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: 1756849
Sex: M
Age: 28
State: NY

Vax Date: 05/24/2021
Onset Date: 05/25/2021
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: Innumerable tests were done - ECG's, an echocardiogram, cardiac event monitoring, pulmonary function testing, blood work and, by the patient's report, a CT of the chest and an MRI of the chest and / or the heart; with the exception of pulmonary function testing, which reportedly showed evidence of asthma, everything else was normal or unremarkable.

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: The patient initially complained of chest pain, dyspnea, and palpitations that he apparently found extremely disconcerting, such that he sought medical attention at varied urgent care centers, emergency rooms, and doctors offices including, at least, that of a cardiologist (the current reporter), a pulmonologist , and an infectious disease specialist (name uncertain). He later complained of head aches, for which he saw a neurologist / neurosurgeon.

Other Meds: Zolpidem 10 PO QHS

Current Illness:

ID: 1756850
Sex: M
Age: 17
State: NY

Vax Date: 04/06/2021
Onset Date: 04/06/2021
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:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: There were no sympyoms.

Other Meds:

Current Illness:

ID: 1756851
Sex: F
Age: 50
State: CO

Vax Date: 08/10/2021
Onset Date: 08/23/2021
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: Sulfa, Aspirin, NSAIDS, levaquine, Valium, Percocet

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

Symptoms: Heavy Menstrual Bleeding for an entire month

Other Meds: Allegra, Albuterol inhaler, Benadryl , Vitamin D, C, Calcium, Magnesium

Current Illness: None

ID: 1756852
Sex: F
Age: 59
State: PA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: Sulpha med, ssri med

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Within 3 hours of getting second shot I began experiencing chills, swollen lymph nodes under both arms, encephalitis headache, shooting pains in legs and arms, muscle pains, flare up of my costocondritis. I was unwell in bed and unable to do anything for 5 days. A complete and total body inflammatory response.

Other Meds: Exemestane, vit d, calcium

Current Illness:

ID: 1756853
Sex: F
Age: 37
State:

Vax Date: 09/23/2021
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: None

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

Symptoms: Arm pain, fatigue, fever, painful axillary lymphadenopathy, neck/back/chest aches

Other Meds: Birth control, hormonal

Current Illness: None

ID: 1756854
Sex: F
Age: 37
State: GA

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: Vital signs.

Allergies: Latex

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

Symptoms: Tingling in mouth and throat, nausea and chest tightness that started about 15 min after vaccine. Chest tightness resolved after 15 min. Tingling in mouth improved but lasted the rest of the day. Nausea also the rest of the day. Second dose of Benadryl 50mg PO taken that evening

Other Meds: Benadryl 30 min before vaccine. Allegra the night before and taking daily for seasonal allergies. Valacyclovir

Current Illness: None

ID: 1756855
Sex: F
Age: 29
State: CA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: Blood pressure measured 10/2/21 by paramedics

Allergies: moderate anxiety with corticosteroids

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient came in for a flu shot with her partner on 10/02/21. She was alert and oriented before and after receiving the vaccine, only mentioning that she does not like watching the injection occur. After administering the shot, we had the couple wait at the store for 15 minutes based on the answers provided on their intake form. The couple browsed around and seemed fine, then took a seat outside the store to wait the rest of their time. Pt then fainted, falling out of her chair and hit her head on a planter. ND attended to her and checked to ensure she was breathing and had a pulse, which she did. A bystander and the pharmacy called 911. Pt regained consciousness shortly after and we had her return to the store where she sat in the consultation room. There, she let us know that she has become dizzy or fainted after vaccines in the past and was not surprised by this response although it had not happened to her for several years. We offered her water and an ice pack for her head as we waited for the paramedics. The paramedics came and assessed her. She was hypotensive, slow to speech, and a bit pallor in appearance so they took over from there. She later called the pharmacy about an hour later to let us know that she was fine. She did not end up going to the hospital but did spend time sitting with the paramedics until she felt better.

Other Meds: Xanax, birth control, Singulair, Flonase,

Current Illness: unknown

ID: 1756856
Sex: F
Age: 43
State: CA

Vax Date: 03/05/2021
Onset Date: 03/11/2021
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: I have reported to my Internal Medicine provider and I have appointment with my OB in two weeks.

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: I have had irregular menstrual cycles ever since I got this shot six months ago. I track my period and am accurate almost to the day for my whole life. I started late 5 days late after my shot and within 6 months have started my period now within 3 weeks. I KNOW this is from the shot. I am now having irregular and more frequent periods. I am not on any prescription medications and nothing has changed the last 6 months in my life since I have got the shot.

Other Meds: None

Current Illness: None

ID: 1756857
Sex: F
Age: 67
State: OK

Vax Date: 02/01/2021
Onset Date: 02/20/2021
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: None

Allergies: Sulfa drugs

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Unable to control my bowels (sphincter muscel) at all for 24 hours. As of this day I do not have good muscle tone. The least smallest urge I must go to a facility quickly or risk soiling myself.

Other Meds: Baby Asprin Lasinopril Prilosec HTC Glipizide Estradiol Probiodtic

Current Illness: None

ID: 1756858
Sex: M
Age: 12
State: IA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
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: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The patient was to receive his second Pfizer Covid dose but was accidentally administered a flu shot. He had already received his flu shot for the year so this was his second dose. He got his first flu shot on 9/7/21. When the patient was followed up with the next day he had no adverse reactions at that time. It's unknown if he had any later on.

Other Meds: Fluoxetine

Current Illness:

ID: 1756859
Sex: F
Age: 65
State: CA

Vax Date: 01/25/2021
Onset Date: 03/31/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data:

Allergies: None.

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

Symptoms: In the days and weeks following the second dose, my mother began experiencing itching skin symptoms, initially in March and much more severe in April.She began experiencing burning sensations across her entire body. She went to seek treatment through a dermatologist and other medical doctors and was initially treated for other conditions. In late July of 2021, she had a biopsy performed, and in August, she was diagnosed with Pemphigus Vulgaris. She began seeking medical attention for this condition, and on Wednesday, September 1, 2021, she received her first treatment of three injections for the drug Rituxan. On September 19, 2021 my mother was admitted to the ICU and it was discovered in a CT scan that she had sever abdominal issues as a result of her reporting pain in the area. It was discovered that her stomach lining has thinned too much for corrective surgery to heal perforations in her abdomen and diverticulitis. She was transferred to another healthcare facility and admitted to their ICU on September 21, 2021. Her admitting doctors decided she needed another CT scan which then discovered bubbles and a fluid build up as well as a severe infection in her abdomen. They decided she needed to have emergency surgery to remove a part of her intestine and colon. She is in high risk of infection and other complexities as a result of the measures taken and is still undergoing treatment.

Other Meds: None.

Current Illness: None.

ID: 1756860
Sex: F
Age: 69
State: IL

Vax Date: 09/29/2021
Onset Date: 09/30/2021
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: N/A

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Bruising. Worse on day after administration (Thursday, 9/30/21) and getting better

Other Meds: Unknown

Current Illness: Unknown

ID: 1756861
Sex: F
Age: 36
State: MN

Vax Date: 10/02/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Adhesive tape

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

Symptoms: Fever over 101.6 for over 23 hours, myalgias and malaise, headache

Other Meds: Vitamin D, lecithin

Current Illness: Cold 2 weeks prior, covid negative

ID: 1756862
Sex: F
Age: 64
State: NY

Vax Date: 03/12/2021
Onset Date: 06/25/2021
Rec V Date: 10/02/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Muscle movement observational tests, taste test, blood work, CT scan, MRI scan on 6/25/2021 upon admission to E.D. CT scans daily for next 3 days to watch for more bleeding. Neurosurgery (craniotomy with drain insertion) on 6/26/2021.

Allergies: Codeine Oxycodones Outdoor seasonal allergies

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

Symptoms: Discovered drooping face on right side about two hours after noting watering right eye. Immediately went to Emergency Dept. Diagnosed BOTH Bell's Palsy as well as Acute Spontaneous Subdural Hematoma in Fronto/Parietal Area

Other Meds: Losartan 50mg qd Dexilant 60 mg qd Multi-Vit one qd Vit D 5000mg qd Vit C 1000mg qd MSM 1000mg qd Tumeric 1000mg qd

Current Illness: NONE

ID: 1756863
Sex: F
Age: 13
State: WA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: n/a

Allergies: pineapple, tomatoes, grapefruit

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

Symptoms: Patient was given Moderna as a 13 year old, was told by manager that 2nd dose was to be given per CDC recommendations since patient was over the age of 12.

Other Meds: melatonin, ashlyna

Current Illness: UTI

ID: 1756864
Sex: M
Age: 13
State: GA

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data: Troponin (peak) 0.85 10/2/2021 @ 1011

Allergies: None

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

Symptoms: Developed chest pain and shortness of breath, especially with exertion. Had elevated troponin and ST segment abnormalities on EKG.

Other Meds: Fluoxetine 40 mg Bupropion 150 mg

Current Illness:

ID: 1756865
Sex: F
Age: 28
State: IN

Vax Date: 09/30/2021
Onset Date: 10/01/2021
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: Depakote, geodon

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

Symptoms: Hard to breathe, started coughing today, lethargic, sore throat

Other Meds: B12 St. John's wort

Current Illness: None

ID: 1756866
Sex: M
Age: 58
State: MO

Vax Date: 10/01/2021
Onset Date: 10/01/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756867
Sex: F
Age: 57
State: MA

Vax Date: 10/01/2021
Onset Date: 10/02/2021
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: Na

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Chills severe headache. Body aches pain at injection site Fever 102. Still for over 24 hours. Headache won?t quit. 8/10

Other Meds: None

Current Illness: Injection site reaction to initial dose

ID: 1756868
Sex: F
Age: 54
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756869
Sex: M
Age: 69
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756870
Sex: F
Age: 25
State: UT

Vax Date: 08/19/2021
Onset Date: 08/24/2021
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: CT Spine Lumbar w/o Contrast (08/24/2021) CT Spine Thoracic w/o Contrast (08/24/2021) CT Stone Protocol (08/24/2021)

Allergies: None that I'm aware of

Symptom List: Unevaluable event

Symptoms: 3 days after the second dose, I experienced severe muscular lower back pain. The pain started that night on the 3rd day, and increased in intensity as the night progressed toward 3AM. I tried to keep water and Ibuprofen down to treat the pain, but after several hours of intermittent dry-heaving after initially being unable to keep the painkiller down, I was taken to the ER at 9:30AM. After puking, I would experience a small reprieve before the pain would slowly increase again, as would my feeling of nausea. The nausea correlated with my pain level.

Other Meds: Duloxetine HCL DR 60mg (generic for Cymbalta) Omeprazole DR 20mg

Current Illness: None

ID: 1756871
Sex: M
Age: 44
State:

Vax Date: 09/11/2021
Onset Date: 09/12/2021
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: hemorroids

Other Meds:

Current Illness:

ID: 1756872
Sex: F
Age: 66
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756873
Sex: F
Age: 62
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756874
Sex: F
Age: 68
State: OH

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: NONE AT THIS TIME

Allergies:

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

Symptoms: PATIENT FALSIFIED HER ADMINISTRATION FORM AND VACCINE INTERVIEW CLAIMING SHE HAD NEVER HAD THE COVID VACCINE BEFORE. UPON BATCH FILLING HOURS LATER, CMS REJECTED STATING SHE ALREADY RECEIVED THE J&J VACCINE. LOOKING AT SYSTEM, PATIENT RECEIVED VACCCINE IN MARCH 2021. WILL CONTACT MD MONDAY

Other Meds:

Current Illness:

ID: 1756875
Sex: F
Age: 23
State: FL

Vax Date: 08/04/2021
Onset Date: 08/09/2021
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: 8/9/21- chest xray, ecg, ct of chest (elevated d-dimer 0.93) 8/12/21- chest xray (elevated d dimer 0.94) 9/23/21 Echocardiogram , Holter Monitor, diagnosed with AVNRT

Allergies: Augmentin, Azithromycin latex

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 8/9/21 went into SVT 190s, went to ER self converted. Did a whole PE work up, CT,Xray chest,cardiologist referral (vagal maneuver) started Metropolol 12.5 mg 2x a day, 8/12/21 went into SVT 190s while driving, went to ER self converted, chest Xray and cardiologist referral.

Other Meds: Nexplanon birth control arm implant

Current Illness: None

Date Died: 09/23/2021

ID: 1756876
Sex: F
Age: 69
State: KY

Vax Date: 03/10/2021
Onset Date: 09/17/2021
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: Abbot rapid nasal covid swab on 09/17/2021 X 2, both with + results

Allergies: morphine

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Received covid vaccine at another (unknown) location prior to admission to facility. experienced multiple falls with significant fractures (prior to facility admission), which put her in the hospital, then needing rehab. transferred to this facility, facility sent to the hospital r/t medical concerns on 09/05/2021, returned to the facility on 09/10/2021, tested positive for covid 19 on 09/17/2021. was treated per facility APRN and MD, however, despite efforts, expired on 09/23/2021. Death is under investigation with health department for cause.

Other Meds: Norco, duloxetine, midodrine, melatonin, calcium carbonate, amitriptyline, senna, lidocaine, nitrofurantoin, nystain,

Current Illness: depression, iron deficiency, repeated falls, constipation, dementia

ID: 1756877
Sex: M
Age: 72
State: AZ

Vax Date: 05/26/2021
Onset Date: 05/26/2021
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: Penicillin Bee Stings

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

Symptoms: The evening after getting shot, developed headache and sore arm. Progressing to now the symptoms include: brain fog, seeing fuzz or spots in vision, tremors, numbness & tingling in extremities, feeling of loss of control of limbs, dizziness. Sore arm has never gotten better, other symptoms continue to become progressively worse.

Other Meds: Doxazosin Mesylate 4mg Ventolin HFA

Current Illness:

ID: 1756878
Sex: M
Age: 59
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756879
Sex: F
Age: 63
State: VA

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: Within 12 hours of vaccine had and continue to have persistent significant headaches that are not relieved by NSAID or other agents. Also body fatigue that was never experienced prior to the vaccine. Swelling and rash at injection site that dissipated over next 3-4 days after vaccine.

Other Meds: Estratest; Progesterone Magnesium prn ARED eye vitamins

Current Illness: None

ID: 1756880
Sex: F
Age: 70
State: TX

Vax Date: 03/27/2021
Onset Date: 04/07/2021
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: Blood work showed high inflamation Sedimentation 51 C reactive protein 67

Allergies: latex

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

Symptoms: One week after shot sharp muscular pain in various muscles. Shoulder pain, hip and tailbone pain 2 weeks later. Collarbone pain shortly after. Prednisone taper for 2 weeks. short term help. Waited 2 months to get into the Rheumatology clinic. Prescribed more prednisone. Better while taking. Pain returns when I stop.

Other Meds: Budesonide, magnesium, vitamin D

Current Illness: none

ID: 1756881
Sex: M
Age: 43
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756882
Sex: M
Age: 53
State: MO

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: Tremor

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756883
Sex: F
Age: 57
State: VA

Vax Date: 08/12/2021
Onset Date: 08/01/2021
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: None

Allergies: All narcotics, vicodine, daluadid, percocet, hydrocodone

Symptom List: Erythema, Pruritus

Symptoms: Severe skin irritation on the chest, red, itchy, blister like, and skin peeled off the chest as well as nose. Fever 101, chills, body aches

Other Meds: Cymbalta, levothyroxine, celebrex, pantoprazole, benadryl, Singulair, Flonase, multivit for women over 50, vitamin B2, biotin, trazodone, colace, Maxalt, Relpax, excerdrin migraine, Zyrtex, magnesium,

Current Illness: None

ID: 1756884
Sex: F
Age: 62
State: WV

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: none

Allergies: penicillins

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

Symptoms: administration error. patient got 2 doses of shingrix at same time, one in each arm

Other Meds: unknown

Current Illness: unknown

ID: 1756885
Sex: F
Age: 86
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756886
Sex: F
Age: 38
State: AZ

Vax Date: 08/21/2021
Onset Date: 09/28/2021
Rec V Date: 10/02/2021
Hospital:

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

Lab Data: 9/28/21- abdominal ultrasound x1, intravaginal ultrasound x2 with no cardiac activity noted- missed abortion

Allergies: Latex (rash)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Newly pregnant during vaccination, with EDD 4/29/22. Normal ultrasound at 8 weeks (9/16/21) with developing fetus and yolk sac observed with heart rate measured at 164 bpm. Two weeks later (9/28/21), no cardiac activity seen x 3 ultrasounds; estimated fetal size ~9 weeks, suggesting demise one week prior.

Other Meds: Prenatal vitamin, prenatal probiotic, prenatal omega 3, cetirizine, melatonin

Current Illness: None

ID: 1756887
Sex: F
Age: 39
State: MO

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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756888
Sex: F
Age: 48
State: TN

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

Lab Data: none

Allergies: penicillin

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

Symptoms: pt called about a sore arm and feeling beat up. she called back 3hours later complaining of jerking of muscles in arms, jaw, face, and upper torso.

Other Meds: unknown

Current Illness: adrenal insufficiency

ID: 1756889
Sex: F
Age: 9
State: MI

Vax Date: 05/27/2021
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:

Symptom List: Pain in extremity

Symptoms: We were contacted by Improvement Registry and told to report this incidence to you. The mother of the above patient lied her date of birth so she could get Covid vaccines. No insurance was given to us so we ran our special way to run the vaccines. We had no idea that this patient was only 9 years old. By the way, the patient/her mother hasn't reported any adverse events.

Other Meds:

Current Illness:

ID: 1756890
Sex: M
Age: 57
State: MO

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: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756891
Sex: F
Age: 61
State: NJ

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Blood work, ECG, BP and pulse observation in ER, nausea medication, saline drip. I will seek primary care follow up and cardiology follow up.

Allergies: latex, erythromycin, codeine, clonazepam

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

Symptoms: 15 minutes post shot, started feeling light headed, dizzy, weak legs. EMTs on sight took BP and pulse. 196/147 and 169 pulse. Normal BP and pulse is 105/65 and 74 pulse. 30 minutes after shot, BP at 157/83 and pulse at 110, also nausea started and still shaky, light headed, dizzy. At 45 minutes after shot, decision made to transport me to hospital because BP/pulse not coming further down, and nausea getting worse. At ER, given saline IV, Zophran for nausea (which is now over a 10 on 1-10 scale), blood work and ECG tests. Zophran did not touch escalating nausea, so a second med was added. 1st dose of that did not help, second dose of second me 5 hours after shot finally got nausea to a 6 (1-10 scale) which was way more tolerable. BP and pulse still not lower than 140/84. Was sent home after 5 hours in ER (6 hours after shot). 3 days later still nauseous, light headed, not feeling 'right' or good, not going anywhere, just resting, hydrating, eating. Prior to shot I was well hydrated and had eaten regularly that day and was feeling well.

Other Meds:

Current Illness:

ID: 1756892
Sex: M
Age: 50
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Patient mentioned he had a cramp in his left thigh. Declined pain medication. Took blood pressure. Offered patient cold water. Advised to be observed for additional 30 minutes. Patient felt better and was cleared by Nurse.

Other Meds:

Current Illness:

ID: 1756893
Sex: M
Age: 67
State: MO

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Administration error mixed series mRNA vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756894
Sex: F
Age: 74
State: TN

Vax Date: 09/07/2021
Onset Date: 09/08/2021
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: On September 14th I was scheduled with Optometrist, OD, on referral from my Opthalmologist. Routine visual tests were completed and Dr. sent me back to the office of Opthalmologist for further testing of visual fields. All tests were reported to be normal. The eye aches behind my eyes with extreme light sensitivity and also headaches have persisted since this event and are not previously experienced by me.

Allergies: Sulfonamides Zithromax Dosepak Clindamycin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: The morning after the CoVid Moderna injection at 8:30 I was sitting in room at home and at one point when I blinked my eyes, I could see nothing but dark gray. I closed my eyes and repeated, nothing but gray. No sight. I did this numerous times breathing deeply for 20-30" approximately between eye opening. This continued for approximately 6 minutes. The experience was terrifying. At one point, I opened my eyes and my sight was returning. I lay down and slept for approximately 3 hours. I had eye aches and significant headaches following this event which were new and sought the advice of an Optometrist since I could not get an appointment with my ophthalmologist for weeks.

Other Meds: Dietary supplements: Vitamins B Complex, C, E, Purity Gold Pack, Biotin, MSM Chondroitin, Turmeric Prolia Injections twice yearly

Current Illness: None

ID: 1756895
Sex: F
Age: 52
State: CA

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: RA

Lab Data: Transferred to ER

Allergies: Sulfa AntibioticsRash, non-urticarial TomatoAnaphylaxis Sesame [Black Sesame Seed]Rash, Unspecified Tree NutRash, Unspecified Compazine [Prochlorperazine]Other Latex [Banana Cream Flavor] Metoclopramide Dihydrochloride

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

Symptoms: Patient here on 10/1/21 to receive booster covid 19 Pfizer vaccine. Shortly after vaccine patient began to to experience lightheadedness, wheezing, cough, throat tightness and scattered rash-like around chest and arm area. Staff notified and was taken back to private exam room, patient mentioned that at time of feeling these symptoms, patient administered self provided Xopenex inhaler. Patient responsive and conscious, alerts and oriented, skin dry, no severe distress noted. Initial vital signs:@11:15am BP-142/87, Pulse-112 Resp-19, O2-98%RA. ; 25mg of Liquid Oral Diphenhydramine was given. Patient stated began to feel feel better, symptoms were beginning to subside, and roughly 20-25 minutes after 25mg of Liquid Oral Diphenhydramine was given patient reported symptoms were returning and worsening. At this time vitals were reassessed BP-126/79, Pulse-117 Resp-18, O2-98%RA, no severe distress noted. Epinephrine 0.3mg was administered to right vastus lateralis with EpiPen, patient remained alert an oriented at all times. EMS was called to transport to higher level of care via ambulance.

Other Meds: TIROSINT 125 MCG CAPS TAKE ONE CAPSULE BY MOUTH EVERY MORNING metFORMIN (GLUCOPHAGE) 500mg Tab TAKE TWO TABLETS BY MOUTH TWICE A DAY WITH BREAKFAST AND DINNER GENERIC FOR GLUCOPHAGE zolpidem (AMBIEN) 10mg Tab Take one Tab by mouth at bedtim

Current Illness: None disclosed

ID: 1756896
Sex: F
Age: 48
State: MO

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: 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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756897
Sex: F
Age: 48
State: MO

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 vaccination Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1756898
Sex: F
Age: 16
State: GA

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

Lab Data: none

Allergies: none

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

Symptoms: Hives, facial swelling, nausea and fatigue OTC benedryl, zyrtec and pepcd, as well as tylenol for headache

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am