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: 1761463
Sex: M
Age: 65
State: MN

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

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

Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: PT comes to the ER due to shortness of breath which has been progressing over 1-2 weeks. Sats when EMS arrived in the high 90's, pt requested O2 for comfort (does not use regularly). Pt is also much more weak but has hx left sided weakness from past stroke.

Other Meds:

Current Illness:

ID: 1761464
Sex: F
Age: 0
State: WI

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: none

Allergies: contrast dye, keniso tape, ibuprofen

Symptom List: Anxiety, Dyspnoea

Symptoms: Chills, fever, projectile vomiting(2 episodes), headache, uncontrollable shaking due to feeling so cold, lasted 5 hours. Next day has residual headache

Other Meds: nothing

Current Illness: none

ID: 1761465
Sex: F
Age: 54
State: NC

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/05/2021
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: sulfur, chemo, adhesive

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

Symptoms: extremely heavy eyelids

Other Meds:

Current Illness:

ID: 1761466
Sex: M
Age: 71
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
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: 1761467
Sex: M
Age: 51
State: ID

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 10/05/2021
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: None

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

Symptoms: Very sore arm for four days. After one week a lump appeared in my arm for about four days then has started to reduce in size.

Other Meds: ezetimibe-simvastatin (VYTORIN) 10-80 mg tablet, GNC Fish Oil, GNC Multi-Vitamin, Costco Vitamin D

Current Illness: None

ID: 1761468
Sex: F
Age: 30
State: OH

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/05/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: N/A

Allergies: Sulfa

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

Symptoms: Nearly immediately after receiving the vaccination, I developed tingling/numbness in bilateral legs. Approximately 15 minutes later, I noticed numbness near my nose on the right side of my face. Over the next hour and a half the tingling/numbness spread throughout other areas of my body such as, the backside of my upper arms, portions of my hands, lower back, torso, left upper side of my face, ears, tongue, along with other sporadic areas. There was sensation of muscle weakness upon standing in bilateral lower legs as well. During this time, I had an unusual sense of pressure in my neck and the tingling/numbness mentioned on my tongue was at the very back portion that made the sensation of swallowing feel very odd, but not difficult. Around this time I contacted the vaccination coordinator to review my current symptoms and was monitored for a short time and had taken a dose of Benadryl. The tingling/numbness on the left upper portion of my face developed a burning sensation. However, my eye sight was never affected throughout my reaction. After taking the Benadryl I went to sleep for around two hours and woke up with all areas of tingling/numbness, red that area and painful to the touch with a burning sensation. I took an additional dose of Benadryl and the symptoms were clear by the end up the night, next morning. Since that time I have sporadic areas and episodes of tingling/numbness, some in which appear to have the tingling/numbness at all times and are unrelieved with different efforts performed.

Other Meds: Tylenol

Current Illness: Shingles

ID: 1761470
Sex: M
Age: 50
State: GA

Vax Date: 09/16/2021
Onset Date: 09/18/2021
Rec V Date: 10/05/2021
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: chest pain, sore left arm, fever, flu-like symptoms

Other Meds: Pegasis

Current Illness:

ID: 1761471
Sex: M
Age: 52
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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: 1761474
Sex: M
Age: 51
State: NC

Vax Date: 04/01/2021
Onset Date: 06/20/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: ultrasound, urine test, blood work

Allergies: peas

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: right after the vaccination I had headaches not that severe but that was it and then months later I found something weird on my body. I contacted my doctor and they ran some tests. I weighted for a while and then got serious about it and went to the neurologist and they said i had a lump on my testicles and then i got an ultrasound and they said it was an inflamed lump. It was epidemies, i went to the second neurologist and they told me i do not need any ultrasound and he said it was inflammation.

Other Meds: Crestor, Niaspan, multivitamin, Nexium

Current Illness: none

ID: 1761475
Sex: M
Age: 74
State:

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1761476
Sex: M
Age: 26
State: FL

Vax Date: 10/03/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: unknown

Allergies: unknown

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

Symptoms: PT said he awoke on Monday and his left side of face was twitching under eye . It proceeded to continue all day I told him to report to CDC -vsafe and I would report to VAERS. HE should see a doctor, but he does not have a family physician. I told him to see a walk in clinic to establish baseline

Other Meds: unknown

Current Illness: unknown

ID: 1761477
Sex: M
Age: 25
State: MA

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: No tests.

Allergies: Allergic to NSAIDS

Symptom List: Rash, Urticaria

Symptoms: In the middle of my sleep, the day of my vaccination I felt horrible. Probably the sickest I have felt in my whole life. Shivering and sweating at the same time as well as a fever. Burning pains in my veins on both arms. Very bad migraine. Allergic reaction, which included hives all over my body from my legs to head. Face was swollen from the hives. Had to take claritan to get reduce the allergic reaction. The migraine and cold sweats lasted for about 3 days. I was taking acetaminophen to get rid of the headache pains. The following day I had a lot of pain in my shoulder. The burning sensation also lasted for another day. I had severe fatigue for the 5 days following my vaccination. I still have a good amount of fatigue 8 days later. I also had hives consistently for 5 days straight. The claritan was able to make it slow down for only a couple hours at a time. The hives were pretty severe, covering my whole limbs at some points. I also had dizziness for the first 4 days and a lot of mental fog.

Other Meds: Vitamin D, Melatonin

Current Illness: None

Date Died: 09/26/2021

ID: 1761478
Sex: M
Age: 64
State: MI

Vax Date: 03/06/2021
Onset Date: 08/31/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: Tested positive on 8.31.21

Allergies:

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

Symptoms: Patient came in with respiratory failure

Other Meds: multivitamin, metoprolol, vitamin d, lipitor

Current Illness:

ID: 1761479
Sex: M
Age: 95
State: MO

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
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: UNKNOWN

Allergies: NONE

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

Symptoms: Patient received 2nd vaccination from Hospital during a hospitalization. When patient returned back to the long term care facility, and facility requested another vaccination for patient. Patient recieved 2nd dose on 09/30/2021 and then another dose on 10/01/2021.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1761480
Sex: F
Age: 28
State: KS

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/05/2021
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: Uncontrollable shakes, chills, nausea, body aches, headache, onset in middle of night suddenly. Treatment with rest and hydration. Body aches and headaches and fatigue lasted all next day. Uncomplicated pregnancy. Edd 10/31/2021.

Other Meds: Prenatal vitamin Dha supplement Probiotic

Current Illness:

ID: 1761481
Sex: F
Age: 79
State: WA

Vax Date: 10/03/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
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: Very dizzy, fever, right arm and lymph nodes painful

Other Meds: Levothyroxine, Valtrex, hydrocodone, Tylenol, calcium, daily vitamin, atorvistatin, zarelto

Current Illness: None

ID: 1761482
Sex: M
Age: 53
State:

Vax Date: 04/06/2021
Onset Date: 10/03/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: Covid + 10/03/2021

Allergies: Penicillin

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

Symptoms: Breakthrough Covid+ 53 y/o male who presented to ED via EMS d/t decreased responsiveness. Pt c/o weakness, subjective fever, chills, and wheezing; but he denies syncope, night sweats, sore throat, productive cough, CP, palpitations, or dyspnea. Patient did report some blood in his stool.

Other Meds:

Current Illness:

ID: 1761484
Sex: M
Age: 3
State: TX

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

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

Lab Data: None

Allergies: None known

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient came in to office for flu vaccine 10/4/21 at 10:55 am. At 4:17 pm mother of the child called stating that the patient has red hives all over his body. The rash mainly appeared on both of his legs, arms abdomen and on his face. The provider advised the mother to start the child on children's Benadryl every 6 hours as needed.

Other Meds: None

Current Illness: Pneumonia and RSV

ID: 1761485
Sex: F
Age: 69
State: GA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761487
Sex: M
Age: 69
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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: 1761488
Sex: M
Age: 41
State: WY

Vax Date: 09/08/2021
Onset Date: 10/01/2021
Rec V Date: 10/05/2021
Hospital: Y

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: Ultrasound, CT scan 10/1/2021

Allergies: Amoxacillin

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

Symptoms: Shortness of breath and leg numbness began within 1-2 weeks (specific time unknown) of receiving 2nd dose. Leg pain began 9/29/2021, went to ER 10/1/2021 with severe leg pain and swelling. Ultrasound discovered clot in left leg. CT scan discovered multiple pulmonary embolism in both lungs. Admitted to hospital and started on blood thinners. Was released 10/2/2021 with explicit instructions and prescriptions. Still suffering from leg pain and shortness of breath, light headed and dizzy, weak and lethargic.

Other Meds: Losartan 25mg Omeprazole 40mg Fluticasone 50mcg Symbicort 160/4.5mcg Albuterol 2.5mg

Current Illness: None

ID: 1761489
Sex: M
Age: 79
State: WI

Vax Date: 04/05/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: Coronavirus 2 PCR Detect, V asymptomatic POSITIVE

Allergies:

Symptom List: Unevaluable event

Symptoms: Admitted for procedure 10/4/2021-BPH with obstructions Discharged 10/5/2021 Asymptomatic for COVID

Other Meds:

Current Illness:

ID: 1761490
Sex: M
Age: 76
State: MI

Vax Date: 01/23/2021
Onset Date: 10/03/2021
Rec V Date: 10/05/2021
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:

Allergies:

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

Symptoms: Pt with COPD, hypertension, and oxygen dependent at night only, presented to ED with increasing shortness of breath , and change in his sputum production. He was tachypneic and placed on high flow. COVID test returned positive.

Other Meds:

Current Illness:

ID: 1761491
Sex: F
Age: 54
State: SC

Vax Date: 03/30/2021
Onset Date: 05/26/2021
Rec V Date: 10/05/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: These test were done through May, June, and July of 2021: Bacterial Analogical Analysis- found strep and bacterial vaginosis Ultrasound- good, no masses were found CT scan- good, no masses were found

Allergies: Trees Grass Pollen Dogs Cats Dust

Symptom List: Injection site pain, Pain

Symptoms: At the need of May 2021 I woke up with some lower abdominal cramping, which I believe is from a bacterial infection related to menopause. Even with the antibiotics that I take for it I still have pain in my lower pelvic uterus area. The pain isn't significant but it is there. I believe it is related to menopause. The doctors don't know what it is and they are still investigating.

Other Meds: Imitrex (as needed) Estrace (as needed)

Current Illness: none

ID: 1761492
Sex: M
Age: 51
State: GA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 10/05/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761493
Sex: M
Age: 57
State: MN

Vax Date: 03/29/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
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: POSITIVE COVID TEST 10/4/21

Allergies:

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

Symptoms: ASYMPTOMATIC

Other Meds: acetaminophen (TYLENOL) 325 mg Oral Tab amitriptyline (ELAVIL) 10 mg Oral Tab baclofen (LIORESAL) 10 mg Oral Tab bisacodyl (DULCOLAX) 10 mg Rectal Supp suppository bisacodyl (DULCOLAX) 5 mg oral delayed

Current Illness:

ID: 1761494
Sex: F
Age: 35
State: GA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 10/05/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761495
Sex: M
Age: 55
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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: 1761496
Sex: F
Age: 32
State: GA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 10/05/2021
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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1761497
Sex: M
Age: 56
State: WA

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

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

Lab Data: ultrasound

Allergies: none

Symptom List: Nausea

Symptoms: Chest pains first 3 days. Sept 4th back ache starts. Back ache surges with pain down left leg. Sept 15th visit to Doctor for anti-inflamatories and back adjustment. Sept 17th excessive back and nerve pain Sept 18th high fever started at noon, peaked 102 - 103 that evening, on and off for 3 days of fevers. Setp 19th went to urgent care. Hot spot on thigh identified as "dermal infection starting". sent to ultrasound to check for blood clots, none. skin rash starts to spread down left leg over next day 9/20.. Can barely walk now, pain in leg and back. Bed rest all day with fever. Sept 21 able to slowly walk, red patch on lower left leg deepens in color. A doctor in the family

Other Meds: Rosuvastatin calcium 10 mg tab; Lisinopril 10 mg

Current Illness: none

ID: 1761498
Sex: F
Age: 57
State: NC

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: EKG, MRI brain, blood tests, flu/covid tests,

Allergies: Macrodanton, most fruits, avocado, nuts, honey, bananas, seafood

Symptom List: Injection site pain

Symptoms: Headache, soreness in upper body, cloudy thoughts, lucid dreams, fragmented thoughts, dizzy, drugged feeling, heaviness in whole left side, partial paralysis, impaired speech, impaired thinking, could not talk fast.

Other Meds: Synthroid, .23mg

Current Illness: Sinusitis Hashimotos

ID: 1761499
Sex: M
Age: 62
State:

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

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1761500
Sex: F
Age: 77
State:

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1761501
Sex: F
Age: 87
State:

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 10/05/2021
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: COGNITIVE & STRENGTH DECLINE. WORSENING ALZHEIMER'S.

Other Meds:

Current Illness:

ID: 1761502
Sex: M
Age: 12
State: WI

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Pfizer vaccine given 33 days after put in the refrigerator. Use by date 9/25/2021

Other Meds:

Current Illness:

Date Died:

ID: 1761503
Sex: F
Age: 57
State: IA

Vax Date: 09/07/2021
Onset Date:
Rec V Date: 10/05/2021
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: No Allergies known per the decedent's Son

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

Symptoms: The Decedent's son described that she was having GI issues between four days to a week before death (they could not be more specific). Unknown if this is related. She was reportedly also suffering from alcoholism per her son. Death of patient occurred 21 days after Vaccination. It is unknown at this time if this death is related in any way to the vaccination. This is being submitted at the request of Pathologist.

Other Meds: Decedent's family are not sure

Current Illness: Not per the decedent's family

ID: 1761504
Sex: M
Age: 63
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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: 1761505
Sex: F
Age: 32
State: CA

Vax Date: 03/31/2021
Onset Date: 09/01/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: EKG, D Dimer test, Chest X-rays. none of the test came back unusual. I opted out of CT scan. Chemistry panel- standard range with exception creatine value, D-Dimer was below standard range.

Allergies: Tylenol extra strength during COVID was giving me rashes.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I had a sore throat, sensitivity to light. I had lost of taste and smell by September 3rd. I had a cough, sneezing, nasal drainage. I had brain fog, I couldn't think right. I lost my appetite and my throat was really raw and it hurt to eat. I had a low grade fever between 99-100. I went to ER twice, my oxygen was dancing around 95-96. My oxygen dropped around 94 and I had really unbearable migraine not typical to my migraines. I had shortness of breath. I went back to ER, They did a D dimer test, chest X-ray, EKG, IV fluids and gave me Ibuprofen and Tylenol. I still have fatigue and shortness of breath. The doctor recommended I use steroid.

Other Meds: Levothyroxine

Current Illness: TSH levels were not good at that time.

ID: 1761506
Sex: F
Age: 51
State:

Vax Date: 04/27/2021
Onset Date: 10/04/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: TB quantiferon positive result.

Allergies:

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

Symptoms: I recently had a positive TB quantiferon lab test and I am wondering if this could be related to the vaccine.

Other Meds:

Current Illness:

ID: 1761507
Sex: M
Age: 48
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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: 1761508
Sex: M
Age: 63
State: AL

Vax Date: 04/22/2021
Onset Date: 10/05/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: Had dr advise on whether there is reliable allergy testing for other vaccine.

Allergies: Amoxicillin and sulpha

Symptom List: Pain in extremity

Symptoms: Metallic taste then tongue tingle then skin turned red the throat tighten up and tongue felt enlarged. Lasted 4 hours.

Other Meds: Atenolol, losartin, amlodapine, rosuvastatin, cardio for life

Current Illness: Aneurysms. HBP.

ID: 1761509
Sex: M
Age: 76
State: MN

Vax Date: 12/23/2020
Onset Date: 08/26/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: SARS C0V Rapid- Positive 8/30/21

Allergies:

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

Symptoms: 8/28/21 developed symptoms of weakness, fatigue, body aches, and fevers. Fully vaccinated. given IV fluids, supportive cares for at home return if 02 levels drop.

Other Meds:

Current Illness:

ID: 1761510
Sex: F
Age: 45
State: CA

Vax Date: 12/23/2020
Onset Date: 12/23/2020
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: I have seen the doctors multiple times from December 23-present. I missed 4 days of work after the first shot and 5 days after the second. I have never been the same since the shots.

Allergies: PCN,CIPRO

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

Symptoms: Moderna Covid-19 vaccine EUA Joint pain, headaches, fatigue, vision worsening

Other Meds: Levothyroxine

Current Illness: Hypothyroidism, hearing impairment, arthritis, post hysterectomy from uterine cancer, insomnia, anxiety, depression, obesity.

ID: 1761511
Sex: F
Age: 81
State: MI

Vax Date: 02/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/05/2021
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:

Allergies:

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

Symptoms: congestion, coughing, difficulty breathing, fever

Other Meds:

Current Illness:

ID: 1761512
Sex: F
Age: 52
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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 vaccine Pfizer and Moderna.

Other Meds:

Current Illness:

ID: 1761513
Sex: F
Age: 72
State: TN

Vax Date: 09/01/2021
Onset Date: 09/25/2021
Rec V Date: 10/05/2021
Hospital: Y

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

Lab Data: CT scans, MRI 9/28/2021 TIA confirmed 9/28/2021

Allergies: Floxin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: TIA, on 9/25/2021 TIA, on 9/27/2021 Headache, slurred speech, memory loss Whole body weakness Confusion

Other Meds: Keppra, Omeprazole, Alprazolam, Levothyroxine

Current Illness:

ID: 1761514
Sex: F
Age: 52
State: FL

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 10/05/2021
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: COVID-19-positive; Chest X-Ray

Allergies: Norflex; Amitiza

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

Symptoms: Later that night after the vaccine I developed severe body aches, nauseous, head and chest congestion, coughing, sore throat and ran a fever. All of which lasted about 3 days. Fog brain developed within the next couple days resulting in the inability to engage at normal capacity and not feeling as I was as productive as I should be which has subsided a little but still to date it I am still experiencing mild symptoms. I developed severe fatigue which lasted about 2 weeks as well. On 08/31 I started feeling those same flu like feelings again which caused me to take a COVID test on 9/1 which was negative, but on 9/4 another test was performed and I tested positive to COVID-19 at that time. I quarantined until 9/12 but the fog brain has since accelerated again and now the chest congestion, sinus pressure and the cough has returned and is now await radiology's confirmation of Pneumonia and have been prescribed doxycycline, Sudafed and Mucinex to help with the congestion and discomfort

Other Meds: Levothyroxine; Rubi statin; 50+ Women's Multivitamin

Current Illness: No

ID: 1761515
Sex: F
Age: 68
State: FL

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/05/2021
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: None. My dr. told me not to worry.

Allergies: Pencillin.

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Severe pain in injection site immediately when vaccine was administered lasting for several minutes. The same evening I woke up with foot and leg pain on my left side. It felt like my leg / foot were on fire and lasted about 30 miutes.

Other Meds: Metformin, losartan, zofran, folic acid.

Current Illness: Lung cancer.

ID: 1761516
Sex: M
Age: 67
State:

Vax Date: 10/04/2021
Onset Date:
Rec V Date: 10/05/2021
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: 1761518
Sex: F
Age: 53
State: CA

Vax Date: 04/05/2021
Onset Date: 04/06/2021
Rec V Date: 10/05/2021
Hospital:

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

Lab Data: EKG slightly different from pre-vaccine baseline.

Allergies: Barium; Iodine; Tetanus Shot; Teflex; Seafood (Shellfish); Spider Bites; Bee Stings

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

Symptoms: 1 day after the 2nd dose of vaccine, began experiencing symptoms of diarrhea, vomiting, which persisted for about 2 weeks. Had severe lasting migraines for 2 months, had issues with chest pressure, heart palpitations on and off for the first 2 months as well. After the initial 2 weeks of diarrhea and vomiting, still had occasional episodes of nausea and diarrhea. Chronic fatigue developed. Went to see cardiologist for chest pressure and palpitations and had an EKG done, was told the symptoms were likely linked to the COVID vaccine. EKG was slightly different from pre-vaccine, but no significant changes. Advised to continue monitoring heart symptoms, and go to ER if symptoms became more severe. Went to pulmonologist for same symptoms, and gastroenterologist for GI issues, all concluded that they were vaccine side effects and advised to go to ER. Did not change anything at the time, did not take any new prescribed medications (none were prescribed at the time). Some symptoms began to resolve (GI issues), however, the chronic fatigue is still there, although it is slightly improved. Occasional chest palpitations have occurred since then. The major concern is that I developed blood clots recently (unclear if it is related to the vaccine at this time). Put on prescribed blood thinners and aspirin, and is being closely monitored. Notably, I do not have a family history of blood clotting, and I have had multiple surgeries with no issues with blood clotting. In July, the time of the first blood clot was given xarelto 20 mg for 30 days, then aspirin 81 mg once a day, now back on xarelto 10 mg indefinitely because I had a second blood clot incident in September. Given the closeness of blood clot incidents and other conditions (pulmonary issues, heart issues, hypertension, diabetes, etc.).

Other Meds: Diltiazem; Lisinopril; Subastatin; Breo Inhaler; Albuterol Inhaler; Jardins; Spironolactone; Injections for Migraines (Botox),

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am