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: 1744518
Sex: M
Age: 21
State: MO

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744519
Sex: F
Age: 36
State: OK

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: holter heart monitor and bloodwork

Allergies: Biaxin

Symptom List: Anxiety, Dyspnoea

Symptoms: Onset of symptoms started 8/28-/8/29, and worsened 8/30 to vomiting, rapid heart rate and tightness in chest, fever, fatigue, and aches. Since then heart rate has been erratic and fluttering. Symptoms seemed to ease gradually around 9/13, and are continuing to improve through the month. Heart monitor was ordered.

Other Meds: Levothyroxine

Current Illness: Bug bites - treated with permethrin 8/20/2021, first Pfizer (FC3180) vaccine 8/07/2021 - fever, fatigue, and aches

ID: 1744520
Sex: F
Age: 80
State: FL

Vax Date: 02/01/2021
Onset Date: 09/16/2021
Rec V Date: 09/29/2021
Hospital: Y

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: Not completed at this facility

Allergies: No known allergies

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

Symptoms: 09/16/2021 The patient presents with asymptomatic COVID-19. Per EMS: Pt has tested positive for COVID-19 but has no symptoms. Pt is baseline a/o x 0. EMS states pt received morphine by hospice nursing staff. The onset was unknown. Risk factors consist of hypertension and age. Therapy today: emergency medical services. Associated symptoms: Unable to obtain. Hospice nursing staff says asymptomatic.

Other Meds: Ditiazem, VIc C, Zinc, Tylenol, Enoxaparin, Metoprolol, Ondansetron

Current Illness: Unknown

ID: 1744521
Sex: F
Age: 18
State: OH

Vax Date: 04/27/2021
Onset Date: 09/04/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: Rapid at home test done and reported on 9-4-2021

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1744522
Sex: M
Age: 17
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744523
Sex: M
Age: 67
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1744524
Sex: M
Age: 80
State: MI

Vax Date: 02/15/2021
Onset Date: 09/23/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: Unknown

Allergies: Augmentin, Demerol HCI, IV dye contrast, Dander, Animal, Dust, Mildew, Trees, Gluten.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: SOB, Weakness, legs gave out, nonproductive cough.

Other Meds: Unknown

Current Illness: Unknown

ID: 1744525
Sex: M
Age: 58
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744526
Sex: M
Age: 18
State: ND

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Vaccine was found to be expired as of 8-31-21. Contacted MD. They then followed up with Moderna. Received confirmation from Moderna that vaccine given was still considered viable. No adverse outcomes noted.

Other Meds: NA

Current Illness: NA

ID: 1744527
Sex: M
Age: 89
State: FL

Vax Date: 07/17/2021
Onset Date: 09/07/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: Not yet repeated

Allergies: PCN

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 09/07/2021 The patient presents with shortness of breath. Pt with hx of COPD not on oxygen at home. Pt states he was discharged from the hospital on x5 days ago, he was COVID-19 positive. States since then he has felt increasingly short of breath. Pt was given a pulse oximeter, states PTA his O2 saturation dropped below 90% so he called EMS. The onset was 5 days ago. The course/duration of symptoms is worsening. Degree at onset mild. Degree at present moderate. The Exacerbating factors is exertion. The Relieving factors is sitting upright. Prior episodes: multiple ED visits.

Other Meds: Anoro Slipta, Dorzolamide-Timolol, Eliquis, Lantanoprost,

Current Illness: Unknown

ID: 1744528
Sex: M
Age: 20
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744529
Sex: F
Age: 35
State: SC

Vax Date: 09/20/2021
Onset Date: 09/27/2021
Rec V Date: 09/29/2021
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 so far

Allergies: Seasonal allergies to trees, grass, pollen and households allergies. erithromycin for medications

Symptom List: Rash, Urticaria

Symptoms: about a week after injection the injection site got very swollen, extremely painful, and the skin around the injection area looks similar to an infection and started a white spot and has continued to get worse and looks now like an open wound that does not bleed.

Other Meds: None

Current Illness: No illnesses

ID: 1744530
Sex: F
Age: 82
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744531
Sex: F
Age: 54
State: CA

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: None

Allergies: Allergic to shellfish, mushrooms, sulfites, dust mites, environmental allergies

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

Symptoms: Redness , pain and swelling at injection site, the size of a bar of soap. Rash under arm and Body aches

Other Meds: Type 2 diabetes medication Cholesterol medication

Current Illness: None

ID: 1744532
Sex: F
Age: 55
State: FL

Vax Date: 04/06/2021
Onset Date: 04/14/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: EKG, Eco, X-ray, Ultra sounds 4/15/21

Allergies: No

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

Symptoms: Felt heart pounding, irregular heart rate, faint feeling overall bad, ended up in hospital. I had 5 other episodes following over the next 4 months which was pounding heart in the middle of the night for no reason and feeling off-could faint feeling.

Other Meds: Birth Control Pill, Spironolactone, Krill Oil 1500mg, COQ10 200mg, Daily Vitamin

Current Illness: None

ID: 1744533
Sex: M
Age: 59
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1744534
Sex: M
Age: 52
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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:

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

Symptoms: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744535
Sex: M
Age: 30
State: VA

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: No tests

Allergies: NA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Went to bed around 830pm woke up around 10 with a migraine, chills, body aches, felt like someone was sitting on my chest, upper arm where shot was administered was super sore. Dealt with that all night and barely slept. Next morning still had a migraine and body aches worse than when I had Covid the prior month. Took an 800mg Ibuprofen and dealt with the pain all day. Went to bed and tossed an turned but got more sleep than the night before. Tuesday wasn't too bad arm was still sore and still had a migraine. Wednesday my left elbow ached all day through Thursday. Felt like my arm was in a vice.

Other Meds: Vitamin D

Current Illness: COVID 19 (Delta) and Pneumonia the beginning of August

ID: 1744536
Sex: F
Age: 42
State: FL

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: At 1pm, I received my Janssen Vaccine. Soon thereafter, I still felt tenderness at injection site. At around 9pm, I started feeling very tired, and my body ached from my neck down to my LE bilaterally; it began hurting (dull, muscle-like pain, that remained constant) until the following day 9/25/21 at 6pm when it subsided after taking 2 tabs of 500 mg of Tylenol in the morning (9/25/21 at 830am) and 1 tab of Motrin 800 mg at 430 pm 9/25/21. The evening of 9/24/21 at 1145pm, I was feeling so fatigued, I had to lay down and once I did, I began with severe chills that would not subside with warm clothing (pants, socks, sweater & thick blanquet) that lasted 1-2 hours. On 9/25/21 in the am, I had a moderate headache, intermittent, pulsating with a mild low grade fever in the evening about 630pm.

Other Meds: None

Current Illness: None

ID: 1744537
Sex: F
Age: 97
State: OH

Vax Date: 04/06/2021
Onset Date: 09/27/2021
Rec V Date: 09/29/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data: PCR collected on 9-27-2021, resulted positive

Allergies:

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

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1744538
Sex: M
Age: 70
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744539
Sex: M
Age: 68
State: MN

Vax Date: 04/02/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: Positive SARS COV 2 test by PCR

Allergies:

Symptom List: Unevaluable event

Symptoms: This case meets vaccine breakthrough criteria review. SxS include SOB, N/V, weakness, headache, chills, body aches,.

Other Meds:

Current Illness:

ID: 1744540
Sex: M
Age:
State: IN

Vax Date: 07/23/2021
Onset Date: 07/24/2021
Rec V Date: 09/29/2021
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: unknown

Allergies:

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

Symptoms: Pt reported loss of function of whole left side of body

Other Meds:

Current Illness:

ID: 1744541
Sex: M
Age: 51
State: MO

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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:

ID: 1744542
Sex: F
Age: 57
State: TX

Vax Date: 03/02/2021
Onset Date: 08/15/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: Covid Tests (x2)

Allergies: None.

Symptom List: Injection site pain, Menorrhagia

Symptoms: I was Exposed to Covid around 08/08/2021 or 08/09/2021, 5 months after vaccination. On 08/15/2021,I had a fever of 101 and I went to the Dr and I had cold like symptoms and those were the first symptoms that I got and then I went to the Dr I believe on 08/15/2021 and was diagnosed with Covid. I was also given ivermectin and a steroid and once I took those two medications all of my symptoms disappeared overnight and woke up next morning feeling better but the virus still progressed but I didn't have a cough or anything like that and lost smell and taste on day 5 or day 6. I also got covid conjunctivitis and had to go back to Dr and get eye drops. It lasted 10-14 days. Towards the end I got the brain fog and I didn't feel like myself, but the beginning I had fever, cold like symptoms, lost smell on day 5 or 6, and day 7 I ended up going back to Dr because of the conjunctivitis. Then towards the end, maybe day 10-14, I got the brain fog and I didn't feel like myself and by day 14 it was starting to go away and my sense of taste and smell all came back, but when I went back to Dr on day 7 they tested me again and I still tested positive. I did have a runny nose that was like allergy type symptoms, a little bit of a sore throat but not bad. The fever brought me to the doctor and sore throat because I thought I had strep throat.

Other Meds: Synthroid daily, Multivitamin, Vitamin D, Zinc, Vitamin C.

Current Illness: None.

ID: 1744543
Sex: M
Age: 27
State: IN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 09/29/2021
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: none we are aware of

Other Meds:

Current Illness:

ID: 1744544
Sex: F
Age: 60
State: FL

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/29/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Friday 09/24/21 I woke up with sore throat, congested nose and ear on right side, Fever 101.2, chills, body aches, headache, fatigue, pain in right arm after vaccine lasted two days. Took Ibuprofen and rested. Did not go to work. On Monday 09/27/21 started with Vice grip type headache in afternoon, pain level 10/10 (0-no pain/10 - worst pain) . Took OTC Migraine medicine , didn't help. Took Fioricet and Sumatriptan. slept somewhat and woke up with headache pain 3/10 . Went to work on Monday. On Tuesday 09/28/21 began with severe headache again in the late afternoon after work, pain level 10/10 and all through the night and into morning. I took Ibuprofen, which didn't help. Since migraine meds didn't help much the day before I then took oxycodone, little relief so I took migraine meds- Fioricet and Sumatriptan, put ice to forehead and back of head and drank coffee 0430 on09/29/21. Pain subsided (2/10) enough to go to work. Still with a nagging discomfort at back of my head at 1055 09/29/21. 2-3/10

Other Meds: Cosentyx, Sulfasalazine, Flexeril, Atorvastatin, Atenolol, Cevimeline, Restasis, Vitamin D3, Probiotic, Magnesium, Vitamin C, Calcium, Multivitamin, Prolia, Tramadol, Sumatriptan, Nortriptyline, Gabapentin, Blink lubricating eye drops, Syst

Current Illness: None

ID: 1744545
Sex: M
Age: 66
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744546
Sex: F
Age: 50
State:

Vax Date: 01/21/2021
Onset Date: 09/24/2021
Rec V Date: 09/29/2021
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: Covid test 9/26/21 Positive test result 9/28/21

Allergies: Nickel Penecillin Gluten intolerance

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

Symptoms: Muscle aches

Other Meds: Oxtellar before switched to lithium etc.

Current Illness:

ID: 1744547
Sex: F
Age: 52
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744549
Sex: F
Age: 38
State: MN

Vax Date: 01/13/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: 9/28 SARS/COV-2, NAAT, Positive

Allergies:

Symptom List: Injection site pain

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1744550
Sex: F
Age: 55
State: ND

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: NA

Allergies: NA

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

Symptoms: Vaccine was found to be expired as of 8-31-21. Contacted State Health. They then followed up with Moderna. Received confirmation from Moderna that vaccine given was still considered viable. No adverse outcomes noted.

Other Meds: NA

Current Illness: NA

ID: 1744551
Sex: M
Age: 38
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744552
Sex: M
Age: 43
State: NJ

Vax Date: 02/10/2021
Onset Date: 07/26/2021
Rec V Date: 09/29/2021
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: - Cardiac MRI - CT Angiogram - Orthostatic Tile Table Test - CT Lungs - MRI Brain - Endoscopy & Colonscopy - Ultrasound Abdomen - Ultrasound Kidneys - Pulmonary Function Test/Spirometry - Thyroid Panel - Catecholomines - Metanephrines - Serum Tyrptase - 5HIAA - CBC w/differential - Allergy panel (blood and skin) All tests are normal

Allergies: None

Symptom List: Tremor

Symptoms: - New, random, and episodic flushing in face and neck (never experienced before) that can last for hours - Unprovoked variability in resting heart rate and blood pressure - Chest discomfort - Dyspnea - Brain fog

Other Meds: Synthroid 88 MCG, Symbicort Inhaler, New Chapter Men's 40+ Multivitamin, Nordic Naturals Omega 3 Fish Oil

Current Illness: None

ID: 1744553
Sex: F
Age: 89
State: NC

Vax Date: 03/30/2021
Onset Date: 04/10/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: CT Code Stroke Head wo IV Contract - 4/10/21 POCT ISTAT GEN PNL 4/10/21 PTT 4/10/21 PROTIME-INR 4/10/21 TROPONIN T 4/10/21 BASIC METABOLIC PANEL 4/10/21 CBC WITH DIFFERENTIAL 4/10/21 CT CODE STROKE HEAD HECK ANGIO 4/10/21 ECG 12-LEAD 4/10/21 POCT GLUCOSE 4/10/21 MRI HEAD WO IV CONTRAST 4/10/21 ECG 12-LEAD 4/10/21 XR CHEST AP PORTABLE 4/10/21 LIPID PANEL 4/11/21 TSH 4/11/21 COMPREHENSIVE METABOLIC PANEL 4/11/21 CBC 4/11/21 HEMOGLOBIN A1C 4/11/21 CT CHEST WO IV CONTRACT 4/11/21 VITAMIN B1, WHOLE BLOOD 4/12/21 FOLATE 4/12/21 VITAMIN C 25 HYDROXY 4/12/21 VITAMIN B12 4/12/21 PHOSPHORUS 4/12/21 MAGNESIUM 4/12/21 BASIC METABOLIC PANEL 4/12/21 POCT GLUCOSE 4/12/21 ECHOCARDIOGRAM 4/12/21 CT HEAD WO IV CONTRACT 4/12/21 PHOSPHORUS 4/14/21 MAGNESIUM 4/14/21 (MUCH MORE BUT MY TIME FILLING THIS OUT IS RUNNING OUT IN 5 MINUTES)

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Patient had a Stroke, acute, thrombotic on 4/10/21 (10 days after receiving the Moderna vaccine) Patient was given Tylonol 325mg, Zyloprim 100mg, Atorvastatin 40mg, Colchicine 0.6mg, Docusate Sosium 100mg. Patient was released to a Physical Therapy facility to begin therapy to try and walk again and patient needs speech therapy as well. Note: While in hospital, patient also developed gout in left hand. Patient ended up falling and breaking her hip at the Rehabilitation Facility in which she was released to and had to come back to Hospital for a full hip replacement. After the hip replacement surgery, patient had several more strokes and developed pneumonia. It was noted on her chart also that she seems to have Linear Nodular Thickening within the lung apices as well as small pulmonary nodules. There are some scattered areas of groundglass density which are nonspecific, possibly related to atelectasis infectious/inflammatory process.

Other Meds: donepezil HCI (Aricept) 5mg Lisinopril-hydrochlorothiazide(Prinzide,Zestoretic)20-12.5mg Vitamin D3 1000iu Omega-3 Fatty Acids (Fish Oil) 1200 mg

Current Illness:

ID: 1744554
Sex: M
Age: 75
State: MO

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744556
Sex: M
Age: 25
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744557
Sex: F
Age: 80
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744558
Sex: F
Age: 40
State: OH

Vax Date: 01/23/2021
Onset Date: 09/10/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: PCR collected on 9-14-2021, resulted positive on 9-15-2021

Allergies:

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

Symptoms: muscle aches, runny nose, cough, headache, fatigue, loss of taste and smell, congestion

Other Meds:

Current Illness:

ID: 1744559
Sex: F
Age: 70
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744560
Sex: F
Age: 41
State: IL

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data:

Allergies: NO

Symptom List: Pain in extremity

Symptoms: Headaches - Migraines still going on now 6 months later, never had them before Running/restless leg can't sleep at night

Other Meds: Daily Vitamin

Current Illness: NOne

ID: 1744561
Sex: M
Age: 56
State: DE

Vax Date: 05/01/2021
Onset Date: 05/29/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Continual Trouble breathing unexpectedly. Haven't been able to elevate my heart rate like prior to vaccine. This is ongoing since vaccination

Other Meds: Amlodipine

Current Illness: None

ID: 1744562
Sex: F
Age: 31
State: CA

Vax Date: 03/29/2021
Onset Date: 07/06/2021
Rec V Date: 09/29/2021
Hospital:

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

Lab Data: Heart Stress test - Dr ordered it - July 8th and test results on August 2nd. -Incomplete right bundle branch block; borderline ECG Chest x-ray - everything came back normal for me on that - July 8th

Allergies: Gluten, peanuts (may have grown out of peanut allergy).

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

Symptoms: Starting on July 6th, I started experiencing chest pain: shooting chest pain from left ear and down my left arm. I was also having heart palpitations. With exertion, the chest pain would get worse. Overtime, 2-3 weeks later, the shooting pain became much more infrequent and eventually stopped. But I was having continuing chest palpitations when I was exerting myself physically. The shooting pain and heart palpitations (one or the other) has popped up a couple of times since, but nothing with that initial pain and it is lasting for a shorter duration. I am way more likely to experience it when I am exerting myself but it can even happen when I am laying on the couch. No treatment - after I got my test results, the doctor said that everything seems kind of normal so we won't do anything about it. It doesn't seem normal to me.

Other Meds: Gabepentin, femynor

Current Illness: No. General positive tests for antinuclear antibodies and other nonspecific autoimmune results (10+ years).

ID: 1744563
Sex: F
Age: 64
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744564
Sex: M
Age: 68
State: GA

Vax Date: 03/01/2021
Onset Date: 09/23/2021
Rec V Date: 09/29/2021
Hospital: Y

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: Patient hospitalized for 1 day due to COVID-19. He is fully vaccinated. Patient had fever, chills, cough, SOB, fatigue, headache

Other Meds:

Current Illness:

ID: 1744565
Sex: M
Age: 15
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744566
Sex: M
Age: 76
State: SC

Vax Date: 09/27/2021
Onset Date: 09/29/2021
Rec V Date: 09/29/2021
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: No known allergies

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

Symptoms: Itching, swelling, redness, warm

Other Meds:

Current Illness: None

ID: 1744567
Sex: M
Age: 51
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
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: 1744568
Sex: U
Age: 15
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 09/29/2021
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: Vaccine was reconstituted with sterile water instead of normal saline.

Other Meds:

Current Illness:

ID: 1744569
Sex: F
Age: 69
State: OH

Vax Date: 03/25/2021
Onset Date: 09/22/2021
Rec V Date: 09/29/2021
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: unknown

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am