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: 1757334
Sex: M
Age: 68
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757335
Sex: F
Age: 68
State: CO

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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 at pharmacy. Patient went to ER.

Allergies: Patient reports allgeries to other vaccines

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient reported allergic reaction after leaving pharmacy. Patient reports going to Emergency department after experiencing rash and throat swelling. Patient notified pharmacy by phone the next day.

Other Meds:

Current Illness:

ID: 1757336
Sex: F
Age: 68
State:

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Started low grade temperature, sore throat, diarrhea, body aches, headache, chills the day after injection Tylenol and Excedrin, symptoms resolved.

Other Meds:

Current Illness:

ID: 1757337
Sex: M
Age: 82
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757338
Sex: M
Age: 68
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757339
Sex: F
Age: 26
State: CA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: CXR - Possible mild pulmonary vascular congestion. Transthoracic echocardiogram - TECHNIQUE **: Limited cardiac views obtained. ** INDICATION **: Dyspnea ** IMAGE QUALITY **: Good ** FINDINGS **: LEFT VENTRICULAR GROSS SYSTOLIC FUNCTION: Mod. Depressed PERICARDIAL EFFUSION: None IVC SIZE AND RESPIRATORY VARIATION: large, var.<50% ** IMPRESSION **: See comments reduced LV = Measured EPSS > 1 cm. Heart appears dilated. left atrial ballooning. Trace pleural effusions. Significant spetal bowing from LV into RV on parasternal short axis. CBC: hgb 9.6, hct 31.7, rdw,rbc 16.9 Calcium 8.5 BNP 1,127 Troponin 0.08 UA: hgb, UR QL large, LE, UA small, UQ protein 30 UA Micorscopy panel: wbc, UR 11, rbc, UR 9, UA bact/hpf present

Allergies: Vics Chloraseptic ctd (Menthol)

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

Symptoms: Shortness of breath, no room air sats measured, came into ER on O2 @3.5lpm sating at 94% 26 Y female who presents with shortness of breath. This is occurring in the context of pre-eclampsia with labor induction at 37 weeks and vaginal delivery. Patient presents after being discharged from the hospital on 9/29. She has had worsening leg swelling since since returning home, which has progressed beyond her knees. She woke up to breast feed this morning and felt dyspneic. She was unable to catch her breath, prompting her to come to the ED. She endorses pleuritic chest pain. Denies chest pain otherwise. No tearing, ripping back pain. Denies previous history of clot. Denies one leg swelling worse than other leg. Describes mild vaginal discharge with occasional clots. No abdominal pain. No purulent vaginal discharge. No seizures. She was admitted to the hospital for induction of labor at 37 weeks for pre-eclampsia. She had prolonged labor complicated by chorioamnionitis and sepsis, requiring IV antibiotics. She also required supplemental oxygen via nasal cannula in the hospital but was weaned onto room air before discharge. CT scan negative for PE. Denies history of blood clots. Has been taking labetalol 100 mg BID at home.

Other Meds: Acetaminophen, Docusate Sodium, Ibuprofen, Labetalol, Ondansetron, Sertraline,

Current Illness:

ID: 1757340
Sex: F
Age: 39
State:

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

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757342
Sex: F
Age: 76
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757344
Sex: F
Age: 26
State:

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Painful burning swelling over injection site with both injections, lasted a week with the first injection, second is reacting the same way. Chills and feeling cold after the second shot, still having symptoms 2 days after vaccine. Benadryl cream has not helped.

Other Meds: Birth Control

Current Illness:

ID: 1757345
Sex: M
Age: 27
State: MD

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Member took a COVID test on 30 September 2021. Waiting on results.

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Nausea, vomiting, diarrhea, headaches. Member says symptoms appeared early this morning around 0730.

Other Meds: none

Current Illness: Member stated he had a fever on September 24th. Member does not know temperature

ID: 1757346
Sex: F
Age: 80
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757347
Sex: M
Age: 66
State: WA

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

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: PT at Urgent Care Clinic to receive 3rd Pfizer Vaccine. Report from PA was that shortly after shot he was notified pt pale and dizzy. PT placed on ground Blood pressure 69/39 PT Pale and Diaphoretic. 911 activated and PT transferred to local ER by ambulance

Other Meds: pt was at Clinic at Urgent care receiving 3rd dose of Phizer Vaccine collapsed to floor 911 was activated. Blood Pressure extremely low.

Current Illness:

ID: 1757348
Sex: F
Age: 42
State: PA

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Chest xray, EKG, blood work showed no clinical issues. all was done at urgent care on September 30th.

Allergies: N/A

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

Symptoms: fatigue, shortness of breath, heart palpitations, eye twitching, sweating, dizzy spells - all for 9 days. Neck muscle pain radiating to the ear-for two days. Anxiety and unable to sleep- still present

Other Meds: vit D, Vit C, Zinc

Current Illness: N/A

ID: 1757349
Sex: F
Age: 6
State: VA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: none reported

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

Symptoms: extreme headache, red scleras, upset stomach, extreme fatigue

Other Meds: unknown

Current Illness: none reported

ID: 1757350
Sex: M
Age: 64
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757351
Sex: F
Age: 67
State: WA

Vax Date: 03/14/2021
Onset Date: 03/19/2021
Rec V Date: 10/03/2021
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: March 19 - Ear Ache started March 21 - Went to urgent care for ear ache Neomycin Polymyxin Sulfate and Hydrocortisone prescribed, The ear ache was a symptom of the Bell's Palsy due to the inflamed nerve which we did not realize at the time. March 22 - Bell's Palsy Appeared - went to Urgent Care then to Emergency Room July 21 - Stitches in corner of eye to protect Cornea - Plastic Surgeon August 12 - Eye surgery to correct droopy eye - Plastic Surgeon (more eye surgery will be required) Bell's Palsy Assessment - House Brackman - V - Severe Dysfunction More eye surgery is required in a few months I go to speech therapy weekly

Other Meds: Bisoprolol/HCTZ 2.5/6.25 Biotin, Vitamin D, Tumeric, Fish Oil

Current Illness: None

ID: 1757352
Sex: M
Age: 58
State:

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

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757353
Sex: M
Age: 37
State: CA

Vax Date: 02/15/2021
Onset Date: 03/15/2021
Rec V Date: 10/03/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data: Allergist 3/23/21 Positive ANA (1:160 /Homogenous), Elevated IgE, Scl-70: 1.1 Rheumatology 4/29/21 Sed Rate 17 CRP 0.6 Rheumatology 4/29/21 Positive ANA (1:160 /Speckled), Elevated IgE, Rheumatology 6/29 SARS-CoV-2 (COVID-19) Anti-Spike, Tot Ab : >2500.00 IgE: 94.9 IU/ml

Allergies: dust mites, tree, horses, dander, grass, cats, dogs.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: First Shot 2/15/21: Full Body Itchiness, Went after prednisone. Second Shot 3/15/21: joint inflammation, muscle pain. Still reoccurring since 1 week after 2nd shot.

Other Meds: Amlodipine

Current Illness: HTN, Anxiety, GERD

ID: 1757354
Sex: F
Age: 69
State: NY

Vax Date: 04/07/2021
Onset Date: 06/28/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: 8/5/2021 biopsy positive for squamous cell carcinoma

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: approximately 3 months after receiving the J&J vaccine, i developed squamous cell carcinoma in my vulvar

Other Meds: valsartan,, amlodophine, sertraline atorvistatin, clobetesol, xalatan

Current Illness: high blood pressure, osteoporosis, obesity

ID: 1757355
Sex: M
Age: 24
State: MD

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

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data: none

Allergies: advil

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

Symptoms: Nausea, vomiting, diarrhea, headache

Other Meds: none

Current Illness: none

ID: 1757356
Sex: M
Age: 49
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757357
Sex: M
Age: 43
State: FL

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: none yet. I will be scheduling blood work with my primary doctor soon.

Allergies: none

Symptom List: Unevaluable event

Symptoms: LOT FC3184 was my 2nd pfizer shot. the day after i was very tired, could not get out of bed and body joint pain all over body. It was painful to have the sheets on top of me while asleep. This minimized over the next few days. during the next 2 weeks, I struggled to stay awake during the work weeks and constantly taking over the counter pain relievers to reduce the body joint pains but unsuccessful. Starting September 24 to now I have been suffering random joint pains, pins and needles from my fingers down to my toes, I feel I have bugs crawling on me with itching from my legs and back to my arms, I feel dizzy at times and get very fatigued and tired, my hands legs and feet get spasms or twitching and shaking, I feel overall weak and feels like my vision gets cloudy. Since September 24th it has not changed or has not gotten any better.

Other Meds: benazepril 40mg in the morning every day zoloft 200mg in morning every day

Current Illness: none

ID: 1757358
Sex: F
Age: 34
State: VI

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: Tide detergent

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

Symptoms: October 2: woke up with headache and body pain, mainly back pain October 3: pain in right shoulder and collar bone area, lump in collar bone area, surrounding area hurts at touch too

Other Meds: None

Current Illness: None

ID: 1757359
Sex: M
Age: 80
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757360
Sex: F
Age: 78
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757361
Sex: F
Age: 40
State: MI

Vax Date: 07/10/2021
Onset Date: 07/20/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: Blood Tests- tons of different ones from CK levels to Sed rate, Bun, CBC and much more. CK Levels have been over 4,000 and go up and down. MRIs- to see if the pain and numbness was from spine issues- negative Open Muscle Biopsy- Normal ECG- Normal

Allergies: Metformin, Vioxx, Adhesive on medical tape

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

Symptoms: Symptoms started 10 days after the 2nd dose. I started to have extreme pain in my extremities, elevated CK levels, very weak, very tired. Pain made it to the point of having hard time walking, numbness in hands. Unable to use hands intermittently. I have been hospitalized for 6 days, in medical care since receiving the 2nd dose, so many tests run and still have pain and weakness daily. All symptoms I did not have prior to the vaccine.

Other Meds: Glimepiride 1mg per day Nexium 40mg per day

Current Illness: Diabetes

ID: 1757362
Sex: M
Age: 24
State: PA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: Patient fainted after receiving the vaccine. Gave patient a smelling salt which woke him up. He urinated and became sweaty after passing out.

Other Meds:

Current Illness:

ID: 1757363
Sex: F
Age: 53
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757364
Sex: F
Age: 76
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757365
Sex: F
Age: 42
State: MA

Vax Date: 09/01/2021
Onset Date: 09/29/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Bloodwork EKG Telemetry IV insertion

Allergies: Demerol Morphine Tetracycline Clindamycin Acetaminophen

Symptom List: Nausea

Symptoms: Vaccinated 9/25/21 Malaise & fatigue within 24 hours Mild cold symptoms 3 days later Ringing in left ear within 5 days later Vertigo treatment at ER 8 days later

Other Meds: Valtrex 1 GM daily Multivitamin

Current Illness: None

ID: 1757366
Sex: M
Age: 51
State: CA

Vax Date: 09/24/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: WBC 14.2, abn EKG consistent with pericarditis 10/1/21

Allergies: none

Symptom List: Injection site pain

Symptoms: L upper arm swelling and pain x 2 days. 1 week later developed pleuritic midsternal chest pain radiating to right shoulder. Work up showed pericarditis

Other Meds: none

Current Illness: none

ID: 1757367
Sex: M
Age: 71
State: CA

Vax Date: 02/18/2021
Onset Date: 06/15/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: 08/10/21: After symptoms did not go away I went to (ENT), who did tests, found no apparent problem with ears / drum. Did hearing test which shows apparent sudden signs of loss (worse in R ear). Prescribed prednisone / couldn't continue as it kept me from any sleep. 09/02/21: 2nd set of tests on hearing loss - same result. Prescribed MRI of brain on 10/10/21 - delayed because could not determine type of stent in heart.

Allergies: Bactrim

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

Symptoms: About two months after 2nd shot started experiencing severe ear blockage sensation & tenitus.

Other Meds: * Urocit (potassium citrate) 15 MEQ, 2 p/d * Vytorin 10/20, 1 p/d * Folic acid 800 mcg p/d * Baby asprin (81 mg) - 1 p/d

Current Illness: None

ID: 1757368
Sex: F
Age: 45
State: IN

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
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: None

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

Symptoms: Same day very tired, arm sore, and all over body aches. 24 hrs later had very painful, swollen lymph nodes under arm of injection site

Other Meds: Allergy medication

Current Illness: Allergies

ID: 1757369
Sex: F
Age: 65
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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 vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757370
Sex: F
Age: 36
State: TX

Vax Date: 05/11/2021
Onset Date: 05/11/2021
Rec V Date: 10/03/2021
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: Vicks products, coconut, lobster, strawberries

Symptom List: Erythema, Pruritus

Symptoms: I started throwing up that evening. For three months I would get a strange feeling like a bubble in my throat, then I would throw up. Now I have issues when I drink I start coughing.

Other Meds: none

Current Illness: Mitral Valve Prolapse MVP, Mitral Valve Regurgitation MVR

ID: 1757371
Sex: F
Age: 64
State: MO

Vax Date: 03/09/2021
Onset Date: 09/30/2021
Rec V Date: 10/03/2021
Hospital: Y

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: unknown

Allergies: unknown

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

Symptoms: Cough, wheezing and fatigue

Other Meds: unknown

Current Illness: unknown

ID: 1757372
Sex: M
Age: 56
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757373
Sex: F
Age: 34
State: VI

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: Tide Detergent

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: October 2: woke up with headache and bodily pain, mostly my back October 3: pain in my right shoulder, collar bone area, and side of my neck, lump in collar bone area

Other Meds: None

Current Illness: Mome

ID: 1757374
Sex: F
Age: 69
State: FL

Vax Date: 03/15/2021
Onset Date: 08/15/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Since the shot--I have had an MRI and bone density test

Allergies: codene

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

Symptoms: My left upper arm muscle is in pain. I now have been told it could be arthritis and bursitis. I just know I was not in pain before I took the shot.

Other Meds: none at the time--I will be taking three drugs starting next week

Current Illness: none--my barm was fine before the shot--now my left arm and shoulder are not working properly

ID: 1757375
Sex: F
Age: 73
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757376
Sex: F
Age: 41
State: TX

Vax Date: 09/27/2021
Onset Date: 09/29/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Bloodwork 9/29/21 normal

Allergies: Penicillin Kelflex Levaquin Bactrian Demerol Avocado Pecans Walnuts Melons Cats Dogs Cocoa butter Fragrances Pollens

Symptom List: Pain in extremity

Symptoms: Fatigue, body aches, headache, injection site pain (day 2) Rash around injection site, warm, itchy, painful (day 3) Rash grew larger (day 4) Rash began to go away (days 5-6) Rash returned bigger and itchy (day 7)

Other Meds: Zyrtec Zoloft Singular Doxycycline Benadryl Vitamin D3 Vitamin B12 Vitamin C Zinc

Current Illness: None

ID: 1757377
Sex: F
Age: 70
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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 vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757378
Sex: F
Age: 51
State: ND

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

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

Lab Data: see above

Allergies: morphine - severe headache, elevated blood pressure

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

Symptoms: Received vaccine at 0830 on 2-1-21, felt well, took ibuprofen prophylactically at 0900. Started feeling tired and mildly achy later in afternoon same day. Increased fatigue and achiness when went to bed at 930 pm that night. Woke up suddenly at 11:30 pm with severe shaking bone/body chills, severe weakness, tachycardia, shooting abdominal cramps/pains, nausea, heart pounding. Crawled to bathroom, dry heaves, shooting burning pains through left arm into chest and left breast. Loose stools, near-syncope. Crawled to shower and laid in shower for 1/2 hour, chills improved. crawled to living room couch, could not walk. Tried to rest, could not. Crawled back to bed at 0500 and fell asleep x 1 1/2 hours, son got up for school, he had to help me walk to kitchen. Severe vertigo, headache, and tachycardia and nausea continued. Laid back down to rest for several hours, but tachycardia 120's - 130's heart rate and pounding chest continued. Finally at about 1:30 pm, heart rate came slowly down to 110's and not so bounding. Symptoms slowly improved over next 4-5 hours where I could walk and drink. Shooting pains through left chest and breast continued for several months, still have left breast tenderness. Mammogram and US's on 1-20-21 an d1-21-21 were abnormal after 1st vaccine. Had to repeat. Had screening cancer labs/24 hour urine on 2-4-21 due to SDH-B mutation in blood and were all abnormal, 3 days after second vaccine. WBC was 2.5, neutrophils decreased. urine metanephrines and catecholamines were all very elevated due to stress reaction of vaccine per endocrinologist, had to repeat all tests one month later and were normal. Vertigo and fatigue took several months to slowly improve. Tachycardia and exertional dyspnea took months to improve.

Other Meds: ibuprofen 800 mg po x 1 at 0900 on 2-1-2021

Current Illness: none

ID: 1757379
Sex: M
Age: 68
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1757380
Sex: F
Age: 34
State: NM

Vax Date: 09/12/2021
Onset Date: 09/22/2021
Rec V Date: 10/03/2021
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: Septra

Symptom List: Vomiting

Symptoms: ongoing numbness in hands, arms and feet especially the left one.

Other Meds: NA

Current Illness: NA

ID: 1757381
Sex: M
Age: 70
State: TN

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: none

Allergies: NO

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient and wife both presented with appointments for Pfizer booster with out CDC vaccination card or any other form of vaccine information. Technician checking them in for the appointment went back and forth multiple times due to language barrier trying to help them understand we needed vaccine documentation since they had not received any vaccinations from us in the past. Finally, the wife pulls out a card for patient, but she did not have hers. He immediately wanted to go get her card but was very persistent in getting his shot first before he left. The appointment was proceeded in processing, but it was never caught by the technician that the Health Department had given the patient Moderna previously. With all of the persistent distraction and language barrier from the patient, she was so focused on verifying the dates lining up that she did not notice Modern on the Health department sticker on cdc vaccine card. Being a 3rd dose, the software system is not sending info to be verified by the pharmacist anymore, so the paperwork went straight from processing to the Pharmacists intern staffing today which he proceeded to give the Pfizer vaccine (only what we have ever carried in stock). He too did not see on the tiny blount county health dept sticker that it showed patient got the Moderna vaccine. Patient waited the required 15 minutes, left to go get his wife's cdc card at home and came back. It was then when both were handed back in to the same technician is when she noticed the mistake. patient again was very persistent that his wife got the vaccine at the same time as him, but county's health dept. did not show that on the dates with her card. Her vaccine was still too soon by 19 days according to the card and verified by the states vaccine database, however, this was when the mistake was noticed when she was verifying dates for her at this point with his card nearby.

Other Meds: NO

Current Illness: NO

ID: 1757382
Sex: F
Age: 73
State: FL

Vax Date: 03/11/2021
Onset Date: 07/25/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: SARS-COV-2, NAA, Detected: 07/25/2021, 08/17/2021, 09/01/2021

Allergies: NKDA

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

Symptoms: Patient required hospitalization due to breakthrough infection. Patient was given the J&J vaccine on 03/11/2021. Patient was hospitalized from 07/25/2021 - 09/08/2021. Below is copied from patients discharge summary: Hospital Course: HPI: Patient is a 74 yr old female with PMH HTN, CKD? who initially presented to the ED via EMS for SOB. EMS found the pt satting in 30s with poor waveform, was placed on 3L NC and brought to the ED where she was found to be satting in the 40s. Pt was placed on HFNC on setting of 60L and 80% FiO2 with pt satting in lower 90s, tested positive for COVID. Pt was seen in the ED and was visibly working to breath, though was able to speak full sentences. Pt reports she has been feeling SOB for approx 1 week, also endorsing mild nausea and fatigue. Pt denies having any abd pain, chest pain, cough, dysuria. Pt was able to produce vaccination card which showed pt received Johnson and Johnson vaccine on 3/11/21

Other Meds: ? atorvastatin (LIPITOR) 80 MG Oral Tablet Take 80 mg by mouth daily. ? bumetanide (BUMEX) 2 MG Oral Tablet Take 2 mg by mouth 2 times daily. ? calcium-vitamin D (Cal-Citrate Plus Vitamin D) 250-100 MG-UNIT Oral Tablet Take 1 tablet by mout

Current Illness:

ID: 1757383
Sex: M
Age: 46
State: WA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: pt stated he is allergic to all vaccines

Symptom List: Injection site swelling, Limb discomfort

Symptoms: pt. ears started to turn red approx. 4 mins after injection approx. 2 mins later pt. stated that his throat was closing. Epi 0.15 mg administered at 1026 a.m. patients blood pressure and oxygen levels was assesed every 15 mins. until patient was cleared to leave. Patient left approx. 45 minutes later with normal vitals.

Other Meds: n/a

Current Illness: n/a

ID: 1757384
Sex: M
Age: 64
State:

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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: 1757385
Sex: M
Age: 89
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am