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: 1756543
Sex: F
Age: 78
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756544
Sex: M
Age: 60
State: NJ

Vax Date: 09/21/2021
Onset Date: 09/28/2021
Rec V Date: 10/02/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None.

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Blurred or double vision especially after slight exertion or going up/down stairs, constant fatigue and low-level headache (this has been for more than a week now), mild spatial disorientation (as would be evidenced with --one symptom--incorrect typing of keys on keyboard), lack of proper bowl movement (more than 1 week), enhanced appetite (hungry).

Other Meds: Amlodipine/Benazepril 5/40, SeroVitol

Current Illness: BP

ID: 1756545
Sex: F
Age: 23
State: IL

Vax Date: 09/19/2021
Onset Date: 09/19/2021
Rec V Date: 10/02/2021
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: NKA

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

Symptoms: Pt reports hours after receiving the covid moderna vaccine at pharmacy, he experienced shortness of breath on 9/19/21. On Wednesday, 9/23/21 the shortness of breath worsened to chest pain with inspiration and movement, lightheadedness and cough. He was seen by PCP on Wednesday 9/29/21 and was diagnosed with pleuritic chest pain, had an EKG and chest xray, and started azithromycin and prednisone. Today he's following up for shortness of breath, chest pain, lightheadedness and cough that continue but have not worsened.

Other Meds: Certrizine 10mg daily as needed.

Current Illness: None

ID: 1756546
Sex: M
Age: 51
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756547
Sex: M
Age: 36
State: NC

Vax Date: 09/17/2021
Onset Date: 09/24/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies: Environmental allergies/unknown to product and food allergies

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

Symptoms: Bilateral ear fullness, unable to resolve

Other Meds: None

Current Illness: None/unaware

ID: 1756548
Sex: M
Age: 77
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756549
Sex: F
Age: 40
State: SC

Vax Date: 04/20/2021
Onset Date: 05/11/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I was approximately 5 weeks pregnant and had a miscarriage after I got the first Covid vaccine.

Other Meds: None

Current Illness: None

ID: 1756550
Sex: M
Age: 56
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756551
Sex: F
Age: 33
State: OH

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/02/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Bruised, swollen left eye lid. Whole body aches. Hurting left arm at injection site. Cough, and runny nose. Chest feels sick like a respiratory infection.

Other Meds: None

Current Illness: None

ID: 1756552
Sex: M
Age: 48
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756554
Sex: M
Age: 84
State: NY

Vax Date: 02/10/2021
Onset Date: 08/29/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: TEE

Allergies: BEE STINGS

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

Symptoms: SHORTNESS OF BREATHE AFIB

Other Meds: SEVERAL

Current Illness: HEART

ID: 1756555
Sex: F
Age: 37
State: TX

Vax Date: 09/09/2021
Onset Date: 09/22/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: None

Allergies: ALL Triptans; Prochlorperazine; Promethazine; ALL Phenothiazines.

Symptom List: Rash, Urticaria

Symptoms: Rash; swollen face; eyes swollen almost shut; dry, scaly skin on eyelids & undereyes; SOB, extreme trouble breathing; post nasal drip; lung congestion.

Other Meds: Venlafexine, alpralozam, hair vitamins

Current Illness: None

ID: 1756556
Sex: M
Age: 73
State: NC

Vax Date: 09/28/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA that I recall

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

Symptoms: Had a diagnosed CVA

Other Meds: unknown at this time

Current Illness: Diabetes

ID: 1756557
Sex: F
Age: 53
State: OR

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 10/02/2021
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: Penicillin, Demoral, Diflucan

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

Symptoms: Awoke gasping for air, lasted for about 45 min. Took Benedryl and it helped. Didn't have full lung function most of the day but it got better next day. Extreme soreness at times in left arm.

Other Meds: AMBIEN

Current Illness: None.

ID: 1756558
Sex: M
Age: 59
State: IN

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: None.

Allergies: Sensitive to antibiotics.

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

Symptoms: Low grade fever, chills, headache , body aches, nausea, sore throat. Runny nose, left arm pain. Abdominal pain.

Other Meds: No prescription drugs. But multi-Vitamin supplements.

Current Illness: Contracted the COVID virus four weeks prior to my second shot.

ID: 1756559
Sex: M
Age: 65
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756560
Sex: M
Age: 68
State: TX

Vax Date: 02/25/2021
Onset Date: 04/01/2021
Rec V Date: 10/02/2021
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: Vancomycin

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: A short while after receiving the vaccine I began seeing "wavy lines" on the right side of spreadsheets, a few weeks later it became difficult to read small print and numbers. I contacted my ophthalmologist and he referred me to a retinal specialist who injected medication into my eyes. I believe the medication was Eylea.

Other Meds: Toprol, amitriptyline, Levothyroxine, Abilify, CYmbalta, Prednisone, Insulin, Magnesium, Multi-vitamin

Current Illness: Diabetes, peripheral neuropathy

ID: 1756561
Sex: F
Age: 37
State: TX

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
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: ALL Triptans; Prochlorperazine; Promethazine; ALL Phenothiazines.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Rash; swollen face; eyes swollen almost shut; dry, scaly skin on eyelids & undereyes; SOB, extreme trouble breathing; post nasal drip; lung congestion.

Other Meds: Venlafexine; busiprone; alpralozam

Current Illness: Allergic reaction to covid 19 vaccine dose #1

ID: 1756562
Sex: F
Age: 40
State: SC

Vax Date: 05/18/2021
Onset Date: 06/09/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: Blood work done multiple times. June 9, 2021 July 13, 2021 August 12, 2021 Retaking blood work again soon to recheck.

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: My blood work done less than a month after my 2nd shot showed elevated red blood cells. They were concerned it was Polycythemia Vera. They put me on low dose aspirin, redid the tests with same results and sent me to the oncologist. A few weeks later, the blood tests results went back to normal. I also had blood work done about a month before getting my 1st vaccine that was normal.

Other Meds: None

Current Illness: None

ID: 1756563
Sex: M
Age: 55
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756564
Sex: F
Age: 58
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756565
Sex: F
Age: 35
State: TX

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies: Wellbutrin

Symptom List: Unevaluable event

Symptoms: Swollen lymph node in armpit

Other Meds: No

Current Illness: No

ID: 1756566
Sex: M
Age: 70
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756567
Sex: M
Age: 55
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756568
Sex: M
Age: 41
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756569
Sex: M
Age: 23
State: NC

Vax Date: 09/17/2021
Onset Date: 09/18/2021
Rec V Date: 10/02/2021
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: Denies

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

Symptoms: Patient woke up the next morning following her 2nd dose of the vaccine (17SEP) with a 7/10 unilateral headache on the left side. Patient went to the ER on the same day (18SEP). Patient was given naproxen and told to hydrate. Patient then returned to ED on 02OCT with complaint of headaches presenting in the morning on a daily basis since the vaccine was administered. Patient states the headache cause left sided neck pain, left eye pressure and lacrimation. Headache lasts 45-60min and is relieved with ibuprofen and a hot shower. Once symptoms subside then headache dose not return until following day

Other Meds: Taking Ibuprofen for the headaches. Did take Naproxen for x2 days when symptoms started, but discontinued.

Current Illness: Denies

ID: 1756570
Sex: M
Age: 66
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756571
Sex: F
Age: 29
State: TX

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: N/A

Allergies: Bacterium

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Rash over stomach, back and chest

Other Meds: - Larin Fe -Advil

Current Illness: N/A

ID: 1756572
Sex: M
Age: 19
State: TX

Vax Date: 05/19/2021
Onset Date: 05/22/2021
Rec V Date: 10/02/2021
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: None known.

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

Symptoms: The patient became extremely fatigued, ran a fever, and the hair on his head began falling out in large quantities. The fever went away after a couple of days, but the fatigue and hair loss continued. The patient received the second Moderna dose on 6/16/21 (050C21A). Patient started sleeping over 12 hours a day and the hair loss (alopecia) continued. There was tons of hair on his pillow, sink and shower floor. The hair on his head is still thin all over, but has quit falling out in abnormal quantities (as of 10/2/2021), and has not started to regrow yet. The patient is back to his normal sleeping habits and feels better.

Other Meds: None

Current Illness: None

ID: 1756573
Sex: M
Age: 56
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756574
Sex: M
Age: 42
State:

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756575
Sex: M
Age: 47
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756576
Sex: M
Age: 63
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756577
Sex: M
Age: 36
State: IL

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: Tremor

Symptoms: Large itchy raised rash on neck with petechia

Other Meds: Vyvanse, Escitalopram, Bupropion

Current Illness: none

ID: 1756578
Sex: M
Age: 32
State:

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756579
Sex: M
Age: 48
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756580
Sex: F
Age: 58
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756581
Sex: F
Age: 33
State: GA

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

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

Lab Data: No medical test

Allergies: Ativan Hadol Zoloft Glitter Pork

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I received the vaccine on 10/01/2021, I waited 15 minutes after receiving the first does. After driving home, I became tired ( sleepy). The following day 10/02/2021 I woke up with a massive headache, blurred vision, sensitivity to light, dizzy and some weakness during ambulating. I took two Tylenols and one Ibuprofen. symptoms were alleviated.

Other Meds: Ibuprofen 800 milligrams ( 3 times a day) , Tylenol rapid release 500 milligrams times two every 6 hours

Current Illness: No prior illnesses until one day following the vaccine.

ID: 1756582
Sex: F
Age: 57
State: NJ

Vax Date: 03/21/2021
Onset Date: 09/24/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data: Vaccinations: Pfizer 3/21/21 - Lot ER8732 Pfizer 4/18/21 - Lot EW0170 COVID-19 Tests: PCR - 9/24/21 - Positive

Allergies: Unknown

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

Symptoms: Vaccine Breakthrough Case - Hospitalized The individual was fully vaccinated for COVID-19 and was hospitalized due to the severity of her symptoms. Symptoms started 09/21. She was a contact of a case with last date of exposure 09/15 and had no symptoms when interviewed on 09/17. She is a private caretaker for that case. She and the case had a PCR done on 09/14 and she was negative then. Currently in the hospital (as of last contact from the Health Dept on 9/25) - Medical Center admitted 09/24 - Breathing more difficult than normal as she has asthma and COPD. She was lethargic, had a lot of tightness in her chest, and was very pale/bluish. Patient is experiencing the following symptoms: Rigors, runny nose/sinus congestion, fatigue, cough, shortness of breath (dyspnea), difficulty breathing, chest pain, abdominal pain, diarreha, low oxygen levels, inability to wake or stay awake (lethargy), pale, grey, or blue-colored skin, lips or nail beds, depending on skin tone (cyanosis). If they've ever had any adverse events/reactions, post-vaccination in the past: NO **Reaction to COVID vaccine - was weak for about 24 hour, 3 days after 2nd shot she believes

Other Meds: Unknown

Current Illness:

ID: 1756583
Sex: F
Age: 34
State: CA

Vax Date: 09/26/2021
Onset Date: 09/28/2021
Rec V Date: 10/02/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Large, protruding blister on the inside of the right cheek. Smaller blister nearby on the same cheek. Swollen gums, slightly swollen on roof of mouth. Very dry lips.

Other Meds: None

Current Illness: None

ID: 1756584
Sex: F
Age: 53
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756585
Sex: M
Age: 84
State: NY

Vax Date: 03/01/2021
Onset Date: 06/01/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data:

Allergies: Metformin

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

Symptoms: Platelets decreased to 13,000

Other Meds:

Current Illness: None

ID: 1756586
Sex: M
Age: 87
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756587
Sex: F
Age: 51
State: NC

Vax Date: 08/28/2021
Onset Date: 09/05/2021
Rec V Date: 10/02/2021
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: Codeine, Tramadol, latex

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

Symptoms: Moderna vaccine received on 8/28/2021 and caused a red spot the size of a quarter. 9/5/2021 the red spot started itching and turned into a raised hive with hot feel and then a couple days later arm turned red in a circle 2 1/2 inches wide.

Other Meds: Tamoxifen, Multivitamin, Lipitor

Current Illness: no

ID: 1756588
Sex: F
Age: 62
State: TN

Vax Date: 03/01/2021
Onset Date: 03/05/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: Heart stress test, blood work, gene analysis, bone marrow biopsy. Diagnosed with what appears to be Essential Thrombocytothemia.

Allergies: Sulfa, Penicillin

Symptom List: Vomiting

Symptoms: Racing heartbeat, chest and abdominal pain and pressure, pain for 24 hrs in inner thighs, headache.

Other Meds: Wellbutrin, Sertraline, Xarelto, Valacyclovir, calcium, fish oil, glucosamine, Ocuvite, biotin, folic acid, B-12.

Current Illness:

ID: 1756589
Sex: F
Age: 66
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756590
Sex: F
Age: 26
State: NJ

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/02/2021
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: Tiredness, chills, headache, heart palpitations, feeling weak, shakiness, fever (100.9), and nausea

Other Meds:

Current Illness:

ID: 1756591
Sex: M
Age: 28
State: ID

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 10/02/2021
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: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Slight soreness in arm the next day

Other Meds: Insulin

Current Illness: N/A

ID: 1756592
Sex: M
Age: 58
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/02/2021
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: 1756593
Sex: M
Age: 56
State: IN

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/02/2021
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: Light allergies to many things, no severe allergies. Caffeine is a bugaboo with me.

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

Symptoms: Extreme fatigue, lasting about 2 days. Occasional fever. Achy joints. Mild nausea (no vomiting).

Other Meds: vitamin D, Tylenol, sildenafil

Current Illness: Prostate surgery 08/07/2021

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am