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: 1744570
Sex: M
Age: 43
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: 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: 1744571
Sex: M
Age: 73
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1744572
Sex: F
Age: 32
State: ND

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

Allergies: NA

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

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: 1744573
Sex: M
Age: 75
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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

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

Other Meds:

Current Illness:

ID: 1744575
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:
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: 1744576
Sex: F
Age: 22
State: IL

Vax Date: 11/02/2010
Onset Date: 11/12/2010
Rec V Date: 09/29/2021
Hospital: Y

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: CBC 11/18/2010

Allergies: Mango

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

Symptoms: ITP, petechiae, bruising, low platelets, had to have two rounds of dexamethasone and it took 6 months for my platelets to stabilize.

Other Meds: None

Current Illness: None

ID: 1744577
Sex: F
Age: 29
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: Pyrexia, White blood cell count decreased

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

Other Meds:

Current Illness:

ID: 1744578
Sex: F
Age: 82
State: OH

Vax Date: 02/17/2021
Onset Date: 09/17/2021
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: Rapid test positive on 9-22-2021

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: cough, fatigue, loss of taste and smell

Other Meds:

Current Illness:

ID: 1744579
Sex: F
Age: 67
State: IN

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: None

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After receiving the Pfizer COVID-19 booster, I experienced soreness of the vax site. After one day I began to have soreness in my back and knees, which at this writing is ongoing.

Other Meds:

Current Illness:

ID: 1744580
Sex: F
Age: 24
State: DC

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/29/2021
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: n/a

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received moderna vaccine in April but came in today with a different date of birth and received pfizer vaccine.

Other Meds:

Current Illness:

ID: 1744581
Sex: M
Age: 37
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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: N/A

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

Symptoms: patient was given a vaccine 1 day after the expiration date.

Other Meds: N/A

Current Illness: N/A

ID: 1744582
Sex: M
Age: 60
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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

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

Other Meds:

Current Illness:

ID: 1744583
Sex: M
Age: 60
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: N/A

Allergies:

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

Symptoms: no adverse event we are aware of. Vaccine given 1 day s/p expiration date

Other Meds:

Current Illness:

ID: 1744584
Sex: F
Age: 45
State: MN

Vax Date: 01/30/2021
Onset Date: 09/26/2021
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: 9/28 SARS/COV-2 NAAT Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1744585
Sex: M
Age: 54
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: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1744586
Sex: F
Age: 21
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1744587
Sex: M
Age: 53
State: ND

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

Allergies: NA

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

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: 1744588
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: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

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

Other Meds:

Current Illness:

ID: 1744589
Sex: F
Age: 13
State: SC

Vax Date: 09/18/2021
Onset Date: 09/18/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

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

Other Meds:

Current Illness:

ID: 1744590
Sex: F
Age: 40
State: IN

Vax Date: 09/22/2021
Onset Date: 09/22/2021
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:

Allergies: Denied

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

Symptoms: None we are aware of

Other Meds:

Current Illness:

ID: 1744591
Sex: F
Age: 72
State: OH

Vax Date: 03/29/2021
Onset Date: 09/20/2021
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: Rapid test positive on 9-20-2021

Allergies:

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

Symptoms: Fever, muscle ache, shortness of breath, nausea, vomiting, diarrhea, weakness

Other Meds:

Current Illness:

ID: 1744592
Sex: F
Age: 37
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1744593
Sex: M
Age: 28
State: TX

Vax Date: 09/08/2021
Onset Date: 09/12/2021
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: Chest x-ray, Chest CT, ECO. checked for blood clots, everything came back normal

Allergies: none

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

Symptoms: 4 days after shot: shortness of breath, numbness, chest pain. Feeling hot but no fever. still continuing as of 9/29/2021

Other Meds: Lisinopril

Current Illness: none

ID: 1744594
Sex: F
Age: 63
State: CO

Vax Date: 03/29/2021
Onset Date: 06/01/2021
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: X-ray, Echo, EKG, blood work

Allergies: Lectic, avocolada, poppy seeds

Symptom List: Injection site pain, Pain

Symptoms: I was having atrial fibrillation with uncontrol rhythm activity. I have a blood clot in my heart. I am going to be having a procedure for that. I went to the ER twice.

Other Meds: 15 different prescriptions (did not want to got through the whole list)

Current Illness:

ID: 1744595
Sex: M
Age: 57
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: 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: 1744596
Sex: M
Age: 81
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1744597
Sex: M
Age: 55
State: KY

Vax Date: 04/16/2021
Onset Date: 09/25/2021
Rec V Date: 09/29/2021
Hospital: Y

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

Lab Data: COVID19 test 9/22/21

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Hospitalization on 9/25/21 for COVID19

Other Meds:

Current Illness:

ID: 1744598
Sex: M
Age: 74
State: FL

Vax Date: 02/16/2021
Onset Date: 08/06/2021
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: Covid test, lab work.

Allergies: NKA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Pt came to ER c/o abdominal pain and distention onset 1 week prior.

Other Meds:

Current Illness:

ID: 1744599
Sex: M
Age: 85
State: MO

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:
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: 1744600
Sex: M
Age: 39
State: ME

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: Pain at injection site, fever of 101 degrees, chills, aching body. Lasted 2 days and needed ibuprofin for fever and pain management.

Other Meds: None

Current Illness: None

ID: 1744601
Sex: M
Age: 55
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: Injection site pain

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

Other Meds:

Current Illness:

ID: 1744602
Sex: M
Age: 33
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 Health facility. 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: 1744603
Sex: M
Age: 60
State: NY

Vax Date: 05/02/2021
Onset Date: 06/30/2021
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: CAT Scan, Blood test (lymes disease = results negative) Bell Palsy

Allergies: none known

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

Symptoms: Bell Palsy, still healing, pain behind right ear, sensitivity to sound, impaired speech, and currently facial muscle control.

Other Meds: Levothyroxine, pantoprazole, vitamin D, fish oil

Current Illness: none

ID: 1744604
Sex: M
Age: 54
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

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

Other Meds:

Current Illness:

ID: 1744605
Sex: F
Age: 57
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: 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:

Date Died: 09/28/2021

ID: 1744606
Sex: M
Age: 88
State: KY

Vax Date: 06/11/2021
Onset Date: 09/28/2021
Rec V Date: 09/29/2021
Hospital: Y

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: Pt died after contracting COVID in September 2021

Other Meds:

Current Illness:

ID: 1744607
Sex: F
Age: 53
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: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1744608
Sex: M
Age: 34
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1744609
Sex: F
Age: 80
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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1744610
Sex: F
Age: 18
State: CA

Vax Date: 04/01/2021
Onset Date: 04/18/2021
Rec V Date: 09/29/2021
Hospital: Y

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: NKDA

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

Symptoms: Patient is an 18 year old previously healthy young lady who on 3/11/2021 and 4/1/2021 received the first and second immunizations of the COVID-19 vaccine; Lots# EN6199 & #EP7534; respectively. Subsequently, on 4/18/2021 she began to have symptoms of muscle aches and then by 4/25/2021 muscle pain and weakness. Her mom who is a doctor ordered labwork on 5/25 testing including CBC, BMP, ESR/CRP, ANA, Iron panel, TFTs around May, which was all normal except AST/ALT elevation. Mono was negative at the time. Went to pediatrician, repeated the labs around 6/3 and performed EBV titer testing. Notable for transaminitis and EBV IgG/IGM + and elevated CK around 1700 back in May. Was diagnosed with Mono by pediatrician. Then symptoms worsen in mid-June around 6/14. At the end of June on 6/30 had additional labs performed including CBC, CMP normalized except for LFTs which were still high: AST 128, ALT 52. CK 1709. Imaging workup on 7/1/21 included Ultrasound Abdomen which showed borderline hepatomegaly, otherwise unremarkable & Ultrasound Pelvis w/o TV which showed Limited exam due to extensive bowel gas, colonic stool, inadequate bladder filling. Uterus/ovaries not visualized. Appendix not visualized. No free fluid. She also had a X-ray Chest 7/6/21 with no acute cardiopulmonary disease. Seen by Dr. on 7/9 who referred to ID & Rheum for further evaluation. Unfortunately, patient missed the 7/12 ID appointment and I do not have records of the Rheumatology appointment available for review. She was diagnosed with polymyotitis after seeing a neurologist and rheumatologist. Reportedly had anti MDA and anti NXP antibodies present suggestive of dermatomyositis. Rheumatologist thought dermatomyositis very unlikely without skin manifestations, while neurologist felt that the diagnosis of dermatomyositis was warranted. The patient was placed on prednisone 60mg daily and was tapered down over several weeks. During that time, the symptoms initially improved 20-40%. She did have diarrhea, but stool testing for Ecoli and salmonella were negative. Neurologist recommended 5 day course IVIG, which patient started 8/11, but stopped after 3 days when patient had an ER visit on 8/13 and had US Abdomen and CT Abdomen/Pelvis which showed 1. Findings are reflective of an mild enterocolitis, 2. The appendix is within normal limits, & 3. Mild free fluid present throughout the abdomen and pelvis. 10 days later, patient was given 4th dose of IVIG, but patient got abdominal pain and the 5th dose was delayed 10 days again. Subsequently, MRI: 09/08/21Diffuse edema in the skeletal muscles including the intercostal space, paraspinal muscles and pelvic muscles presenting polymyositis. She was then taken to ER on 9/12 and admitted. Labs during recent admission: 09/12/21 WBC 16.6* HGB 10.2* HCT 32.4* PLT 606* On admission, her C-reactive protein was high at 8.2 mg/dL (ref 0.5-0.9) and her ESR was high at 110 mm/hr (ref 1-20). Abdominal xray with findings suggestive of a small bowel obstruction. Admission CT showed large 20cm pelvic abscess, s/p percutaneous drain. Repeat CT showed improvement of pelvic abscess. She spent 11 days in the hospital and was discharged on 9/22. The intra-abdominal abscess was suspected to have a GI source (cultures grew E. coli and alpha hemolytic strep). Discharge diagnoses were: Pelvic abscess in female Sinus tachycardia Polymyositis Acute abdominal pain Mild protein-calorie malnutrition Leukocytosis SIRS (systemic inflammatory response syndrome) UTI (urinary tract infection) Normocytic anemia Thrombocytosis Acute colitis Associated symptoms include 15 lb weight loss since the start of her symptoms.

Other Meds:

Current Illness:

ID: 1744611
Sex: M
Age: 57
State: CA

Vax Date: 05/27/2021
Onset Date: 09/01/2021
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: None yet. Making an early report of this observation because it never was experienced before the COVID vaccine was administered, and because it is becoming chronic.

Allergies: None

Symptom List: Pain in extremity

Symptoms: Nerve twitching on my face above left corner of mouth, an almost daily occurrence that may last up to one or two minutes.

Other Meds: Valsartan, Omeprazole, Centrum silver multi-vitamin, Vitamin C, Vitamin D3

Current Illness: None

ID: 1744612
Sex: F
Age: 93
State: OH

Vax Date: 02/28/2021
Onset Date: 09/22/2021
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: PCR collected and resulted positive on 9-22-2021

Allergies:

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

Symptoms: Unknown

Other Meds:

Current Illness:

ID: 1744613
Sex: F
Age: 49
State: NY

Vax Date: 09/27/2021
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: IM
Vax Site: LA

Lab Data: None

Allergies: Unknown

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

Symptoms: Started feeling ill, starting vomiting for 27 straight hours, wheezing, was unable to keep food or water down. Unable to sit up .

Other Meds: Synthroid 75mg (once daily)

Current Illness: None

ID: 1744614
Sex: F
Age: 88
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: 1744615
Sex: M
Age: 23
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

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

Other Meds:

Current Illness:

ID: 1744616
Sex: M
Age: 61
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: 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: 1744617
Sex: F
Age: 83
State: CO

Vax Date: 09/25/2021
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: 9/29/2021 CT scan, CBC, Cardiac Enzymes, CMP

Allergies: codiene

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

Symptoms: Occipital headache, denies vision changes Epidural hematoma Non-STEMI elevated troponin Rigors

Other Meds: Lactobacillus Vitamin D Vitamin D Klor-Con Xarelto

Current Illness: Unknown new to our facility

ID: 1744618
Sex: M
Age: 52
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: 1744619
Sex: M
Age: 71
State: MI

Vax Date: 02/01/2021
Onset Date: 09/20/2021
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: RA

Lab Data: Unknown

Allergies: No Known Allergies

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

Symptoms: Increasing SOB, hypoxic, cough without sputum production.

Other Meds: Unknown

Current Illness: Unknown

ID: 1744620
Sex: F
Age: 36
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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: patient was given a vaccine 1 day after the expiration date

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am