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: 1750812
Sex: M
Age: 73
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: 1750813
Sex: M
Age: 54
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: 1750814
Sex: M
Age: 78
State: TX

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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:

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

Symptoms: Patient received an additional dose that they were not eligible for. Patient is not immunocompromised.

Other Meds:

Current Illness:

ID: 1750815
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: 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: 1750816
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: 1750817
Sex: M
Age: 86
State: CA

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: n/a

Allergies: NKA

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

Symptoms: Patient came in for an additional dose of Moderna and was administered a dose of Pfizer. Vaccine mismatch.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1750818
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

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

Other Meds:

Current Illness:

ID: 1750819
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: 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: 1750820
Sex: F
Age: 59
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: Abdominal pain, Chills, Sleep disorder

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

Other Meds:

Current Illness:

ID: 1750822
Sex: M
Age: 48
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: 1750823
Sex: F
Age: 38
State: WA

Vax Date: 08/31/2021
Onset Date: 09/02/2021
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: none

Allergies: TETANUS

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

Symptoms: Patient complained a 36 hours after the first dose of Moderna she felt stiff on left arm and leg, her fingers and toes clinched involuntary, her Left fingers were numb as well.

Other Meds: IBUPROFEN

Current Illness: CHRONIC PAIN

ID: 1750824
Sex: F
Age: 33
State: TX

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: SYR
Vax Site: RA

Lab Data: NA

Allergies: NKDA

Symptom List: Rash, Urticaria

Symptoms: The patient got Moderna as her first dose and was given Pfizer as the second dose. The patient did not have an adverse reaction to our knowledge at this time.

Other Meds: Unknown

Current Illness: No known illnesses

ID: 1750825
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: 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: 1750826
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: 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: 1750827
Sex: M
Age: 86
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: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750828
Sex: F
Age: 40
State: TX

Vax Date: 04/11/2021
Onset Date: 04/12/2021
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: The FNP I see checked my arm 1 month post injection and told me to contiue watching it.

Allergies: None

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

Symptoms: I had a local injection site reaction with swelling and redness for 2 weeks. I started having pain with physical limitations when pushing/pulling movements with arm. The pain is not in shoulder but deep in arm at injection site. If I use my arm to push or pull in up, down, forward, backward motions I have pain that restricts further action.

Other Meds: Levothyroxin 50mg Rosuvastatin 5mg Apple cider vinegar 1 tab Certirazine 1 tab Flonase Multivitamin Vitamin C Biotin D3 + K2 Aspirin 81mg Potassium Collagen powder Melxoicam

Current Illness: None

ID: 1750829
Sex: M
Age: 68
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: 1750830
Sex: M
Age: 39
State: VA

Vax Date: 09/17/2021
Onset Date: 09/30/2021
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: None

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Dizziness and spinning suddenly while lying in bed. Woke up to feeling off severe dizziness. Mildly nauseous as well. Persisted as light headedness and mild dizziness through the day. Blood pressure routinely checked and normal. HR normal. No fever. No recent head trauma. Never had this before. No new or different foods in prior days.

Other Meds: None

Current Illness: None

ID: 1750831
Sex: F
Age: 14
State: NH

Vax Date: 07/26/2021
Onset Date: 08/30/2021
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: EEG, labs, head CT. all normal

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 2 weeks after the first Vaccine the patient had a seizure, then 7 days after the second vaccine the patient had another seizure. The patient has never had a history of seizures. now being worked at at the Hospital and has not had any issues since

Other Meds: none

Current Illness: none

ID: 1750832
Sex: F
Age: 68
State:

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

Other Meds:

Current Illness:

ID: 1750833
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: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750834
Sex: F
Age: 29
State: UT

Vax Date: 09/20/2021
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: 9-30-21 negative covid test

Allergies: None

Symptom List: Unevaluable event

Symptoms: Headache, fever, chills, body ache, cramping, diehreah, nausea from 9-21-21 and ongoing as of 9-30-21

Other Meds: Ibuprofen, tums

Current Illness: None

ID: 1750835
Sex: M
Age: 75
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: 1750836
Sex: M
Age: 51
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: 1750837
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: 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: 1750838
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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1750839
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: Nausea, Pain in extremity, Pyrexia

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

Other Meds:

Current Illness:

ID: 1750840
Sex: F
Age: 30
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: 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: 1750841
Sex: F
Age: 40
State: CT

Vax Date: 09/28/2021
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: Sulfa drugs Latex

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

Symptoms: Large red, raised area. Itchy. Arm numb. Very painful.

Other Meds: Synthroid Jardiance Metformin Glipizide

Current Illness: None

ID: 1750842
Sex: M
Age: 74
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: Nausea

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

Other Meds:

Current Illness:

ID: 1750843
Sex: F
Age: 55
State: IL

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Blisters on inside of mouth. White blisters on inner lining of lips and jaws. No course of treatment was taken. Blisters were of varying sizes. Lasted around 72 hours before beginning to go away. Went away completely and with no lingering problems.

Other Meds: Zyrtec, tylenol

Current Illness:

ID: 1750844
Sex: F
Age: 32
State: MO

Vax Date: 06/07/2021
Onset Date: 09/02/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Stroke, right coratid artery dissection within 3 months, blood clot in neck artery, headaches

Other Meds: Synthroid

Current Illness: None

ID: 1750845
Sex: F
Age: 28
State: HI

Vax Date: 09/28/2021
Onset Date: 09/29/2021
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: RA

Lab Data:

Allergies:

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

Symptoms: Fever: 38.5 C, responsive to Acetaminophen 1g IVPB, and 1g ceftriaxone IV down to 37.1 C, 90 minutes after administration Patient reported altered mental status, unable to remember how she arrived to ER

Other Meds:

Current Illness:

ID: 1750846
Sex: F
Age: 36
State: GU

Vax Date: 01/27/2021
Onset Date: 06/02/2021
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: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow. Patient bled and had to undergo surgery at the Hospital emergency and to OR for urgent Dilation and Curettage.

Allergies: None

Symptom List: Tremor

Symptoms: LMP, 02/26/2021 -- > EDD 12/03/2021 Patient stated vaginal discharge, 06/02/2021 Miscarriage @ 13 + 5 D & C, 06/28/2021

Other Meds: OTC multivitamins

Current Illness: None

ID: 1750847
Sex: M
Age: 37
State: KY

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

Lab Data: N/A

Allergies: N/A

Symptom List: Erythema, Pruritus

Symptoms: Injection site hurt so much I couldn't lift my arm over my head, chest burned, muscles ached, sore throat and headache, elevated temperature of 99? when checked, chilling followed by sweating all night long in my sleep. Symptoms began appearing around noon the day after my vaccine and dissipated overnight while I slept.

Other Meds: Prilosec, Zyrtec, Buspirone

Current Illness: N/A

ID: 1750848
Sex: F
Age: 25
State: NJ

Vax Date: 09/27/2021
Onset Date: 09/28/2021
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: First two days after vaccine - muscle aches and joint paint throughout body; these symptoms subsided by day 3 First 3 days after vaccine - pain and swelling in the lymph nodes under armpit near vaccine. Pain and swelling still present.

Other Meds: Lexapro

Current Illness:

ID: 1750849
Sex: F
Age: 69
State: OH

Vax Date: 04/01/2021
Onset Date: 09/01/2021
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: No antibodies were developed 6months after my vaccine

Allergies:

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

Symptoms: I have not developed any antibodies 6months after taking the Pfizer vaccine. Am I protected, should I try another vaccine?

Other Meds: Prednisone, vitamin D3

Current Illness: Chronic kidney disease

ID: 1750850
Sex: F
Age: 63
State: TX

Vax Date: 01/01/2021
Onset Date: 03/15/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swollen joints, extreme arthritis pain in finger joints, wrists, and elbow. The increasing pain in joints includes more joints each week.

Other Meds: levothyroxine Lexapro Prevacid melatonin

Current Illness: none

ID: 1750851
Sex: F
Age: 26
State: GU

Vax Date: 04/10/2021
Onset Date: 06/01/2021
Rec V Date: 09/30/2021
Hospital:

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

Lab Data: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow because she continued to have dysfunctional bleeding after recovering.

Allergies: None

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

Symptoms: LMP, 03/06/2021 Miscarriage, 06/2021 Prolonged bleeding since Sep 2021

Other Meds: None

Current Illness: None

ID: 1752824
Sex: F
Age: 37
State: CA

Vax Date: 02/03/2021
Onset Date: 09/20/2021
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: None

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

Symptoms: I am a female healthcare worker who is reporting a miscarriage at approx. 6 weeks + 4 days; for data acquisition of a female who became pregnant within 6 months of receiving an mRNA vaccine with which there is limited data surrounding pregnancy and birth defects. I am otherwise healthy with 1 previous pregnancy and 1 healthy full term child born pre-pandemic in 2019.

Other Meds: Pre-natal vitamins

Current Illness: none

ID: 1752825
Sex: F
Age: 43
State: GU

Vax Date: 01/26/2021
Onset Date: 06/01/2021
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: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow, as she passed heavy clots, tried to avoid surgical intervention.

Allergies: None

Symptom List: Pain in extremity

Symptoms: Miscarriage, 06/2021 (-) FHT

Other Meds: None

Current Illness: None

ID: 1752826
Sex: F
Age: 36
State:

Vax Date: 09/22/2021
Onset Date: 09/24/2021
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: I have severe brain fog. I have struggled to get my thoughts together to make sentences. I try to write work emails and can't think straight enough to comply one. Its hard to explain it just seems like a blur over my brain and I'm just confuy.

Other Meds:

Current Illness:

ID: 1752827
Sex: F
Age: 62
State: CT

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shrimp and Strawberries

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

Symptoms: Not sure why, but since August 24th I have been dizzy.

Other Meds: Vitamins

Current Illness: None

ID: 1752828
Sex: F
Age: 54
State: CA

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

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

Lab Data: NONE

Allergies: none

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

Symptoms: PT CAME BACK ON 9/30/21 FOR HER SECOND SHOT REVEALED THAT SHE HAD SEVERE SYMPTOM THE NIGHT OF 8/20/21. PT HAD HEADACHE 4-5 TIMES A WEEK; ROOM SPINNING ON AND OFF THAT NIGHT; SWELLING OF THE ANKLES; LEG PAIN; HEAVY LEGS; FEVER AT NIGHT 3 TIMES A WEEK,;WEAKNESS; BACK PAIN; AND CHEST PAIN AT TIMES. PT DID NOT REPORT THESE SYMPTOMS UNTIL TODAY. TODAY, PT SAID SHE STILL HAS ANKLE SWELLING, FEVER, BACK PAIN. ADVISED PT TO TAKE TYLENOL OR MOTRIN. PT DID NOT SEE ANY DOCTOR REGARDING THESE EFFECTS.

Other Meds: none

Current Illness: none

ID: 1752829
Sex: M
Age: 32
State: HI

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

Lab Data: NA

Allergies: NKA

Symptom List: Vomiting

Symptoms: second vaccine: Severe dizziness, nausea, gastro upset first vaccine: muscle weakness, dizziness, nausea

Other Meds: Adderall (40mg)

Current Illness: NO

ID: 1752830
Sex: F
Age: 49
State: LA

Vax Date: 08/03/2021
Onset Date: 08/03/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Vaccination #1: headache, nausea, severe pain in arm, fatigue, body/muscle aches, flutter in chest (created shortness of breath), diarrhea. These symptoms began approximated 20-30 minutes after injection and lasted for four days. Vaccination #2: pain in arm, headache and severe flutter in chest (causing shortness of breath) began about two hours after injection. When I laid down in bed, the /flutter/shortness of breath got worse. Body/muscle aches, fatigue, and diarrhea began in the morning after injection and lasted for days. Then the pains in the chest began and the shortness of breath/flutter in chest continued and did not subside until 9/17/2021. I developed insomnia and low libido since receiving second vaccination.. My first good night of rest was 9/26/20. Still experiencing low libido from vaccination

Other Meds: Losartan 100mg

Current Illness: High Blood Pressure

ID: 1752831
Sex: F
Age: 21
State: GU

Vax Date: 05/04/2021
Onset Date: 07/27/2021
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: FIRST TRIMESTER MISCARRIAGE CONFIRMED POST VACCINE BY ULTRASOUND AND Beta HCG. Patient is recovering from physical and emotional trauma. Will continue to follow.

Allergies: None

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

Symptoms: Miscarriage / heavy bleeding, 07/2021

Other Meds: None

Current Illness: None

ID: 1751603
Sex: F
Age: 77
State: VA

Vax Date: 01/28/2021
Onset Date: 02/27/2021
Rec V Date: 10/01/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Test Name: Heart rate; Result Unstructured Data: Heart rate greater than100 beats per min; Test Date: 20210803; Test Name: MRI; Result Unstructured Data: she did not have Carpal Tunnel Syndrome in right hand

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Diarrhea; Eye itching; Eye red; Numbness; Flushing; Feeling hot; Long term adverse reactions; irritation; Low energy; Fatigue; Pain in the hip; Muscle pain; Pain in shoulder of the right arm (injection site); Pain in the pelvis/ lower back/ upper back; Swelling in the hands; Inability to complete daily tasks; Pain in thighs; Swelling in the wrists; pelvic pain; Swelling of joints; This spontaneous case was reported by a consumer and describes the occurrence of DIARRHOEA (Diarrhea), EYE PRURITUS (Eye itching), OCULAR HYPERAEMIA (Eye red), HYPOAESTHESIA (Numbness), FLUSHING (Flushing) and FEELING HOT (Feeling hot) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 022M20A and 007M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient's past medical history included Hay fever. Concurrent medical conditions included Hypothyroidism in 1999, Asthma (Restarting serum shots since september), Blood pressure high, Pre-diabetic (pre- diabetic but since Steroidson med) since 2021, Drug allergy (Eye drop solution, swollen eyes area, ichy and burning sensation for 5 days even with antiisthamine) since 2015, Latex allergy (Result in rash,itchy rash around mouth at dentist after work was done) since 1980, Drug allergy (Cipro,maybe digestive) since 2018, Drug allergy (Crestor (Statin),myalgias) since 1995, Drug allergy (Percocet) and Osteoarthritis (left shoulder operated on 01-15-2021) since 2005. Concomitant products included LEVOTHYROXINE from 04-Mar-2017 to an unknown date, ACETAMINOPHEN, AMOXICILLIN from 04-Mar-2017 to an unknown date, HYDROCHLOROTHIAZIDE, LOSARTAN POTASSIUM (LOSARTAN POTASSIUM/HCTZ), FLUTICASONE PROPIONATE, SALMETEROL XINAFOATE (ADVAIR) from 04-Mar-2017 to an unknown date, MELATONIN and PROBIOTICS NOS for an unknown indication. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 27-Feb-2021, the patient experienced DIARRHOEA (Diarrhea) (seriousness criterion hospitalization), EYE PRURITUS (Eye itching) (seriousness criterion hospitalization), OCULAR HYPERAEMIA (Eye red) (seriousness criterion hospitalization), HYPOAESTHESIA (Numbness) (seriousness criterion hospitalization), FLUSHING (Flushing) (seriousness criterion hospitalization), FEELING HOT (Feeling hot) (seriousness criterion hospitalization), IMPAIRED WORK ABILITY (Inability to complete daily tasks) and PELVIC PAIN (pelvic pain). 27-Feb-2021, the patient experienced PAIN (Pain in the pelvis/ lower back/ upper back), PERIPHERAL SWELLING (Swelling in the hands), PAIN IN EXTREMITY (Pain in thighs), JOINT SWELLING (Swelling in the wrists), SWELLING (Swelling of joints), ASTHENIA (Low energy), FATIGUE (Fatigue), ARTHRALGIA (Pain in the hip), MYALGIA (Muscle pain) and INJECTION SITE PAIN (Pain in shoulder of the right arm (injection site)). On an unknown date, the patient experienced SKIN IRRITATION (irritation) and VACCINATION COMPLICATION (Long term adverse reactions). The patient was hospitalized on 08-Mar-2021 due to DIARRHOEA, EYE PRURITUS, FEELING HOT, FLUSHING, HYPOAESTHESIA and OCULAR HYPERAEMIA. The patient was treated with PREDNISONE (oral) from 09-Mar-2021 to 09-Jul-2021 at a dose of 30 mg; PARACETAMOL (TYLENOL) at a dose of 600 mg every eight hours and CELECOXIB from 03-Aug-2021 to 18-Sep-2021 at a dose of 200 mg. On 27-Jul-2021, PAIN (Pain in the pelvis/ lower back/ upper back), PERIPHERAL SWELLING (Swelling in the hands), IMPAIRED WORK ABILITY (Inability to complete daily tasks), PAIN IN EXTREMITY (Pain in thighs), JOINT SWELLING (Swelling in the wrists), SWELLING (Swelling of joints), ASTHENIA (Low energy), FATIGUE (Fatigue), ARTHRALGIA (Pain in the hip), MYALGIA (Muscle pain) and INJECTION SITE PAIN (Pain in shoulder of the right arm (injection site)) had resolved. At the time of the report, DIARRHOEA (Diarrhea), EYE PRURITUS (Eye itching), OCULAR HYPERAEMIA (Eye red), HYPOAESTHESIA (Numbness), FLUSHING (Flushing), FEELING HOT (Feeling hot), PELVIC PAIN (pelvic pain) and SKIN IRRITATION (irritation) had not resolved and VACCINATION COMPLICATION (Long term adverse reactions) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Aug-2021, Magnetic resonance imaging: normal (normal) she did not have Carpal Tunnel Syndrome in right hand. On an unknown date, Heart rate: abnormal (abnormal) Heart rate greater than100 beats per min. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. On 27 Aug, she visited to Rheumatologist and hands was still swollen and painful so he prescribed a MRI for the left hand. Still she had pain around the pelvis area since stopping Prednisone, problems specialy sitting and getting up. She was on medications like destoratadine 5 mg tablet 1 tablet daily when needed, Centrum silver 1 tablet daily started on 04-03-2017, Caltrate 600 plus Vit D tablets, taking 1 a day started on 04-03-2017, Tinnitus 911, 2 tablets a day started in 2020 November at the time of vaccines. Company comment - This case concerns a 77-year-old female patient with relevant medical history of Hypothyroidism, Hypertension and multiple allergies, who experienced the unexpected serious events of Diarrhoea, Eye pruritus, Ocular hyperaemia, Hypoaesthesia, Flushing and Feeling hot. The events occurred approximately 2 days after the second dose of Moderna COVID-19 Vaccine administration. The rechallenge was not applicable as no events reported after the first dose and no additional dosing will be given. The benefit-risk relationship is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 27-Jul-2021: Follow up added- event added as long term adverse reactions to vaccine On 29-Jul-2021: Follow-up contains Non-Significant Information. On 22-Sep-2021: Updated relevant medical history, Allergies, lab details added, Concomitant medication added, new events added.; Sender's Comments: This case concerns a 77-year-old female patient with relevant medical history of Hypothyroidism, Hypertension and multiple allergies, who experienced the unexpected serious events of Diarrhoea, Eye pruritus, Ocular hyperaemia, Hypoaesthesia, Flushing and Feeling hot. The events occurred approximately 2 days after the second dose of Moderna COVID-19 Vaccine administration. The rechallenge was not applicable as no events reported after the first dose and no additional dosing will be given. The benefit-risk relationship is not affected by this report.

Other Meds: LEVOTHYROXINE; ACETAMINOPHEN; AMOXICILLIN; LOSARTAN POTASSIUM/HCTZ; ADVAIR; MELATONIN; PROBIOTICS NOS

Current Illness: Asthma (Restarting serum shots since september); Blood pressure high; Drug allergy (Percocet); Drug allergy (Eye drop solution, swollen eyes area, ichy and burning sensation for 5 days even with antiisthamine); Drug allergy (Crestor (Statin),myalgias); Drug allergy (Cipro,maybe digestive); Latex allergy (Result in rash,itchy rash around mouth at dentist after work was done); Osteoarthritis (left shoulder operated on 01-15-2021); Pre-diabetic (pre- diabetic but since Steroidson med)

ID: 1751657
Sex: U
Age:
State: CA

Vax Date: 10/30/2015
Onset Date:
Rec V Date: 10/01/2021
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: multiple sclerosis; serious neurological issues; issues with left leg; numbness on left side; depression; constant pain; fatigue; anxiety; This initial spontaneous report was received from a lawyer regarding a case in litigation referring to a patient of unknown age and gender. The patient's pertinent medical history, concurrent conditions or concomitant medications were not reported. In or about 30-OCT-2015, the patient was administered zoster vaccine live (ZOSTAVAX) (lot#, expiration date, dosage, route of administration and anatomical location were not provided) for the long-term prevention of shingles and zoster-related conditions by a healthcare provider. Subsequently, on an unknown date, the pt was treated by unspecified providers, for the following injuries resulting from the pt's use of zoster vaccine live (ZOSTAVAX): serious neurological issues, issues with left leg, fatigue, constant pain and numbness on left side, depression, anxiety and multiple sclerosis. The outcome of the events was not reported. The reporter considered all events to be related to Zoster Vaccine Live (ZOSTAVAX). Upon internal review, the event of multiple sclerosis was determined to be medically significant. The event of nervous system disorder was considered serious by the reporter.

Other Meds:

Current Illness:

ID: 1751689
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 10/01/2021
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: got the shot years ago then got shingles/Suspected vaccination failure; got shingles; This case was reported by a consumer via interactive digital media and described the occurrence of suspected vaccination failure in a female patient who received Herpes zoster (Shingles vaccine) for prophylaxis. On an unknown date, the patient received Shingles vaccine. On an unknown date, unknown after receiving Shingles vaccine, the patient experienced vaccination failure (serious criteria GSK medically significant) and shingles. On an unknown date, the outcome of the vaccination failure and shingles were unknown. It was unknown if the reporter considered the vaccination failure and shingles to be related to Shingles vaccine. Additional details were reported as follows: The case was reported by the patient's sibling. The patient got the shot just a few years prior to the reporting and when she move back, she got the shingles. This case was considered as suspected vaccination failure as details regarding completion of primary vaccination schedule, time to onset and laboratory confirmation of shingles were unknown at the time of reporting

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am