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: 1750532
Sex: F
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: 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: 1750533
Sex: F
Age: 21
State: GU

Vax Date: 04/01/2021
Onset Date: 08/01/2021
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: Confirmation of miscarriage via ultrasound and beta HCG.

Allergies: Shrimp

Symptom List: Anxiety, Dyspnoea

Symptoms: LMP, 12/2020; Miscarriage, 08/2021

Other Meds: Vit-C (OTC)

Current Illness: None

ID: 1750534
Sex: M
Age: 40
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
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:

Allergies: None

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

Symptoms: The client stated that approximately 30 minutes after receiving the vaccine he developed "swelling on the roof of my mouth, near the back of my throat." The client stated the swelling lasted about 1-2 hours. The client also stated that 2 hours after the vaccine he developed a rash that "looked like pimples on my arms and back." The client stated the rash lasted 1-2 weeks. The client stated the rash was not itchy. The client did not take any medications for his symptoms or for the rash. The client did follow up with a doctor in another country, who did not provide any advice regarding the 2nd COVID vaccine Pfizer. The client denied any shortness of breath after receiving the first dose of the COVID vaccine Pfizer. The client has no chronic conditions or medications. The client reports that he develops a cough when the weather is cold.

Other Meds: None

Current Illness: Unknown

ID: 1750535
Sex: F
Age: 75
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: 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: 1750536
Sex: M
Age: 72
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: 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: 1750537
Sex: M
Age: 62
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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:

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: 1750538
Sex: M
Age: 42
State: AL

Vax Date: 08/01/2021
Onset Date: 08/01/2021
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: Doppler ultrasound confirmed area of blood clot and healing.

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Blood clot in lower right leg.

Other Meds: HCTZ

Current Illness: N/A

ID: 1750539
Sex: M
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:
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: 1750540
Sex: F
Age: 28
State: NY

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

Lab Data: None.

Allergies: None.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Left axillary lymph node swelling and tenderness

Other Meds: None.

Current Illness: None.

ID: 1750541
Sex: M
Age: 63
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: 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: 1750542
Sex: F
Age: 60
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750543
Sex: F
Age: 50
State: SC

Vax Date: 09/28/2021
Onset Date: 09/30/2021
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: Saw dr today. Fever and swollen lymph nodes on the left side near my clavicle and neck. The swollen area around the lymph is full of fluid and about 2 inches in each direction. Dr thinks that this is from the flu shot I had on Tuesday. It is warm and painful. The shot site is also warm to the touch but not red. Dr said it should take a few weeks to go all the way down.

Allergies: codeine, sulfa antibiotics, tramadol,

Symptom List: Rash, Urticaria

Symptoms: I asked the nurse when I had the shot for information and she said she didn't know. I asked my doctor today when I went to be seen what it was called and she said Flulaval Quad.

Other Meds: Red yeast rice, zyrtec, advil

Current Illness: Covid illness 09/12/21

ID: 1750544
Sex: F
Age: 73
State: FL

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

Symptoms: Patient was given a booster dose that was not eligible and outside of the guidelines

Other Meds:

Current Illness:

ID: 1750545
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: 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: 1750546
Sex: F
Age: 33
State:

Vax Date: 08/12/2021
Onset Date: 08/19/2021
Rec V Date: 09/30/2021
Hospital: Y

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

Lab Data: Holter monitor placed, Cardiac echo Labs: cortisol, ACTH, CBC, CMP, and several others per her PCM and cardiology

Allergies: none

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

Symptoms: Received 1st dose of Pfizer vaccine on 8/12/2021. Pt states she noted increasing tachycardia since first injection that has gotten progressively worse over time. Pt now c/o syncope daily, is noted be orthostatic with tachycardia of 140-150bpm with simple ambulation. Pt has been evaluated by cardiology with no significant findings as of this time. Pt is now hospitalized on floor for further evaluation

Other Meds: Prenatal vitamin Lexapro

Current Illness: none

ID: 1750547
Sex: F
Age: 66
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: 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: 1750548
Sex: M
Age: 86
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1750549
Sex: F
Age: 24
State: MD

Vax Date: 03/01/2021
Onset Date: 08/01/2021
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: EKG, holter monitor 09/2021

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: heart palpitations, chest tightening and pressure beginning 08/2021 no confirmed relation to the covid vaccine.

Other Meds: synthroid 50mcg

Current Illness: none

ID: 1750550
Sex: M
Age: 82
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

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

Other Meds:

Current Illness:

ID: 1750551
Sex: M
Age: 41
State: CA

Vax Date: 09/23/2021
Onset Date: 09/28/2021
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: Contacted for advice. Prescribed hydrocortisone. Did not help the itching

Allergies: None

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

Symptoms: Rash on both feet and lower legs 5 days post shot.

Other Meds: None

Current Illness: None

ID: 1750552
Sex: M
Age: 82
State: TX

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: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

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

Symptoms: No adverse reactions were seen at the time of administration, but the patient received the Pfizer Covid vaccine instead of a flu shot and had previously been fully vaccinated with the Moderna Covid vaccines back on 03/27/2021.

Other Meds: Metoprolol, ezetimibe, simvastatin, digoxin

Current Illness:

ID: 1750553
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:
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: 1750554
Sex: F
Age: 72
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: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750555
Sex: M
Age: 72
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: 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: 1750556
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:
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: 1750557
Sex: F
Age: 65
State: AZ

Vax Date: 09/14/2021
Onset Date: 09/20/2021
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: N/A

Allergies: Vicodin, Codeine, Indocin, Celebrex

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

Symptoms: Lichen planus oral cavity autoimmune occurrence. Gum redness, inflammation, pain. Vertical white line from tooth to gum. Symptoms occurred beginning Sep 20, 2021 (6 days after first dose of Moderna COVID vaccine). Diagnosis by dentist on Sep 24, 2021. Treatment: Dexamethasone elixir-swish 1 tsp. for 2 minutes, 4 times a day. Follow-up appointment Oct 1, 2021. Also mucocele inside of bottom lip (etiology unknown).

Other Meds: Losartan, Cartia, CoQ10, OcuVite, Vit C, Vit B complex

Current Illness: N/A

ID: 1750558
Sex: M
Age: 21
State: NE

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After immunization, patient fainted. He was unconscious approximately 1 minute. I had him remove his mask and gave him a bottle of water. I sat with him for 10 minutes, then had his girlfriend sit with him another 15 minutes. After that time he felt fine and they left the phamacy area.

Other Meds: no

Current Illness: No

ID: 1750559
Sex: F
Age: 62
State: WA

Vax Date: 02/11/2021
Onset Date: 02/17/2021
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: CBC, CMP, BNP EKG, CXR

Allergies: Sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Within days bilateral lower extremity lymphedema developed & persists to this day

Other Meds: Bupropion, Lexapro, methocarbamal, estradiol, Singular, omeprazole, Areds II,

Current Illness: None

ID: 1750560
Sex: M
Age: 91
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: 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: 1750561
Sex: F
Age: 57
State: NJ

Vax Date: 09/15/2021
Onset Date: 09/15/2021
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: Seasonal

Symptom List: Nausea

Symptoms: Severe debilitating headache left side Fatigue Chills Fever Body aches Lower back pain Nausea Vomiting Internal pains/Organs Dizziness Swelling and redness at injection site Weakness Swelling/redness around eyes

Other Meds: Multivitamin

Current Illness:

ID: 1750563
Sex: F
Age: 43
State: GU

Vax Date: 03/18/2021
Onset Date: 08/01/2021
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: Confirmation of miscarriage via ultrasound and beta HCG. PATIENT UNDERWENT EMERGENCY DILATION AND CURETTAGE.

Allergies: None

Symptom List: Injection site pain

Symptoms: LMP, 05/30/2021 Miscarriage, 08/2021

Other Meds: Levothyroxine

Current Illness: None

ID: 1750564
Sex: F
Age: 81
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: 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: 1750565
Sex: M
Age: 50
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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750566
Sex: F
Age: 44
State: MS

Vax Date: 03/31/2021
Onset Date: 04/01/2021
Rec V Date: 09/30/2021
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: 4/8/2021 4/8/2021 Vascular 4/8/2021 4/19/2021 4/27/2021 5/3/2021 5/20/2021 Vascular 6/11/2021 ER and Hospitalization 7/2/2021 7/16/2021 7/20/2021 8/24/2021 Vascular

Allergies: N/A

Symptom List: Tremor

Symptoms: After the first dose I was sick as expected with a sore arm, fever, etc... After the second dose I got really sick. I had flu like symptoms for about a week or so. Then I had issues breathing , chest pains, and my legs were really sore. I had developed new blood clots in both legs, superficial and deep vein. I did not have a heart related chest pain though. I continue to have these issues right today.

Other Meds: N/A

Current Illness: N/A

ID: 1750567
Sex: F
Age: 59
State: IN

Vax Date: 09/13/2021
Onset Date: 09/14/2021
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: None

Allergies: Bee / hornet / wasp stings

Symptom List: Erythema, Pruritus

Symptoms: All over muscle and bone aches, 102 temperature, lasted 24 hours

Other Meds: Methotrexate, folic acid, calcium / vitamin D

Current Illness: No

ID: 1750568
Sex: F
Age: 67
State:

Vax Date: 09/29/2021
Onset Date: 09/29/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1750569
Sex: F
Age: 74
State: TX

Vax Date: 09/28/2021
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: n/a

Allergies: none

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

Symptoms: pt had bruise at injection site and rash below injection site

Other Meds: rosuvastatin 5mg, quinapril 10mg, duloxetine 30mg

Current Illness: n/a

ID: 1750570
Sex: F
Age: 61
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: 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: 1750571
Sex: F
Age: 39
State: KS

Vax Date: 09/01/2021
Onset Date: 09/15/2021
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: None

Allergies:

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

Symptoms: Sore/ painful ankles. Have never had this before. Both feel weak and sore.

Other Meds:

Current Illness:

ID: 1750572
Sex: M
Age: 31
State: MN

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: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient fainted, fell to floor, no injuries, was surprised he was on floor. Stated he had walking vertigo and had no drank any liquid that day. sat patient in chair gave water and he felt much much better. Patient departed on his own after a time, said he was doing fine.

Other Meds:

Current Illness: "Walking Vertigo" Dehydration

ID: 1750573
Sex: F
Age: 76
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: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

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

Other Meds:

Current Illness:

ID: 1750574
Sex: M
Age: 67
State: KS

Vax Date: 09/25/2021
Onset Date: 09/25/2021
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:

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

Symptoms: Patient received third dose (booster shot) for Moderna. Patient did not qualify for booster dose

Other Meds:

Current Illness:

ID: 1750575
Sex: M
Age: 80
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750576
Sex: F
Age: 4
State: CA

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: none

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

Symptoms: 10 minutes after vaccines administered, patient developed red flare with wheel around area between where the MMRV and Influenza vaccine were administered on the left arm. The subcutaneous fluid collection seemed to be "outlined" by redness. In addition her right shoulder above the injection site for the Qudracel also became faintly red. There were no other lesions or skin findings, no respiratory symptoms, no facial swelling or vomiting. Patient did get fussy but was consolable to mom and responding appropriately to both mom and medical providers. We had the patient sit quietly for 15 minutes at which point the right shoulder redness resolved and the intensity of the redness on the left arm decreased a bit (total size of that area was approximately 4x4cm area). We gave her benadryl and the mom also requested tylenol for pain which we gave. After this, she was discharged to home. Per mom, she looked "pale" at home and today was more tired than normal. She continues to have a small mark on her arm today (9/30/21) per mother of the child (not confirmed with photo)

Other Meds: none

Current Illness: Had urinary tract infection diagnosed 9/6/2021. Had completed 10 day course of cephelexin

ID: 1750577
Sex: M
Age: 50
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: 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: 1750578
Sex: M
Age: 74
State: WA

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: SYR
Vax Site: LA

Lab Data: No tests or labs were done.

Allergies: N/A

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Immediately after vaccination (Noon on 9/29/21) patient stated he experienced nerve pain, different from soreness pain from previous vaccinations in the past. The next day 9/30 he noticed the pain has increased. Patient states pain is 4 out of 10 and was concerned about the angle of which the needle entered into his arm. He will contact his primary provider tomorrow if symptoms worsen.

Other Meds: N/A

Current Illness: N/A

ID: 1750579
Sex: M
Age: 76
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: 1750580
Sex: F
Age: 47
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: 1750581
Sex: M
Age: 36
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: 1750582
Sex: F
Age: 67
State: CO

Vax Date: 03/11/2021
Onset Date: 03/01/2021
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: Blood tests - all tests negative June 2021 Stool samples - all tests negative June 2021 Colonoscopy - negative July 2021

Allergies: Seasonal

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

Symptoms: Extreme fatigue; 3 - 5 times per week; occurring mid to late afternoon. Six months later, occurs 1 - 3 times per week & still occurring mid to late afternoon.

Other Meds: Rosuvastatin 5mg 1x/day Lisinopril 10mg1x/day Calcium Magnesium Vitamin B Complex Vitamin D Zyrtek

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am