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: 1744723
Sex: M
Age: 34
State:

Vax Date: 07/21/2021
Onset Date: 07/28/2021
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: Tinnitus (ringing in ears) Slowly got better after 30 days but still persists.

Other Meds: Nexium

Current Illness:

ID: 1744724
Sex: M
Age: 72
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1744725
Sex: M
Age: 60
State: VA

Vax Date: 08/05/2021
Onset Date: 08/05/2021
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:

Allergies: n/a

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

Symptoms: Patient recvd Janssen on 3/20/21

Other Meds: n/a

Current Illness: n/a

ID: 1744726
Sex: F
Age: 85
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: 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: 1744727
Sex: M
Age: 61
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:
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: 1744728
Sex: F
Age: 89
State: CA

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: 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: 1744729
Sex: F
Age: 54
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: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: felt a lump and warmth at the injection site on 09/28 in the afternoon and 09/29 there was redness.

Other Meds:

Current Illness:

ID: 1744730
Sex: M
Age: 73
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: 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: 1744731
Sex: F
Age: 64
State: TN

Vax Date: 04/26/2021
Onset Date: 05/10/2021
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: Cervical CT w/ contrast, neurological evaluation, neurosurgical evaluation, blood work

Allergies: Biaxin, Seroiquel, Geodon, Lamictal

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Tingling and numbness in both arms, hand went numb, feet went numb . Horrible pain and numbness in spine, affected all the nerves in body. Very limited mobility, affecting bodily function. 16 days after first hospital stay, was re-admitted into hospital. Second hospital stay lasted one week. Given antibiotics Recommended further testing, no diagnosis given. Feels vaccine activated something that it shouldn't have, "almost killed her."

Other Meds: Prozac, Linisipril, Nexium, Adderral, Clonazetam, Hydroprodone

Current Illness: None

ID: 1744732
Sex: F
Age: 61
State: PA

Vax Date: 03/07/2021
Onset Date: 03/13/2021
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: Hearing test.

Allergies: No

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I started experiencing a hissing sound louder in the right ear than the left. At night when I'm sleeping the sound becomes louder; this started after first vaccine. I went to the doctor in May got my right ear drained. I waited a couple of weeks to see if the hissing sound would leave. It didn't go away I was referred to ENT. I was given a hearing test diagnosed with Tinnitus. Also said might be due to age I have a little bit of hearing loss. I was informed by the doctor to play noises off my phone app to help me sleep.

Other Meds: No

Current Illness: No

ID: 1744733
Sex: F
Age: 36
State: IN

Vax Date: 09/22/2021
Onset Date: 09/23/2021
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: NA

Allergies: NKA

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

Symptoms: For the first day after my 2nd dose of the vaccine, I experienced a constant itching all over my body. I also felt like fire was shooting through my body randomly throughout the day. I am not allergic to anything but felt like the itching was that of an allergic reaction.

Other Meds: None, the only medication I take is Imitrex but had not taken it at time of vaccination or day after.

Current Illness: NA

ID: 1744734
Sex: F
Age: 70
State: MA

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 09/29/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: CT Scan and MRI

Allergies: Comtrex Cold-Cough lisinopri

Symptom List: Rash, Urticaria

Symptoms: palpitation, reversible loss of vision

Other Meds: Adult Low Dose Aspirin clopidogrel Crestor famotidine fluconazole Imodium pantoprazole ProAir HFA Prolia

Current Illness:

ID: 1744735
Sex: M
Age: 64
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: 1744736
Sex: M
Age: 67
State: OK

Vax Date: 01/10/2021
Onset Date: 06/01/2021
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: Left heart catheterization Transthoracic echocardiogram CBC, CMP, Lipids

Allergies: Codiene

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

Symptoms: Diagnosed with unexpected coronary artery disease requiring 5-vessel CABG on 07/03/2021. Minimal classic risk factors: age & gender only. Non-smoker, no diabetes, last total cholesterol 172 in March 2021, SBP ~ 130?s-140?s.

Other Meds: Omeprazole 20 mg 1 hs, Tamsulosin 0.4 mg 2 hs, Loratidine 10 mg 1 qd, Docusate sodium 100 mg 2 hs, Testosterone Gel 1% 50 mg applied daily, Vitamin D 5000 IU 1 qod, Centrum Silver 1 qd, Fluticasone nasal spray 2 sprays per nostril once dai

Current Illness: None

ID: 1744737
Sex: F
Age: 92
State: WV

Vax Date: 01/10/2021
Onset Date: 04/08/2021
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: Unknown

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

Symptoms: Numbness lips, tongue at night. Provider took off BP meds but asked her to have us do a VAERS report

Other Meds: Metaprople

Current Illness: HTN

ID: 1744738
Sex: F
Age: 63
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1744739
Sex: F
Age: 85
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: 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: 1744740
Sex: F
Age: 70
State: CA

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

Allergies: skin allergies to dyes, fragrances, chemicals

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I started with severe chills and fever of 101.4, and nausea during the night about 15 hours after the vaccination. Within a few hours I was so weak I couldn't get out of bed by myself. When my husband helped me up, I started to black out. He got me to the bathroom and I couldn't sit up on the toilet by myself and became so nauseated I got the dry heaves. My husband was holding me up and trying to keep me from going completely unconscious. He gave me a wet washcloth to put on my face, but I was to weak to hold it myself. I became drenched in sweat. Once my husband got me back to bed, I fell asleep and dry heaves stopped. I took Tylenol for the fever and that reduced my fever. I slept through that day and night and the next day I felt fatigued and nauseated, but not so weak and the fever was reduced significantly.

Other Meds: calcium; iron; famotidine; Tylenol

Current Illness: none

ID: 1744741
Sex: F
Age: 42
State: MO

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: 1744743
Sex: F
Age: 32
State: KY

Vax Date: 09/09/2021
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: unknown

Allergies: UNKNOWN

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

Symptoms: Developed Bells Palsy facial dropping and difficulty speaking started on 9/22/2021

Other Meds:

Current Illness: UNKNOWN

ID: 1744744
Sex: M
Age: 69
State: FL

Vax Date: 03/03/2021
Onset Date: 08/06/2021
Rec V Date: 09/29/2021
Hospital: Y

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: UA, labs, covid test.

Allergies: Iodine, NSAIDs, shellfish

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

Symptoms: Pt came to ER c/o weakness, SOB, exertional dyspnea. Onset 3 days ago.

Other Meds:

Current Illness:

ID: 1744745
Sex: M
Age: 47
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: Unevaluable event

Symptoms: Administration error mixed series mRNA vaccine Pfizer and moderna

Other Meds:

Current Illness:

ID: 1744746
Sex: M
Age: 37
State: FL

Vax Date: 05/11/2021
Onset Date: 05/13/2021
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: CBC, CMP, HgA1c, and serial HIV testing (4x) were all WNL. Testing was also done to rule out autoimmune illness however he cannot recall exact tests which were performed - he states all were WNL.

Allergies: cefaclor (rash)

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

Symptoms: He had body aches and fatigue for 2 days following second dose. on day three developed oral candidiasis difluconazole tx x 2 weeks of 200mg qd - resolved and then came back, tx with another week of difluconazole 200mg qd Infection now "comes and goes" "geographic tongue, bad taste" - denies pain.

Other Meds: Meloxicam 15mg daily Amphetamine Resin Complex 15mg daily

Current Illness: none

ID: 1744747
Sex: M
Age: 59
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: 1744748
Sex: M
Age: 28
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: SYR
Vax Site: LA

Lab Data: Went to walk-in clinic 09/29/21 0900 , they tested my blood pressure , O2 levels 100% , tested me for covid - negative . Preformed an EKG and a more depth blood pressure test , can?t remember what they called it . Everything came back fine , they said it was most likely adverse side effects from the vaccine .

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: That night a headache , next day same headache with slight aches and pains fatigue , next morning 0400 exhaustion , lightheaded , dizziness , confusion , and fainting .

Other Meds: Adderall

Current Illness:

ID: 1744749
Sex: F
Age: 30
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: A vial of a previously diluted and mostly empty vaccine was diluted with saline (instead of a new vial). Accidentally assumed to be the correctly concentrated vaccine. Thus, 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. Offered to revaccinate with the booster dose 3.

Other Meds:

Current Illness:

ID: 1744750
Sex: F
Age: 57
State: NC

Vax Date: 09/18/2021
Onset Date: 09/27/2021
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: 9/28/2021 MRI brain?embolic appearing infarcts in the distal left MCA territory.

Allergies: Naproxen Prednisone

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: concerns of right-sided facial and upper extremity numbness. 09/27/202110 AM she noted acute right-sided lip and cheek numbness and right upper extremity numbness. This lasted for about several minutes but currently she still has residual numbness to her right fourth and fifth digit. Also had increased salivation and some myalgias since receiving the vaccine.

Other Meds:

Current Illness: none

ID: 1744751
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:
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: 1744752
Sex: M
Age: 73
State:

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: 1744753
Sex: M
Age: 56
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

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

Other Meds:

Current Illness:

ID: 1744754
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

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

Other Meds:

Current Illness:

ID: 1744755
Sex: M
Age: 73
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: 1744756
Sex: F
Age: 85
State: CA

Vax Date: 05/02/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: mild cough but no chest pain, shortness of breath, abdominal pain, urinary symptoms, emesis, headache

Other Meds:

Current Illness:

ID: 1744757
Sex: F
Age: 62
State: NC

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: Physical assessment, HR

Allergies: none stated

Symptom List: Tremor

Symptoms: PT STATED SHE HAS HISTORY OF "FAINTING" EVERY TIME SHE GETS INJECTIONS. Pt placed in reclining chair for administration. Pt experienced brief vaso-vagal response; closed eyes for less than 30 seconds. Pt regained full consciousness with no injury. Normal HR.

Other Meds: unknown

Current Illness: unknown, none stated

ID: 1744758
Sex: F
Age: 34
State: KS

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: No severe allergies reported.

Symptom List: Erythema, Pruritus

Symptoms: 9 minutes after injection complained of a pounding headache and dizziness. Given juice to drink that didn't help. Complained of tongue feeling weird. Denied shortness of breath. Transported to ER via transport chair. On way to ER complained of chest pressure in the middle of her chest. Report given to RN in ER. Left in care of ER staff about 15 minutes after injection.

Other Meds: Unknown

Current Illness: Not sick at time of vaccination. Prior history unknown.

ID: 1744759
Sex: F
Age: 14
State: FL

Vax Date: 08/06/2021
Onset Date: 08/08/2021
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: Patient went to two different ED and sent ED visit had ESR, CRP, CBC, CMP and TSH all WNL

Allergies:

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

Symptoms: A few days after first dose of COVID 19 vaccine patient started with a headache and neckache and neck stiffness Patient did receive second vaccine but at pharmacy Ist dose given on 8/6/2021 2nd dose given on 8/30/2021

Other Meds: Ibuprofen , Zofran

Current Illness:

ID: 1744760
Sex: F
Age: 30
State: AZ

Vax Date: 01/28/2021
Onset Date: 09/25/2021
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: 2 doctors office visits to rule out stroke one on Monday 9/27 and Tuesday 9/28.. Head pressure, neck pain facial pain and headache. If not better by Friday will go to ER

Allergies: N/a

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

Symptoms: Facial droop-bells palsy

Other Meds: N/a

Current Illness: Vascular malformation Breastfeeding

ID: 1744761
Sex: M
Age: 69
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: 1744762
Sex: F
Age: 73
State: NY

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: Patient was being administered the second dose series of the Shingrix vaccine within the 2-6 month window for the second dose. During administration, the syringe assembly failed between the syringe needle and the rest of the assembly and approximately half of the vaccine was administered into the patient and the other half was sprayed onto the patient's arm. We called the manufacturer GSK to ask about possible readministration. Per Pilar at GSK, it is recommended to revaccinate if less than 0.4mL of the vaccine was administered to the patient. We notified the patient's primary care physician regarding revaccination and agreed with the plan for revaccination. We called the patient and scheduled a revaccination on October 12, 2021.

Other Meds:

Current Illness:

ID: 1744763
Sex: F
Age: 67
State: GA

Vax Date: 09/29/2021
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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Patient had an appointment for their 3rd dose of Pfizer (booster due to age) but was given the Moderna vaccine mistakenly. Patient has not had any problems with the vaccine so far.

Other Meds: Glucos-Chon-MSM-Ca-C-CtCl-SeCu - Tablet Orally. Vitamin B 12 100 MCG Lozenge 1 cap(s) Orally daily. Atorvastatin Calcium 40 mg Tablet 1 tablet Orally Once a day. Losartan Potassium 50 mg Tablet 1 tablet Orally bid. Carve

Current Illness: Hypertension, Hyperlipidemia, Hypothyroidism, GERD

ID: 1744764
Sex: F
Age: 93
State: ME

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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: blood pressure taken

Allergies: none

Symptom List: Pain in extremity

Symptoms: BP 200/100 and rigors began 3 to 4 hours post administration

Other Meds: Unkown

Current Illness: unknown

ID: 1744765
Sex: M
Age: 65
State: GA

Vax Date: 09/22/2021
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:

Allergies: codeine

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

Symptoms: Minutes after taking the shot he got dizzy and nausea when he was still sitting there. It subsided after a few and the he left. Around 9pm the same day he started feeling bad and he stated running a real high fever 100.5 and had chills, he took a real hot shower trying to warm up which didn't work. He took a 500mg bare aspirin and the fever finally broke after an hour. Slight body aches. An hour later he started itching real bad all over and little red bumps popped up all over his body. Started having body aches and chest pains. Took Benadryl and about an hour the itching stopped. Woke up the next morning and everything was gone away but since then he has had continuous chest pains and joint pains in his knees

Other Meds: rosuvastatin 20mg, lisinopril 20mg, omeprazole 20mg, metoprolol 25mg, 80mg bare aspirin, centrum vit, vit b12

Current Illness:

ID: 1744766
Sex: F
Age: 52
State: MO

Vax Date: 03/28/2021
Onset Date: 03/28/2021
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: ER visit first one: scan with the dye (CAT scan) and they saw that I had gall stones that were needing to be removed.

Allergies: Sensitive to codeine; Diflucan - pill form

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

Symptoms: Immediately after, I had a headache right after the injection. I took it easy that day. That night, I started getting some chills but nothing I was concerned about but the next morning, I could barely move, joints aches and had chills and a fever. Towards evening, I still had a fever and then I had diarrhea and was nauseated but didn't throw up. The third day I was just worn out after all of those symptoms were gone but was just fatigued. In June, it was maybe a Monday evening, incredible pain behind right shoulder blade. I couldn't keep food down the next couple of days. I went to onsite nurse practitioner and I called my doctor and he said to go to ER for a scan quickly. Dr. was my surgeon, and he offered to do surgery on Friday that week for Gall Bladder. But I was going to travel. I ended up again on that Saturday morning going to ER for emergency surgery. Dr. was surgeon on Saturday. Removed my gallbladder and I wasn't getting better and so they had to go back in for surgery because a gall stone had clogged my bile duct and caused a tear. I had a full release at the end of June (on the 30th or around there) by the doctor. Description - I did have my last Hepatitis B vaccine of three; January 29th, 2020.

Other Meds: No

Current Illness: No

ID: 1744767
Sex: F
Age: 45
State: MN

Vax Date: 01/18/2021
Onset Date: 09/15/2021
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: September 15, 2021 in house test COVID-19.

Allergies:

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

Symptoms: Patient tested positive after exposure to child positive for COVID-19 with symptoms and test on 9/15/21 with COVID breakthrough after having full Covid vaccination.

Other Meds:

Current Illness:

ID: 1744768
Sex: F
Age: 30
State: LA

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: Patient presented at the pharmacist window approx 5-10mins after administration and said she did not feel well and felt very hot. She then went limp against the plexiglass and passed out. She came to pretty quickly and was able to talk coherently. She said she was hot and had not eaten anything. I have her cold water, cool compress, crackers. EMS arrived and took over. Before she left patient said she was feeling much better.

Other Meds: Otezla

Current Illness: Unknown

ID: 1744769
Sex: M
Age: 67
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: 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: 1744770
Sex: M
Age: 48
State: WA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
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: N/A

Allergies: Unknown

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

Symptoms: A patient was administered an expired dose of the Moderna COVID-19 vaccine. Vaccine expiration date was 9/13/2021.

Other Meds: Unknown

Current Illness: Unknown

ID: 1744771
Sex: M
Age: 27
State: DC

Vax Date: 09/28/2021
Onset Date: 09/29/2021
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: Swore, Chills, Dizziness and weakness

Other Meds:

Current Illness:

ID: 1744772
Sex: M
Age: 30
State:

Vax Date: 08/31/2021
Onset Date: 09/03/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: mild numbness and tingling in fingers of lt arm, resolved after 24 hours. Suspect

Other Meds: none

Current Illness: none

ID: 1744773
Sex: F
Age: 41
State: TX

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: N/A

Allergies: Sulfa, adhesive tape, wine.

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

Symptoms: About 1am after I got the dose I get a fever. My thermometer was broke but I got the chills and felt like I had the flu. Around 8am I then got diarrhea but no nausea. I continued to have diarrhea the whole day went to the bathroom about 5 times on Tuesday. Continued to feel really bad (felt worse than I did with the second shot). I took some Tylenol in the afternoon about 500 mg. Slept most of the day Tuesday. Left arm hurt worse than it did with my second booster. I am afraid if we have to do a 4th shot it might send me to the hospital the next time I get one. No nausea mostly diarrhea and fever. I took 1000 mg of Tylenol around 10 pm and my fever broke and I woke up drenched in sweat. I still feel a little exhausted today and I have a low grade fever of 99 F. Did have a small headache yesterday as well. Just reporting because the side effects this time for me were much worse than the 2nd shot.

Other Meds: Metformin for poly cystic ovarian disease not diabetes and Tremfya for psoriasis. Vitamin D 2000IU.

Current Illness: None. I have actually not really been sick most of the year.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am