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: 1756952
Sex: F
Age: 67
State: TN

Vax Date: 03/31/2021
Onset Date: 04/12/2021
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: Unknown, gastroenterologist following

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient reports GI issues related to IBS that began within weeks of her second Covid-19 vaccine. She has past medical history significant for IBS, but her condition was previously controlled. She says her symptoms are nearly unbearable and that her gastroenterologist has not been able to determine an effective treatment for her. She has had either diarrhea or constipation since April 2021 - she regularly has to take OTC or prescription medications to help manage symptoms.

Other Meds:

Current Illness:

ID: 1756954
Sex: F
Age: 49
State: VA

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Latex, seafood, dilantin, tegretol

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient was given vaccine and told do to history of seizures needed to wait in waiting area for 30 minutes. Patient stated she walked to the bathroom and started feeling dizzy. She came back to the consultation window about 6 minutes later and reported that she was feeling dizzy. she sat down on floor in front of pharmacy. I went and sat with her. she started complaining that her arms were numb and tingling. She said her right arm was tingling more than her left. She then reported her face was feeling numb and her lips looked slightly swollen. Dialed 911 she then reported increase in heart rate and trouble swallowing. Went to get EMTS. They said her blood pressure was up and then guided her out of the store. Spoke with Patient on 10/02 and she stated that reaction had resolved and she was only feeling fatigue and headache from vaccine. Does not plan on getting 2nd dose.

Other Meds: Unknown

Current Illness: unknown

ID: 1756955
Sex: M
Age: 44
State: WA

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

Allergies: Penicillin

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

Symptoms: Six hours after receiving booster, began feeling hot/cold. Fever 39 C. Except for the most basic of bodily functions, spent 24+ hours in bed. Sweaty, stomach/abdominal cramping. Ultra sensitive to everything. Began feeling somewhat "normal" on Saturday, 02 October at about 1130 hours. Symptoms are gone, though I still feel a bit weak.

Other Meds: Fluoxetine 60 mg. q.d. D-amphetamine ER 20 mg. q.d. L-Methylfolate 15 mg. q.d.

Current Illness: None.

ID: 1756956
Sex: M
Age: 57
State:

Vax Date: 03/18/2021
Onset Date: 09/08/2021
Rec V Date: 10/02/2021
Hospital: Y

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: Came to the emergency room with shortness of breath. and was diagnosed with COVID-19 pneumonia. Then patient was started on remdesivir and steroids. Patient started feeling better and patient started breathing on room air. Patient also had acute kidney injury that was also resolved. Since patient was stable enough, patient was discharged home on dexamethasone.

Other Meds:

Current Illness:

ID: 1756957
Sex: F
Age: 67
State: NY

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: demerol, effexor

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

Symptoms: severe nausea and chills

Other Meds: lisinopril, lovastatin, famotidine, vitamin D

Current Illness: IBS

ID: 1756959
Sex: M
Age: 54
State: TX

Vax Date: 12/23/2020
Onset Date: 12/23/2020
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: MRI LEFT SHOULDER 04/21/2021

Allergies: DOGS AND CATS

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

Symptoms: I had mild pain and tenderness at the vaccination injection site immediately after vaccination. The pain never went away and got progressively worse over 1 month, eventually becoming severe without any other known left injury shoulder injury. I took naproxen for a week without improvement. I waited to see if it would get better on its own but after several months of no improvement, I sought medical care. I was diagnosed with adhesive capsulitis of the left shoulder. I underwent 4 hydraulic distension procedures, the first 2 included platelet lysate therapy and the second 2 procedures included dexamethasone. It was only after treatment with dexamethasone that my pain improved significantly. At the time of this report I am still having mild pain and mild restricted range of motion.

Other Meds:

Current Illness:

ID: 1756961
Sex: F
Age: 38
State:

Vax Date: 02/22/2021
Onset Date: 09/08/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Came to the emergency room with a headache, fever, and chills and was diagnosed with COVID-19 pneumonia. Patient was started on remdesivir and steroids. Patient was breathing on room air. Since the patient completed remdesevir course, the patient is feeling better. Patient also has a positive D-dimer, probably secondary to COVID-19 pneumonia. CTA chest was negative for PE. There was a question of CHF. Echo shows EF of 55% to 60% and left systolic function normal. Patient had a complaint of lower extremity swelling. The patient was given oral Lasix, also given 1 dose of IV Lasix. The lower extremity swelling resolved. Since patient was stable enough, patient was discharged to a group home.

Other Meds:

Current Illness:

ID: 1756962
Sex: U
Age:
State: IN

Vax Date:
Onset Date:
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: N/A

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Big red warm round rash and swollen area at injection site. Appeared next day. Sore to touch. Otherwise fine.

Other Meds:

Current Illness:

ID: 1756963
Sex: M
Age: 27
State: MI

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: EKG, CBC, BMP, Troponin, CRP, D-dimer, VBG.

Allergies: None.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient presented with complaints of mild left local injection site pain at the site, but also anxiety, chest pain, shortness of breath, tingling and flushing.

Other Meds: Buspar - Taken for first time, after COVID vaccine, and before onset of symptoms.

Current Illness: None.

ID: 1756964
Sex: M
Age: 1
State: WA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Aches in whole body, headache, considerable swelling of throat and neck, coughing, rash on sides of face from ears to chest. Face feeling warm without fever.

Other Meds: Nexus and Linsinipril.

Current Illness: Covid 19 on 8/30/2021

ID: 1756965
Sex: F
Age: 59
State: MD

Vax Date: 04/17/2021
Onset Date: 05/04/2021
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: none, called my PCP and reported the mark or rash?

Allergies: Adhesive

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

Symptoms: About 2 weeks after the 1st vaccination I got a very large, red, almost perfect circle, rash at the site and it got bigger around my arm. Didn't itch or hurt. Went away within one week..

Other Meds: Meloxicam, Cyclobenzaprine, Alprazalam, Atenolol, Clynddamycin solution as needed for acne, Operamazole

Current Illness: Mako total left knee replacement on March 26, 2021.

ID: 1756966
Sex: F
Age: 82
State: CA

Vax Date: 03/16/2021
Onset Date: 04/02/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data: June 11, 2021 - CT Scan + blood panel testing. June 12, 2021 - MRI plus multiple tests. Diagnosis: Stroke with rotary nystagmus. MRI found tiny linear focus of flair hyperintensity in the right cerebellar. Spent 1+ week in hospital; then had to transfer to nursing facility for rehab for 5 weeks. Now at home living with caregivers.

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Started with vertigo, dizziness, blurry vision and problems with memory April-May. Then by beginning of June, I had high BP over 225 and could not lift head off the couch. I went to the ER. Diagnosed with multiple mini-strokes over the previous months. Left permanently disabled, with need to use walker just to get around the house. Can no longer write or drive. I need help from others with cooking, cleaning and caring for myself; including basic OT activities. BP drops from sit or laying down to stand dramatically.

Other Meds: None

Current Illness: None

ID: 1756967
Sex: F
Age: 77
State: CA

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

Lab Data:

Allergies: Levaquin

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

Symptoms: Only a very sore arm.

Other Meds: Vitamin D.Desvenlafaxine, Finasteride,Rosuvastatin Biotin, Tylenol

Current Illness:

ID: 1756968
Sex: M
Age: 68
State: CA

Vax Date: 02/19/2021
Onset Date: 09/21/2021
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: covid +pcr

Allergies: NKDA

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

Symptoms: hospitalization

Other Meds: Coreg, glipizide, lisinopril, lasix, digoxin, lipitor

Current Illness: DM2, cardiomyopathy, COPD, HTN, epilepsy, CKD 3

ID: 1756969
Sex: M
Age: 78
State:

Vax Date: 02/27/2021
Onset Date: 09/10/2021
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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient was admitted to the hospital with COVID-19 also had respiratory failure he was treated for it. Patient was treated with steroids and oxygen. Once patient was stable he was discharged.

Other Meds:

Current Illness:

ID: 1756970
Sex: M
Age: 60
State: SC

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

Lab Data:

Allergies: None

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

Symptoms: Throughout thy day on October 2, my pulse rate was getting in the 120's for long periods of time. It would sometimes go down to around 1 10 but it never got down to normal. I had some lorazepam for anxiety that I had not taken in monrhs so I took one pill and it brought my pulse rate dowm to the upper 70's to low 80's. I feel like since I received the Pfizer Booster shot yesterday, it is probably related to that.

Other Meds: N9ne

Current Illness: None

ID: 1756971
Sex: F
Age: 32
State:

Vax Date: 01/29/2021
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:

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

Symptoms: Individual tested COVID-19 positive on 10/1/2021, after she cared for a positive patient on 9/27/2021. Symptomatic with HA, body aches and congestion since 10/1/2021. Individual to continue isolation from family in separate rooms for ten days and to callback on 10/11/2021. She is undecided regarding antibody testing. Emailed and voicemail left.

Other Meds:

Current Illness:

ID: 1756973
Sex: F
Age: 20
State: WA

Vax Date: 10/02/2021
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:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt given a vaccine from a vial that had been opened more than 24 hours before. No ADRs reported. Vaccination repeated with a "fresh" vial same day.

Other Meds:

Current Illness:

ID: 1756974
Sex: F
Age: 59
State: VA

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: none

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: fever over 102 chills headache passed out for approximately 30 seconds. symptoms started 14 hours after administration

Other Meds: diovan cytomel synthroid

Current Illness: none

ID: 1756975
Sex: F
Age: 56
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: 1756976
Sex: M
Age: 68
State: FL

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

Lab Data: None

Allergies: None

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

Symptoms: Increasing Fever. Began at 99.7 at 9:00 on 10/1/21 Now 10/2/21 at 8:00 temp is 101.7

Other Meds: Metropolol, simvistatin Multi vitamin, co-Q10, vitamin d, fish oil

Current Illness: None

ID: 1756977
Sex: M
Age: 66
State:

Vax Date: 08/30/2021
Onset Date: 09/12/2021
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:

Symptom List: Unevaluable event

Symptoms: Patient has history of lymphoma, previous history of Covid pneumonia 9 months ago, fully vaccinated for COVID-19 and was admitted to the hospital 17 days peior with shortness of breath. He was diagnosed with COVID-19 pneumonia. Was started on heated flow due to significant hypoxia. Patient was treated with with steroids, antibiotics, he was not given remdesivir due to the late presentation. Baricitinib given for few days, later on discontinued due to further elevation of his white count. Had a CT of the chest that did not show any pulmonary embolus but multifocal pneumonia. All respiratory measures have been tried and they have been not successful. Patient requires supplemental oxygen of 3 l/min. He is at his baseline functioning and ambulatory at home. Patient requires oxygen via nasal cannula due to prolonged hypoxia. He continued taking Bactrim and prednisone, and using his inhalers upon discharge. Of note antibody were checked and they have been negative for Covid.

Other Meds:

Current Illness:

ID: 1756978
Sex: M
Age: 77
State: CA

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

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

Lab Data: CTPE: multiple L-sided pulmonary emboli with cardiac strain, elevated d-dimer to >500

Allergies: NKDA

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

Symptoms: Pt received 2nd dose of Pfizer on 09/08/21, with development of severe L-sided CP and SOB x3 days ago. Pt tachycardic and hypoxic on arrival to ED. Pt desatted to 89% on RA, placed on 2L NC to improve sats to 94%. Pt tx with IV narcotics/antiemtics, EKG and CTPE done. As pt has new oxygen dependence, pt requiring transport to higher level of care. Pt still in ED, pending transfer to outside facility.

Other Meds: METFORMIN, GLIPIZIDE, UNKNOWN DIURETIC

Current Illness: NONE

ID: 1756979
Sex: M
Age: 81
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: 1756980
Sex: M
Age: 69
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: 1756981
Sex: F
Age: 68
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: 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: 1756982
Sex: M
Age: 61
State: CA

Vax Date: 10/02/2021
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: LA

Lab Data: ED visit

Allergies: NKA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: lightheaded hypotension diaphoretic

Other Meds: Insulin Senokot Prednisone Doxycycline Ferrous Sulfate

Current Illness: unknown

ID: 1756983
Sex: F
Age: 62
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: 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: 1756984
Sex: F
Age: 28
State: PA

Vax Date: 10/02/2021
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: No

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

Symptoms: Patient received 2nd dose of COVID-19 Moderna vaccine. Monitored patient for 10 minutes and she reported feeling faint and dizzy. She had not eaten since breakfast. Patient slid out of chair. RN helped ease to floor; observed gasping. The patient became unconscious. RN called 911, initiated CPR and administered EpiPen. Patient responded to CPR and EpiPen. She began aspirating. She was turned to her side and began coughing. Her pulse was irregular. The patient continued to be monitored and vitals obtained: RR 22, pulse 102, SPO2 97, BP 190/56. An ambulance arrived; patient was alert and oriented.

Other Meds:

Current Illness:

ID: 1756985
Sex: F
Age: 18
State: NY

Vax Date: 09/27/2021
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: RA

Lab Data: Sonograms , blood work

Allergies:

Symptom List: Nausea

Symptoms: Spontaneous vaginal bleeding

Other Meds: Propranolol 20 mg x 2 Metformin 1000 mg x2 Vyvance 20 mg Omaperzole 40mg Zrytec Probiotic Thyroid energy (b 6, iodine, zinc, selenium, copper, folate ) Latuda 80 mg Vitamin d 5000i Sodium bi carbonate

Current Illness:

ID: 1756986
Sex: F
Age: 77
State: CA

Vax Date: 03/16/2021
Onset Date: 09/19/2021
Rec V Date: 10/02/2021
Hospital: Y

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

Lab Data: Covid + pcr

Allergies: Cassava, lidocaine, fish and shellfish

Symptom List: Injection site pain

Symptoms: Hospitalization

Other Meds: allopurinol. plavix, hydralazine, lopressor, lipitor, ASA

Current Illness: Dm2 w/ CK 5 on dialysis, CHF, high lipids, HTN, gout

ID: 1756987
Sex: F
Age: 28
State: WA

Vax Date: 09/16/2021
Onset Date: 09/27/2021
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: Head CT, labs 09/27/2021

Allergies: none

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

Symptoms: 11th day after receiving 1st dose of vaccine increased tingling in hands/arms, could not move hand to pick up cup as hand stuck in contorted dystonic manner. began to effect whole body, collapsed on floor as unable to stand. Hands would not open, unable to speak. Went to ER was treated with Benadryl and Ativan, iv medication. Left ER after 6 hours mom drove 4 blocks and it started again in hands and went into whole body, unable to speak. looked as like was having seizure activity. Went back to ER and was immediately taken back to room. received Valium, etc. while in ER mom and nurse noticed involuntary eye movement, facial twitching. For the last week have been taking Vistaril and Ativan regular. Primary Physician request Neuro and Cardiology Evaluation. Still having tingling symptoms in hands, arms, legs and feet. Some muscle cramping/tightness. Started Sertraline and took 6 doses before the issues started, started taking 3 days after receiving 1st dose of vaccine. Never have had this happen before. Not sure if Vaccine or Sertraline related. NO PREVIOUS MEDICAL ISSUES

Other Meds: Sertraline, vitamins

Current Illness: anxiety

ID: 1756988
Sex: F
Age: 26
State: NV

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: RA

Lab Data:

Allergies:

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

Symptoms: patients received 1st dose Pfizer on the 09/25/2021 at a difference pharmacy. Patient requested a J&J vaccine at 10/02/2021 and administered at 4:30pm. Patient did not show us the previous vaccine card or let us know they received a Pfizer vaccine prior to visit. Patient was called right after discovery on 10/02 at 4:45pm and will inform them of any further information of the event.

Other Meds:

Current Illness:

ID: 1756989
Sex: F
Age: 69
State: CA

Vax Date: 03/17/2021
Onset Date: 05/01/2021
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: Office visit with NP, Audioist testing, MRI

Allergies: Bruprophine,

Symptom List: Tremor

Symptoms: Tininius hearing loss left ear.

Other Meds: D3, hyroxyzine 10mgx2, Nortriptyline 50mg, loratadine10mg, occasionally trazodone 50mgx2, Hydrocodone5 mg acetaminophen 325mg Ciclesonide 80mcg, albuterol sulfate 90mcg, Spiriva Respimat 2.5 mcg. fluticasone Propionate 50mcg

Current Illness: None

ID: 1756990
Sex: F
Age: 17
State: HI

Vax Date: 08/27/2021
Onset Date: 08/29/2021
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: Penicillin

Symptom List: Erythema, Pruritus

Symptoms: Diffuse itchy hives that started 2 days after second shot. Temporarily relieved with Benadryl, Claritin and Pepcid but return following day. Hives mostly on face and scalp, also on torso and back of legs. Before this she had no recent history of ANY allergies or allergic reactions, she did have hives at age 5 after a dose of Penicillin.

Other Meds: Omega 3

Current Illness: None

ID: 1756991
Sex: F
Age: 37
State: FL

Vax Date: 09/18/2021
Onset Date: 09/22/2021
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: Onset of Pityriasis Rosea about 4 days after vaccination. This is typically self-limited, unclear if this was related to the vaccination or coincidental.

Other Meds: Dupixent

Current Illness: None

ID: 1756992
Sex: F
Age: 66
State: KS

Vax Date: 03/14/2021
Onset Date: 03/22/2021
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: 3/26 physical examination only-followup 4/16. Topical treatment valcyclovir prescribed-not tolerated and d/c after 1 dose.

Allergies: cephalosporins, atrovent, polysorbate topical

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

Symptoms: 3/22 Macular rash developed in skin dermatome RU chest, became vesicular in quality, pruritus.-spread to axilla R. Seen by dermatologist 3/26 who confirmed herpes zoster, no temperature, no pain. Treated with topical for itching and antihistamine. Resolved without incident at 2-3wk. Followup exam 4/16 showed bluish-purple inflammatory lesions in healing process which ultimately disappeared leaving no marks.

Other Meds: levothyroxine, amlodipine, montleukast, ezetimbe, deplin, rosuvastatin,VitD,lutein,colace, lansoprazole

Current Illness: none

ID: 1756993
Sex: M
Age: 19
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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Denies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Upon sitting down in observation area, client became pale, diaphoretic, and reported feeling dizzy. Client assisted into cot to lie down. Provided water and granola bars. Advised to report adverse effects to primary care provider and VSAFE. Advised client to call 911 or seek emergency medical services if side-effects worsen or severe side-effects develop. Client observed for 30 minutes and vital signs taken every 5 minutes. Adverse effects completely resolved after 30 minutes and client left site unassisted with steady gait.

Other Meds: None

Current Illness: Denies

ID: 1756994
Sex: F
Age: 42
State: OH

Vax Date: 04/14/2021
Onset Date: 04/24/2021
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: See above for tests on 4/24. Then I visited a Cardiologist on 5/3/21 and she prescribed a Echocardiogram and stress test. Ending test was 5/11/21 Stress test was on 5/17/11 Both tests came back normal. It took three-four weeks to feel better and have back full energy.

Allergies: Levaquin

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

Symptoms: Woke up at 6am the morning of 4/24 with chest pains and shortness of breath. Two days earlier I walked/ran 5 miles and on 4/24, I could barely walk up our stairs in our house due to tight chest and shortness of breath. I let it go for a few hours thinking it would go away but it didn't. I was worried I was having a heart attack so I went to the ER. They did several tests including a chest X-ray, Endo cardiogram, blood work. They couldn?t find anything wrong however I had a elevated pulse rate in the 120s and remained high the entire four hours I was there.

Other Meds: Alavert and airborne was taken in the morning

Current Illness: None

ID: 1756995
Sex: M
Age: 61
State: CA

Vax Date: 03/19/2021
Onset Date: 09/20/2021
Rec V Date: 10/02/2021
Hospital: Y

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: covid+

Allergies: NKDA

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

Symptoms: hospitalization

Other Meds: lipitor

Current Illness: High lipids

ID: 1756996
Sex: F
Age: 50
State: MD

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: I reported these symptoms to my occupational health office the very next morning with no support or advice.

Allergies: No Known Drug Allergies

Symptom List: Pain in extremity

Symptoms: Swollen neck glands, entire soft tissue under my tongue/lingual frenulum was swollen, tender and inflamed, muscle aches/cramps, joint pain. Only the mouth and glands have resolved to date, the other symptoms still persist today. I have NEVER had these symptoms before and am not being treated for any medical conditions.

Other Meds: One A Day Women's

Current Illness: No Acute or Chronic medical conditions

ID: 1756997
Sex: M
Age: 73
State: MA

Vax Date: 03/31/2021
Onset Date: 04/02/2021
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: blood tests immune system, liver kidney, electrolytes red cells and platelets, diabetes, urine infection elecroltes no problem found doppler echogram of heart no problem found

Allergies: none

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

Symptoms: stomach cramps and nausea for some hours every day since vaccination. edema in left leg and foot 2 weeks after second dose

Other Meds: Lisinopril spironolactone

Current Illness: none

ID: 1756998
Sex: M
Age: 45
State: CA

Vax Date: 04/14/2021
Onset Date: 05/27/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: I lost hearing in my left ear and developed tinnitus. First I was treated with over the counter allergy medicines and when that didn't work, I was treated with two taper Prednisone treatments. I was told that the loss of hear was probably lost and Tinnitus was not going to go away.

Other Meds: None

Current Illness: None

ID: 1757000
Sex: F
Age: 48
State: NY

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Monitoring by paramedic while at vaccination site. pulse oximeter and Blood pressure cuff. Continue to monitor blood pressure at home.

Allergies: reaction to previous flu vaccine

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

Symptoms: On Sept. 28, 2021 after my first dose at 12:30 pm my Heart rate 130's, Blood Pressure 211/100, lightheaded, weakness began at 12:48 pm. By around 1:35 pm Heart rate down from 130.s and sustained 100's to mid 80's, Blood Pressure was still elevated at 150's-160's/80's-90's and less lightheaded. 6:00pm fever of 100.5 and severe body aches and pins and needles to both hands. Pins and needles to both hands resolved next morning on Sept 29, 2021, fever on and off and severe body aches continue throughout Sept 29, 2021. Headache on Sept 29, 2021 continued all day until Sept 30, 2021

Other Meds: Lo-Loestrin Fe

Current Illness: none

ID: 1757001
Sex: F
Age: 28
State: OH

Vax Date: 09/19/2021
Onset Date: 09/19/2021
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: no known allergies

Symptom List: Vomiting

Symptoms: Patient is experiencing spots/rash on both arms and on right leg 10 days after vaccine. In addition, patient is experiencing headaches which in not normal.

Other Meds: unknown

Current Illness: unknown

ID: 1757002
Sex: F
Age: 32
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Yes.

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: - High Fever - Slight Paralysis on right side of face - Weakened leg muscles

Other Meds: Vitamin C, Valerian Root at night, SAMe and Vitamin D

Current Illness: Migraines / endometriosis

ID: 1757003
Sex: F
Age: 59
State: AL

Vax Date: 09/24/2021
Onset Date: 09/27/2021
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: Patient experienced an enlargement of lymph nodes located on left upper body, particularly the neck and axillary closest to injection site.

Other Meds:

Current Illness:

ID: 1757005
Sex: F
Age: 4
State: AL

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Severely Allergic to fire ants

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vomiting 12 hours after vaccine , headache

Other Meds:

Current Illness:

ID: 1757007
Sex: F
Age: 46
State: OR

Vax Date: 02/07/2021
Onset Date: 04/21/2021
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: Echocardiogram performed 9/27 reveals decreased cardiac function.

Allergies: Penicillin, hydrocodone

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

Symptoms: In April I started experiencing a cardiac arrhythmia that was different than my usual SVT. It was accompanied by shortness of breath and visual disturbance.

Other Meds: Famotidine, vitamin D, melatonin

Current Illness: None

ID: 1757008
Sex: M
Age: 14
State: PA

Vax Date: 09/08/2021
Onset Date: 10/02/2021
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 PERFORMED TO MY KNOWLEDGE

Allergies: AUGMENTIN

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

Symptoms: NO REPORTED ADVERSE EFFECTS. IMMUNIZATION CONSENT FORM, WHICH WAS FILLED OUT BY PATIENT OR SOMEONE IN FAMILY ON-LINE, ERRONEOUSLY HAD THE INCORRECT BIRTHDATE. PRODUCT TO BE GIVEN SELECTED ON-LINE WAS MODERNA. I SPOKE TO Patient's MOTHER THIS EVENING. SHE SAID SHE WAS CONTACTED BY SOMEONE ELSE THIS WEEK, AND WAS TOLD PER CDC RECOMMENDATION, IF THE INCORRECT PRODUCT WAS ADMINISTERED, THE SECOND SHOT SHOULD BE THE SAME PRODUCT. WE PLAN TO GIVE A SECOND DOSE OF MODERNA THIS WEEK.

Other Meds: UNKNOWN

Current Illness: NONE KNOWN

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am