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: 1750480
Sex: M
Age: 70
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: 1750481
Sex: M
Age: 69
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: 1750482
Sex: F
Age: 55
State: CO

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
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: Iodine

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

Symptoms: Pt came in to get her pfizer booster shot during her visit. the ma administering the vaccine was not aware that the vaccine had not been properly reconstituted prior to administration. On 09/29/21 the MA who reconstituted the vaccine the day prior was watching another MA doing it and realized that she had done it wrong the day prior. The MA thought that the pfizer covid 1- vial was a single dose vial so she took the 1.8ml of of the diluent and divided it amongst the 6 vials thinking they where single dose. the MA drew up the vial and administered the entire content to the patient for a total of 6 doses and .3ml of diluent. The provider was made aware and he called the patient to inform her of the incident and to ensure there where no adverse reactions that the patient would need to come in for. Pt stated that she was just having localized soreness around the vaccine site. the provider advised patient to call our office if any symptoms become severe. Discussion with the team included what had happened as well as what we can do to prevent the issue from happening in the future. we agreed that when ever possible we will have the clinic RN reconstitute and draw up the vaccines and if not available we will have 2 MA present during the reconstitution and drawing up of the vaccines as a double check.

Other Meds: na

Current Illness: na

ID: 1750483
Sex: F
Age: 65
State: IL

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: EKG 09/30/2021 Everything OK

Allergies: Corticosteroids Statin drugs Bees

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Fever, chills, pounding heart, unusually extreme fatigue, naseau, extreme weakness, dizziness, headaches, general malaise.

Other Meds: Thyroid Armour 60 mcg Hydroxychlorine 2x day Multivitamin, Vit B, C, D, E Zinc Osteo Biflex Fish Oil capsule 3x day

Current Illness: none

ID: 1750484
Sex: F
Age: 20
State: CA

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 09/30/2021
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: N/A

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

Symptoms: Patient had Moderna as first dose and received Pfizer as second dose. No symptoms or sign of adverse event. Patient received Pfizer as a second dose instead of Moderna.

Other Meds: N/A

Current Illness: N/A

ID: 1750485
Sex: F
Age: 61
State: WA

Vax Date: 01/06/2021
Onset Date: 01/14/2021
Rec V Date: 09/30/2021
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: Covid-19 1/28/21, CBC c diff, metabolic panel, ANA,ANA c Elisa, SED, CRP, Uric Acid, RA factor, TSH c reflex, Urine 1/29/21. CBC c diff, uric acid 3/5/21. Covid 6/14/21. CBC c diff, Peripheral smear 6/16/21, Iron panel 6/22/21 Labs done since June have been ordered by Haemotologist/Oncologist

Allergies: Hydrocodone/Vomiting, Dairy/sinus inflam, Nuts/HSVI,IIflare

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

Symptoms: Initially, just had site soreness, redness & swelling. Starting Jan. 14-Feb 2,2021, Headache, low grade fever 99.8 - 100.4 with chills & sweats, deep fatigue with severe joint pain & muscle aches. Cough productive clear, thick sputum. Right elbow in lower arm started to resolve. But Left elbow became involved. R flared again, red rough rash. Then Left knee, wrists, ankles, stiff and painful. Red hard bump on R wrist. Painful muscle spasm R forearm, red/bruised. R hand/fingers swelling numbness & tingling. Developed sharp stabbing pain in L eye orbit, migraine like but different from previous and pain in L sinus but no congestion. BRAIN FOG! Virtual then clinic visits with Dr during this time. Joint and muscle pain subsided, other symptoms sporatic, waxed & waned in severity, fatigue persistant . Had 2nd Moderna vaccination Feb. 3, 2021. Only had local reaction initially. About 2 weeks out started having joint & muscle pain, swelling & discoloration. Rheumatologist seen without definitive diagnosis. Abnormal lab values since Jan. continiued led to Hematology consult and diagnosis of Polycythemia Vera. Currently being treated with Hydroxyurea and phlebotomy. All symptoms have waxed and waned this year, with continued fatigue I don't believe the moderna vaccine to be causitive of the PV and actually helped get diagnosed but do believe it was at the very least a trigger to systemic inflammation causing other symptoms. Previous vaccines have always just caused site soreness except for Flu and Shingles vaccines I had mentioned in #23

Other Meds: anastrozole 1mg qd, vitamin & mineral tonic

Current Illness: none

ID: 1750486
Sex: F
Age: 30
State: GU

Vax Date: 02/11/2021
Onset Date: 04/01/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Confirmation of miscarriage via ultrasound and beta HCG. Patient was attempting pregnancy, finally achieve but lost her baby .

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Miscarriage, April 2021 LMP, 02/27/2021

Other Meds: None

Current Illness: None

ID: 1750487
Sex: F
Age: 33
State: CA

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: none

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: On the following day of my second dose of pfizer I noticed spots on my right hand and arm. The spots appear to be inside the skin. They are not itchy. They appear like freckles all over my right hand and arm and stop about half way my arm.

Other Meds: Birth control

Current Illness: none

ID: 1750488
Sex: F
Age: 54
State:

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 09/30/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: No adverse event occurred. The patient received the booster dose 4 months after completing her primary series. Before administering the injection, she attested that she completed her primary series of Pfizer 6 months prior but did not have her COVID vaccine card with her. We proceeded to administer the injection and a couple of hours later the patient came back to the clinic to get the information added to her COVID vaccine card that she found. At that time, it was noticed that she completed the primary series 4 months prior.

Other Meds:

Current Illness:

ID: 1750489
Sex: F
Age: 32
State: VA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Patient reported history of fainting for vaccinations from fear/anticipation of needle injection

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient walk in to pharmacy to request her first dose COVID vaccine, she has a history of fainting from immunization from needle injection pain. Pfizer covid vaccine was prepared and administered per manufacturer procedures. Immunizing technician noticed patient's change in behavior/voice and color of face, offered water and patient accepted, she fainted shortly after. Husband and technician was transitioning patient to recovery position as patient became alert and aware. She sat back down, vomited, and recovered, she left store on her own with husband.

Other Meds:

Current Illness:

ID: 1750490
Sex: F
Age: 30
State: AZ

Vax Date: 09/09/2021
Onset Date: 09/23/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Have not got any medical tests, but did get labs done on 9/28/2021 and everything was normal even though I had the stabbing pains and tingle.

Allergies: Penicillin

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

Symptoms: 2 weeks from when I got my vaccine, while I was sleeping at night I got a stabbing pain in my calf. Then the next day it spread to my entire body. Then 2 days later it was tingle everywhere lasting a few seconds and stabbing pain everywhere lasting a few seconds. It's been going on now for a week and hasn't stopped.

Other Meds: Iron, multivitamin

Current Illness: None

ID: 1750491
Sex: F
Age: 32
State: MA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 09/30/2021
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: Acetaminophen Sulfur antibiotics Contrast dye Penicillins Doxycycline Peanut Coconut Strawberry Egg white

Symptom List: Rash, Urticaria

Symptoms: So I got the first dose of the Pfizer vaccine on Sunday.. I had horrible chest pressure and my eyelids and lips ended up swelling up a little but it resolved itself within an hour or so. Ever since my heart has been racing, just walking across the house my hr was 135. I've been feeling sob and tired. Having intermittent chest pain and pressure. My hands and feet have pins and needles and my blood pressure is 159/98 and I normally have perfect bp

Other Meds: Fluoxetine Vit D Iron

Current Illness: Asthma

ID: 1750492
Sex: F
Age: 36
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
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: Second COVID-19 Pfizer vaccine administered sooner than scheduled due date. Administered on 09/28/2021. No adverse reactions noted post observation time

Other Meds:

Current Illness:

ID: 1750493
Sex: F
Age: 26
State: SC

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Patient felt light headed and passed out right after vaccine administration within few minutes. Patient was conscious and had pulse and breathing. pharmacist checked blood pressure and pulse every few minutes .Oxygen saturation was at 99.Initially blood pressure seemed to drop.so called emergency.first responder arrived and checked vitals which were normal by then.so patient chose not to go to the hospital. she felt better and went home.

Other Meds:

Current Illness:

ID: 1750494
Sex: M
Age: 94
State: TX

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: unknown.

Allergies: nkda

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

Symptoms: patient reported a skin infection on the injection site after getting the vaccine.

Other Meds: unknown

Current Illness: unknown

ID: 1750495
Sex: M
Age: 4
State: CA

Vax Date: 09/27/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: MMR and Varicella Vaccine (live vaccines)

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

Symptoms: On 9/30/21, developed five raised red hive lie welts on his right arm near his elbow. The injection site is clear.

Other Meds: Baclofen, Onfi, Klonopin, Keppra, Poly-Vi-Sol, Miralax - all regular medications via g-tube

Current Illness: N/A

ID: 1750496
Sex: F
Age: 66
State:

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
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: swelling and pain in ipsilateral axilla

Other Meds:

Current Illness:

ID: 1750497
Sex: F
Age: 69
State: MD

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Skin scrapings done twice. Skin biopsy.

Allergies: Bactrim

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Nausea that lasted a month. Rash started under left armpit. Rash eventually spread over chest, neck, breasts, under both armpits, on both arms. Left arm pain. Rash under armpit and left arm pain still continue.

Other Meds:

Current Illness: None

ID: 1750498
Sex: F
Age: 24
State:

Vax Date: 09/13/2021
Onset Date: 09/22/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Ekg (9/25). Lab work- troponin, mg, cmp, CBC (9/25). Ekg (9/25). Stress echo (9/30)

Allergies: N/a

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I started having fevers and chills along with headaches 7 hours after getting the vaccine that lasted about 40 hours. I started having vaginal bleeding 9 days after my injection. I do not get a period or have vaginal bleeding due to my depo shot/birth control. I haven?t bleed in almost 3.5 years. Now I haven?t stopped having vaginal bleeding at it?s been 8 days of bleeding. I also am a runner and have heart palpations and chest pain on exertion, currently in the process of a cardiac work up to figur out the problem. I have ran almost 900 miles just this year alone, I?ve never experienced anything like this before. And I?ve ran for many years and thousands of miles and again never experienced anything like this. The heart palpations and chest pain started during one of my runs 12 days after my vaccine

Other Meds: Methylphenidate Singular Wellbutrin Vitamin b12

Current Illness:

ID: 1750499
Sex: F
Age: 25
State: KY

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fever, body wide joint aches, chills

Other Meds: Kelnor Lexapro Zyrtec Melatonin

Current Illness:

ID: 1750500
Sex: F
Age: 38
State: OR

Vax Date: 09/13/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
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: I have called my obgyn and have an appt. scheduled to be seen.

Allergies: None

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

Symptoms: I have had an extremely heavy and painful menstrual cycle. This is extremely abnormal for me as a I have been on the Mirena IUD contraceptive for years and have consistently not had a menstrual cycle. This is the first cycle I have had in years and it has only been 2 weeks since I received the first dose of the Pfizer vaccine.

Other Meds: Mirena IUD

Current Illness: None

ID: 1750501
Sex: F
Age: 39
State: NY

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Vertigo, nausea and vomiting, ear pain, aches in back and knees, 100.5 fever, brain fog? the aches and brain fog are still present today. I also had covid back in January of 2021.

Other Meds: Probiotic, multi-vitamin, b complex, d3, theanine serene

Current Illness: None

ID: 1750502
Sex: F
Age: 35
State: FL

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: None to date

Allergies: Lactose intolerant

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

Symptoms: 8 hours after receiving the first dose I experienced body aches, chills, fever, lack of appetite, fatigue. These symptoms went on for 24 hours before I started feeling better. 3 weeks later, received the 2nd dose and experienced the same side effects for 24 hours before feeling better. However, after second 2nd I?ve been experiencing vertigo-like dizziness occurring episodically. I?ve never experienced this type of dizziness and I am a certain the vaccine caused it.

Other Meds: Women?s multi-vitamin, supplements & minerals

Current Illness: None

ID: 1750503
Sex: F
Age: 37
State: GU

Vax Date: 03/20/2021
Onset Date: 06/01/2021
Rec V Date: 09/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Confirmation of miscarriage via ultrasound and beta HCG.

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Miscarriage, 06/2021; LMP 04/15/2021.

Other Meds: Pre-natal Vitamins

Current Illness: None

ID: 1750504
Sex: M
Age: 52
State: WA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: The facility is for senior people, all flushots brought were HD. However one person is the son of one of the residents, and accidently got the HD. This gentleman has been notified for the possible ADRs and risks of receiving HD flu shot.

Other Meds:

Current Illness:

ID: 1750505
Sex: F
Age: 19
State: WI

Vax Date: 03/17/2021
Onset Date: 03/18/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: EEG both short term and a 72 hour EEG MRI Complete lab work up/blood draw

Allergies: none

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

Symptoms: "seizure" like actions--eyes rapid blinking, clinching of hands, unable to communicate during the event. Event lasts between 30seconds and 2 minutes. Events happen between 1 and 2 times per day.

Other Meds: Depakote--500mg daily Escitalopram--10mg Vyvanse--50mg Estarylla--.25mg

Current Illness: none

ID: 1750506
Sex: F
Age: 39
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: High fever, severe headache, loss of appetite, increased thirst, nausea, fatigue. Same symptoms I had when I was sick with coivd.

Other Meds:

Current Illness: Covid-19 in September 2021

ID: 1750507
Sex: F
Age: 66
State: CA

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever of 100.5, significant joint and muscle pain, headache, stabbing pains

Other Meds: None

Current Illness: None

ID: 1750508
Sex: F
Age: 53
State: IL

Vax Date: 09/24/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: PCN; Sulfa; Codeine

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

Symptoms: subconjunctival hemorrhage. Seen at Eye Center. No treatment other than time.

Other Meds: Aspirin; Ibuprofen; Levothyroxine 100mcg daily; Paroxetine 30mg daily

Current Illness: N/A

ID: 1750509
Sex: M
Age: 36
State: NV

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: over 42 days. 1st dose 08/13/21, 2nd dose 09/30/21

Other Meds:

Current Illness:

ID: 1750510
Sex: F
Age: 45
State:

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Needle/syringe malfunction upon administering Moderna COVID-19 vaccine to patient on 09/30/2021. Administering provider noted approximately half of the vaccine dose administered, and half wasted. Doctor was consulted via telephone, and recommended 0.25ml to be administered to the patient to complete the full vaccination dose. Patient in agreement. No adverse reactions noted after the post vaccine observation period.

Other Meds:

Current Illness:

ID: 1750511
Sex: F
Age: 74
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
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: Patient recevied a booster dose which patient doesnt qualify .

Other Meds:

Current Illness:

ID: 1750512
Sex: F
Age:
State: AZ

Vax Date: 08/20/2021
Onset Date: 09/08/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: I have had Stress Tests multiple times.

Allergies:

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

Symptoms: Later that night I got a pain in my heart that lasted 20 minutes.

Other Meds:

Current Illness:

ID: 1750513
Sex: F
Age: 90
State: FL

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 09/30/2021
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: Penicillin

Symptom List: Tremor

Symptoms: Laryngitis, mild shortnes of breath, generalized hives treated with Bebdryl 50mg PO q12 hours x 2; Reddness and swellng at injection site 3 days.

Other Meds: Vitamin D2 1.25mg 50.000Units, Lisinoprill 20mg bid, Carvedil 25mg bid, Atorvastatin 80mh @ HS, Preservision AREDS2, Ecotrin 81mg Daily, Calcium 600mg with Vitamin D3; Prolia Injections, Dupexient injections twice a month

Current Illness: Cataract Surgery

ID: 1750514
Sex: M
Age: 62
State: MD

Vax Date: 08/24/2021
Onset Date: 09/07/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: CBC, CMP normal, W Sed rate 17. ANA positve 1:40

Allergies: No known

Symptom List: Erythema, Pruritus

Symptoms: The patient developed "Covid toe" with an erythematous zone starting 2/3 up the toe in an expanding width to several inches and restrictied to mid foot (I have picutes) and a 2nd erythematous patch about 3x3" on the opposite ankle region. The patient was placed on 81 mg Aspirin daily and 7 days of prednisone 40 mg per day to taper over 3 days . He had a full and complete resolution of the rash.

Other Meds: Omeprazole 40 mg daily Allopurinol 200 mg daily Vitamin B-12 1,000 micrograms daily

Current Illness: None

ID: 1750515
Sex: F
Age: 66
State:

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient recevied the booster for moderna which patients doesnt qualify for yet.

Other Meds:

Current Illness:

ID: 1750516
Sex: F
Age: 58
State: CA

Vax Date: 09/09/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: Haven't had time to consult physician yet.

Allergies: Sulpha drugs and Tetanus, apples

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

Symptoms: Abdominal pains with light bleeding from the vagina. Sore throat on Wednesday afternoon, 9/29/2021, abdominal pains all day on Thursday 9/30/2021, had light bleeding from vagina after getting home from work. Haven't had a menstruation in about 8 years.

Other Meds: Lisinopril, multivitamin, flaxseed oil, Vitamin D3, Calcium-Magnesium-Zinc, Vitamin C

Current Illness: None

ID: 1750517
Sex: F
Age: 31
State: AR

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: versed, norco, talwin, allegra d

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: My first shot back in August my arm swelled and hurt. This time with the second shot my arm swelled, injection site redness that is continuing to spread and pain.

Other Meds:

Current Illness:

ID: 1750518
Sex: M
Age: 72
State: GA

Vax Date: 09/24/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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 administered 3rd dose of Moderna while not meeting eligibility requirements.

Other Meds:

Current Illness:

ID: 1750519
Sex: F
Age: 36
State: GU

Vax Date: 05/22/2021
Onset Date: 06/01/2021
Rec V Date: 09/30/2021
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: Confirmation of miscarriages via ultrasound and beta HCG. Patient bled heavily and symptomatic. She is very healthy fitness instructor, sadly this was her first miscarriage.

Allergies: None

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

Symptoms: First miscarriage, 06/2021 Second miscarriage, 08/2021

Other Meds: None

Current Illness: None

ID: 1750520
Sex: F
Age: 75
State: GA

Vax Date: 09/24/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
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: Pain in extremity

Symptoms: Patient given 3rd dose of Moderna without meeting eligibility requirements.

Other Meds:

Current Illness:

ID: 1750522
Sex: F
Age: 6
State: MD

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: apperas to be cardiac arrest patient almost passed out and start recovering after getting the epipen

Other Meds: unknown

Current Illness:

ID: 1750523
Sex: F
Age: 47
State: CA

Vax Date: 09/16/2021
Onset Date: 09/18/2021
Rec V Date: 09/30/2021
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: None

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

Symptoms: Tiredness more than 2 weeks post shot and unusual grogginess. Did not have these issues at baseline prior to vaccine

Other Meds: None

Current Illness: None

ID: 1750524
Sex: F
Age: 38
State: TX

Vax Date: 03/30/2021
Onset Date: 07/18/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: Lipase levels >22,000 upon admission to ER

Allergies: Penicillin, codeine, ultram

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

Symptoms: Idiopathic pancreatitis

Other Meds: Synthroid, lexapro, blisovi

Current Illness: N/a

ID: 1750525
Sex: F
Age: 36
State: GU

Vax Date: 05/22/2021
Onset Date: 08/01/2021
Rec V Date: 09/30/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Confirmation of miscarriages via ultrasound and beta HCG. Patient bled heavily and symptomatic. She is a very healthy fitness instructor, sadly this was her second miscarriage post-vaccine.

Allergies: None

Symptom List: Vomiting

Symptoms: First miscarriage, 06/2021 Second miscarriage, 08/2021

Other Meds: None

Current Illness: None

ID: 1750526
Sex: F
Age: 80
State: TN

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Penicillin allergy

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient stated on 9/29/2021, she started feeling flushed and developed severe body aches. This happened in the evening. She said she took Tylenol and went to bed. She slept through the night and felt fine the next day.

Other Meds:

Current Illness:

ID: 1750527
Sex: F
Age: 73
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: Back pain, Cold sweat, Headache, Nausea, Vomiting

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

Other Meds:

Current Illness:

ID: 1750529
Sex: M
Age: 71
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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: 1750530
Sex: F
Age: 70
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750531
Sex: F
Age: 65
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 09/30/2021
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