Meds: Entresto; metoprolol; Jardiance; glipizide; vitamin B; zinc.

Current Illness: No

ID: 1741956
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741957
Sex: F
Age: 32
State: SC

Vax Date: 09/14/2021
Onset Date: 09/21/2021
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: Pineapple, shrimp (suspected)

Symptom List: Vomiting

Symptoms: Increased lymph node swelling and tenderness in left axillary and supraclavicular nodes, general malaise, chills, body aches that developed 1 week post vaccination. Symptoms in arm improved over the next 48 hrs but patient still does have Increased swelling in supraclavicular lymph nodes.

Other Meds: Lo Lo Estrin FE

Current Illness: N/A

ID: 1741958
Sex: F
Age: 74
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1741959
Sex: F
Age: 30
State: NV

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: RA

Lab Data: none

Allergies: Strawberries

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

Symptoms: Very Emotional and headache . Lasted about an hour. Throat felt like i was about to cry .

Other Meds: losartan

Current Illness: no

ID: 1741960
Sex: F
Age: 39
State: WI

Vax Date: 09/23/2021
Onset Date: 09/24/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient received vaccine Thursday, 09/23/21. Was able to go to work the next day on Friday 09/24/21 even though experiencing adverse reactions of headache, fatigue, dry mouth and a sore right arm. Later in day, during the evening hours, patient started to experience tingling or "pins and needles" in both feet. This has continued intermittently since the evening of 09/24/21 until present, when patient called vaccine provider, Tingling sensation in feet does not seem to the patient to be worse or better if at rest or walking.

Other Meds: none

Current Illness: none

ID: 1741961
Sex: M
Age: 50
State: TX

Vax Date: 02/10/2021
Onset Date: 07/29/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Admit 7/29, vaccine 1/20, 2/10. Admitted after reent EGD/colonscopy with N/V/D and blood per rectum. Tested COVID+. Hx of Type 2 DM, HTN, ESRD. Dx include PNA, Sepsis. CXR showed infiltrates, pulmonary effusion. Did not require sustained O2. Treated with steroid, antibiotics. No remdesivir d/t cirrhosis. DC'd to home.

Other Meds:

Current Illness:

ID: 1741962
Sex: M
Age: 90
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: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am