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: 1744622
Sex: U
Age: 22
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

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

Other Meds:

Current Illness:

ID: 1744623
Sex: M
Age: 58
State: MN

Vax Date: 09/23/2021
Onset Date: 09/26/2021
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: 9/23/21: Abnormal pressure headache, improving 9/24/21: Red itchy spots on arms/hands, feet/ankles, stomach, getting worse Also reports tight ankle, both wrists, and joint pain On 9/28/21: pharmacist advised oral and topical antihistamines

Other Meds:

Current Illness:

ID: 1744624
Sex: M
Age: 64
State:

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

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: 1744625
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: 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: 1744626
Sex: M
Age: 27
State: FL

Vax Date: 06/01/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: Covid test, cxr.

Allergies: NKA

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

Symptoms: Pt came to ER c/o weakness and dizziness x 2days.

Other Meds:

Current Illness:

ID: 1744627
Sex: F
Age: 73
State: MO

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: 1744628
Sex: F
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: 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: 1744629
Sex: F
Age: 46
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: 1744630
Sex: F
Age: 86
State: OH

Vax Date: 02/26/2021
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: PCR collected on 9-27-2021, positive

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: unknown

Other Meds:

Current Illness:

ID: 1744631
Sex: M
Age: 70
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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1744632
Sex: M
Age: 58
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: 1744633
Sex: F
Age: 31
State: WI

Vax Date: 03/21/2021
Onset Date: 06/27/2021
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: MRI - and I had two MRAs. - UW

Allergies: Sulfa

Symptom List: Rash, Urticaria

Symptoms: On June 27th, I had Oculosympathetic Palsy and found out I had an aneurism in my neck and dissected my left vertebral artery. I had multiple MRAs and am also on a baby aspirin for life now. I went to the ER at the hospital when I had this occur. Note, I had my DTAP vaccine; it was about 2-3 weeks after my 2nd dose of COVID vaccine. Pregnancy history, third; and all three born during C-section; this one's date of birth June 21st; 9 lbs and 6 ounces.

Other Meds: Prenatal; magnesium supplement; baby aspirin

Current Illness: No

ID: 1744634
Sex: F
Age: 60
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: 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: 1744635
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: 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: 1744636
Sex: F
Age: 35
State: ME

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: BP: 128/98mmHg left arm, sitting

Allergies:

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

Symptoms: About 10 minutes after vaccination the patient experienced lightheadedness and tingling along the right side of her body (the side which was injected) from face to foot. After another 20 minutes the patient said she was starting to feel better but definitely still tingly. Recommended she see doctor to evaluate.

Other Meds:

Current Illness:

ID: 1744637
Sex: F
Age: 23
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: NA

Allergies: NA

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

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. ESTIMATED DATE OF DELIVERY: 10-2021, NORMAL PREGNANCY

Other Meds: NA

Current Illness: NA

ID: 1744638
Sex: M
Age: 14
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: 1744639
Sex: F
Age: 51
State: PA

Vax Date: 02/17/2021
Onset Date: 03/03/2021
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: Penicillin, Amantadine, Ginger

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 2 weeks after shot #1. Redness & bruising at injection site. Red welt was warm to the touch, swollen, about 3" diameter - kind of egg shaped. Bruising in the center. Muscle sore for a couple days. Welt temperature returned to normal after about 3 days. Redness lasted a few days longer, gradually fading.

Other Meds: Aimovig, Levothyoxine, Imitrex

Current Illness:

ID: 1744640
Sex: U
Age: 93
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Administration error: Mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1744641
Sex: F
Age: 34
State: NC

Vax Date: 03/27/2021
Onset Date: 04/02/2021
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: Ultrasound & Endometrial biopsy

Allergies: None

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

Symptoms: Early, heavy period with clots. Cycle went from 25-26 days to 14 days. First period after second shot came 1 week early and was very heavy and lasted 2 days longer than normal. Experienced 3 periods in April the month following the second dose. After that, 2 periods per month and bleeding through super tampons and overnight maxi pads every 2-3 hours with gelatinous blood clots. Experienced lethargy 1-2 days before cycle and during the cycle. Now 7 months after my second dose, My cycle length is back to normal 25-26 days, but the heaviness of the period is still very extreme and heavy with clots. My Obgyn performed an ultrasound and endometrial biopsy to rule out any complications causing the heavy bleeding, that biopsy and ultrasound was normal.

Other Meds: Prenatal vitamin, Vitamin D

Current Illness: None

ID: 1744642
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: 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: 1744643
Sex: M
Age: 55
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: 1744644
Sex: F
Age: 44
State: SC

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

Allergies:

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

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

Other Meds:

Current Illness:

Date Died: 08/19/2021

ID: 1744645
Sex: M
Age: 88
State: OH

Vax Date: 01/19/2021
Onset Date: 08/19/2021
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: unknown

Other Meds:

Current Illness:

ID: 1744646
Sex: F
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:
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: 1744647
Sex: M
Age: 59
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: no

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

Symptoms: None we are aware of

Other Meds:

Current Illness: no

ID: 1744648
Sex: F
Age: 38
State: IN

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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:

Allergies: Gabapentin, Penicillins, Promethazine, Tramadol, Zolpidem Tartrate

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient developed a severe migraine, patient has had the migraine every day since the injection of the vaccine. Also patient has had trouble sleeping since the injection of the vaccine.

Other Meds: Mobic 15 mg, Potassium CL ER 10 MEQ capsule, Furosemide

Current Illness: n/a

ID: 1744649
Sex: F
Age: 33
State: NC

Vax Date: 09/03/2021
Onset Date: 09/20/2021
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: Started to get bad headace's that would last 2-3 day's about 2 wks ago. I never had this problem before.

Other Meds:

Current Illness: Nothing

ID: 1744650
Sex: M
Age: 61
State:

Vax Date: 09/28/2021
Onset Date:
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: 1744651
Sex: F
Age: 69
State: AR

Vax Date: 03/03/2021
Onset Date: 09/26/2021
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:

Allergies:

Symptom List: Nausea

Symptoms: Hospitalized with Covid-19 after full vaccination

Other Meds:

Current Illness:

ID: 1744652
Sex: M
Age: 66
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: 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: 1744653
Sex: F
Age: 77
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 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: 1744654
Sex: F
Age: 25
State:

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

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

Symptoms: received the first covid shot on 9/27/2021 at 815AM. I began having symptoms on 9/28/2021 at midnight. my symptoms include: left side chest pain, tingly fingers/legs/toes, severe body aches, severe headache and dizziness, shivering, chills, sweating, could not move from my bed, plugged ears, severe exhaustion. I was not sick at the time of vaccine nor was I around anyone that had been sick. I am a very healthy person, and currently not on any medications. I tried taking Tylenol every 4 hours, and that did not help with anything.

Other Meds: none

Current Illness: none

ID: 1744655
Sex: M
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: 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: 1744656
Sex: F
Age: 40
State: MA

Vax Date: 04/01/2021
Onset Date: 05/01/2021
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: Following my second covid vaccine my menstrual cycle was irregular for 2 months. During the month of May, I had two menstrual cycles and during the month of June it arrived 5 days early.

Other Meds: Zoloft

Current Illness:

ID: 1744657
Sex: F
Age: 30
State: GA

Vax Date: 03/01/2021
Onset Date: 09/15/2021
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: PCR 9/21/21

Allergies: Bactrim - Hives

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

Symptoms: on 9/15/2021 the following symptoms started : cough, nasal congestion, rhinorrhea, fever, chills, sweats, loss of smell and taste, headaches, abd pain, nausea, diarrhea, light headedness, SOB, fatigue, weak, tired

Other Meds: N/A

Current Illness: N/A

ID: 1744658
Sex: F
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: 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: 1744659
Sex: M
Age: 42
State:

Vax Date: 09/28/2021
Onset Date:
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: 1744660
Sex: F
Age: 46
State:

Vax Date: 02/03/2021
Onset Date: 02/04/2021
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: none

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

Symptoms: The next day started with severe headache, myalgias, arthralgias. Then following day started with nuchal rigidity, photosensitivity and sound sensitivity. I had aseptic meningitis and required oral corticosteroids because Advil 800mg every 6 hours and Tylenol Q4 hours did not help. It took 1 month before my headaches resolved.

Other Meds: none

Current Illness: none

ID: 1744661
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: 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: A vial of a previously diluted and mostly empty vaccine was diluted with saline instead of a new vial and accidentally assumed to be the correctly concentrated vaccine. Thus, the patient was given an extremely diluted vaccine that was mostly saline instead of the correct concentration of the vaccine. The error was discovered approximately one hour after vaccination and an offer to revaccinate with the booster dose 3 will be given.

Other Meds:

Current Illness:

ID: 1744662
Sex: M
Age: 82
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: CT head wiht bilateral hemispheric mixed density extra-axial fluid collection. presence of focal subarachnoid hemorrhage about the parietal region cannot be excluded but unchanged from comparison examination. RBC's 5.71, HGB 17.5, HCT 54.2, PLT 136

Allergies: Amphotericin B, Boric Acid, Chloramphenicol, Neomycin, Sulfonamide Antibiotics, Sulfanilamide, Tixocortol Pivalate

Symptom List: Pain in extremity

Symptoms: Patient presented to ER with c/o generalized weakness, syncopal episode while in shower

Other Meds: Cabergoline, Losartan, Amlodipine, Cetirizine, Baby aspirin

Current Illness: None noted

ID: 1744663
Sex: M
Age: 69
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: 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: 1744664
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Client came in today to receive the pfizer vaccine. After receiving the vaccine, it was noted that she changed her date of birth. She previusly used 01/20/1997 instead of 01/30/1997 which she used today. She previously got moderna on 04/06/2021. No side effects reported here presently.

Other Meds:

Current Illness:

ID: 1744665
Sex: U
Age: 70
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1744666
Sex: M
Age: 56
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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

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

Other Meds:

Current Illness:

ID: 1744667
Sex: M
Age: 23
State: WA

Vax Date: 09/12/2021
Onset Date: 09/25/2021
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: n/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient developed chest pain and was evaluated in the ED. After work-up, diagnosis of pericarditis was given.

Other Meds: Using cannabis

Current Illness: n/a

ID: 1744668
Sex: M
Age: 56
State: NH

Vax Date: 05/18/2021
Onset Date: 07/06/2021
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: listed above

Allergies: none known

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

Symptoms: Initial event 7/6/2021 - Dizzy, nausea, couldn't catch breath, ssweaty, clammy, pale, increased heart rate Continued to have shortness of breath / easily winded. PCP visit 7/29/2021 - had planned on discussing shortness of breath, while waiting to go into the appointment noticed along with a tightness in L leg- there was considerable swelling in calf. PCP's reaction was immediate referral to ER. With CT scan, ultrasound and thorough eval including bloodwork was Dx DVT w/ PE in both lungs. Apixaban Prescribed and is currently still taking this.

Other Meds: Allopurinal 300mg Atenolol50mg Escitalopram 10mg Olanzapine 2.5mg VitD3 5000IU CPAP

Current Illness: none

ID: 1744669
Sex: F
Age: 63
State: PA

Vax Date: 09/24/2021
Onset Date: 09/25/2021
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: Hypersensitivity to narcotics

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe frontal headaches, ataxia, chills, diaphoretic, forehead warm to touch, but afebrile. Anything that I put in mouth went straight through bowels. Nausea,starting 12 hours after injection, has continued for 5. Days. Am now in ED for eval for dehydration

Other Meds: Synthroid, mobic, tylenol, cymbalta

Current Illness: None

ID: 1744670
Sex: M
Age: 29
State: OH

Vax Date: 04/11/2021
Onset Date: 06/19/2021
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: 3hr Troponin 6/21/21 of 514 -> 529 (4%) -> 587 (14%). CK 6/21/21 of 223 CBC/BMP on 6/21/21 unremarkable outside of WBC 14.9 at time of NSTEMI D-dimer 6/21/21 of <0.27 (normal) ECG 6/21/21 sinus tachycardia (HR 107), abnormal QRS-T angle CT aortic dissection protocol 6/21/21 non-acute Cardiac Cath: -1. Markedly elevated left ventricular end-diastolic pressure. -2. Normal left anterior descending and right and dominant right coronary arteries. -3. Minimal (<20%) coronary artery disease of the circumflex artery. -4. Severe diffuse hypokinesis of left ventricle. Estimated ejection fraction of 30% to 35%. -5. No significant mitral regurgitation. -6. Insignificant 9 mm gradient across the aortic valve ECHO 6/22/2021: Normal left ventricle size. Mild left ventricular hypertrophy. Moderate left ventricular systolic dysfunction. The ejection fraction, measured by Simpsons method, is 40 %. EF is reduced globally with no discrete regional wall motion abnormality. Normal diastolic left ventricular function. Mild enlargement of the left atrium. Mild mitral valve regurgitation. No mitral valve stenosis. TSH/fT4/Mg 6/22/21 all normal

Allergies: Tdap (fever)

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

Symptoms: Moderna COVID shot 1 given 3/13/21 and shot 2 given 4/11/21. Patient developed some vague back pain for last 2 days starting 6/19/21 intermittently between the shoulder blades. Patient states in last 24 hours he noticed increasing shortness of breath and shoulder pain worsened with exertion. Patient was found to have suspected myocarditis induced NSTEMI + Heart Failure with Reduced Ejection Fraction to 40%. Patient now requires several medications including ASA, carvedilol, lisinopril, KCl, and ivabradine. Patient only other past medical is obesity (BMI ~45), and family hx of elderly onset CAD of a maternal grandfather who smoked.

Other Meds: None

Current Illness: None

ID: 1744671
Sex: M
Age: 69
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: 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