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: 1768235
Sex: F
Age: 88
State:

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: 1768236
Sex: F
Age: 37
State: NC

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: I went to dr office on following Monday 8/30 and confirmed inflammatory reaction/fluid buildup in my ear and discussed steroid treatment

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Within 24 hours of receiving the vaccine, I experienced fluid in my left ear/impaired hearing.

Other Meds: None

Current Illness: None

ID: 1768237
Sex: M
Age: 64
State: GA

Vax Date: 06/11/2021
Onset Date: 08/24/2021
Rec V Date: 10/07/2021
Hospital: Y

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: 08/24/2021 PCR+ COVID-19 test; 09/03/2021 PCR+ COVID-19 test

Allergies:

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

Symptoms: Asymptomatic Breakthrough COVID-19 case. Hospitalized 8/24/2021-9/3/2021. Patient lives with his sister and she is his caregiver. Sister states PUI had no Covid related symptoms. She took him to the hospital because of low BP and dehydration. Sister states that Patient has only 20% of his colon and its very normal for him to have low BP and not eat as much. Sister suspects that exposure to Covid was within the hospital as he was admitted on 8/12/21 also for dehydration.

Other Meds:

Current Illness:

ID: 1768238
Sex: M
Age: 33
State: WA

Vax Date: 09/11/2021
Onset Date: 09/13/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: CBC, TSH, and BMP. All within normal limits. Head CT scheduled for 10/15.

Allergies: NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: New onset dizziness. Vertigo mimicking the vertigo experienced during acute COVID 19 infection. Vertigo is unrelenting in nature but waxes and wanes throughout the day. Worse with change in position, worse with exercise. Began 48 hrs following 2nd dose of the Pfizer COVID 19. Vertigo has now been present for 26 days,

Other Meds: None

Current Illness: None

ID: 1768239
Sex: F
Age: 23
State: OR

Vax Date: 09/21/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Have not seen a doctor for the symptoms, have no insurance.

Allergies:

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

Symptoms: The first symptoms were immediate pain and swelling in arm which lasted 5 days along with severe fatigue and body aches and headache which lasted two weeks before subsiding. About a week after the shot I started getting pain in my left armpit and could feel a hard painful lump. After doing research I found swollen glands in the armpits were a side effect of the shot. The swollen gland in the armpit went away after 4 days. But is still sensitive to the touch. Then I started to get migraines which have been continuously worse throughout the week with no way to ease the pain. Then I started getting hard painful lumps in my groin area and feeling a sharp pain in my lower stomach and today I noticed I have very cloudy urine but the only pain I have is in my lower stomach.

Other Meds:

Current Illness:

ID: 1768240
Sex: M
Age: 78
State: CO

Vax Date: 03/02/2021
Onset Date: 09/27/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient had a positive COVID PCR test on 9/27/2021 after receiving both COVID vaccine doses

Other Meds:

Current Illness:

Date Died: 10/03/2021

ID: 1768241
Sex: M
Age: 47
State: MD

Vax Date: 09/30/2021
Onset Date: 10/03/2021
Rec V Date: 10/07/2021
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: STATINS.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient's caregiver called us on 10/7/2021 to inform us that patient passed away at 1 am on 10/03/2021 from a heart attack. He had mild redness at the site of injection. No flu like symptoms or fever after receiving the shot.

Other Meds: LOSARTAN 50 MG 1 DAILY, BRILINTA 90MG 1 TWICE DAILY, NITROGLYCERIN 0.4 SUBLINGUAL AS DIRECTED, ISOSORBIDE MONO 30 MG ER 1 IN MORNING, PRALUENT 75MG/MG 75 MG EVERY OTHER WEEK, METOPROLOL TAR 25 MG 1 TWICE DAILY. OTC USE UNKNOWN.

Current Illness: Had undergone a procedure to place stents on 09/27/2021.

ID: 1768242
Sex: F
Age: 5
State: ND

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: none

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Cellulitis, pain, erythema, edema, lesions to right anterior thigh, spreading circumfrentially over anterior thigh area.

Other Meds: None

Current Illness: None

ID: 1768243
Sex: F
Age: 40
State: IN

Vax Date: 09/10/2021
Onset Date: 09/17/2021
Rec V Date: 10/07/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Large, red, itchy circle on right arm at injection site. Swollen lymph node in right armpit.

Other Meds: Collagen, herbal tea

Current Illness: none

ID: 1768244
Sex: F
Age: 60
State: WA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: none

Allergies: lisinopril

Symptom List: Diarrhoea, Nasal congestion

Symptoms: severe arm pain redness swelling and heat, Itching at injection site . Nausea began aprox 1 hr after injection then severe headache, fever of 100.1 and chills progression aprox 5 hr after injection. Nausea with 2 x emesis aprox 9 hr after injection. continuing muscle acheing and abdominal pain aprox 14 hr after injection

Other Meds: losartan,metformin,

Current Illness: none

ID: 1768245
Sex: F
Age: 18
State: MN

Vax Date: 09/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: None

Allergies: Nka

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

Symptoms: Delayed menstrual cycle. Never more than 26-28 days. After receiving both vaccinations, menstrual cycle was delayed 6 days that month.

Other Meds: None

Current Illness: None

ID: 1768246
Sex: M
Age: 35
State: NJ

Vax Date: 04/11/2021
Onset Date: 05/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Blood work (inflammation levels are coming up high) EMG (Nerve and muscle test done, no issues) Upper cervical MRI (came back clean, no issues found)

Allergies: Arythromycin and Penicillin

Symptom List: Rash, Urticaria

Symptoms: May: Sharp pain and stiffness in neck and left jaw. June-August: Pain and weakness started in my shoulders and thighs. September - Now: Pain and weakness started in my legs and soles of my feet and swollen toe in right side. (Left jaw pain went away.

Other Meds: None

Current Illness: None

ID: 1768247
Sex: F
Age: 32
State: KY

Vax Date: 01/29/2021
Onset Date: 09/14/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: SARS CoV + SARS CoV 2 Antigen Positive on 9/16/2021

Allergies:

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

Symptoms: Breakthrough case after Covid vaccination. Dose #1 12/23/2020 Dose #2 01/29/2021. C/O muscle aches, headache, loss of taste/smell, cough, SOA, diarrhea, and stuffy nose/ onset 09/14/2021

Other Meds:

Current Illness:

ID: 1768248
Sex: F
Age: 30
State: MD

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/07/2021
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

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

Symptoms: Within an hour of vaccine, almost immediately had a fever (100.4). 2 hours post vaccination, I had a fever of 102 even. 2.5 hours post vaccination full body aches and a fever of 103.2. Slept most of the day. Following day, low-grade fever. I've had shortness of breath and lethargy ever since the vaccination. I am a very healthy 30 year old female, in shape with an appropriate diet. Who has never had these symptoms prior to the vaccination.

Other Meds: None

Current Illness: None

ID: 1768249
Sex: M
Age: 16
State: CA

Vax Date: 10/02/2021
Onset Date: 10/03/2021
Rec V Date: 10/07/2021
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: keflex, trees, pollens, cat dander

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

Symptoms: sore throat, coughing, congestion, pain in chest and side/back after coughing for long periods, wheezing, fatigue, cold sweats/chills, sinus infection. given z-pack, told to continue sinus treatment regimen and allergy medication

Other Meds: loratadine, allergy shots

Current Illness:

ID: 1768250
Sex: F
Age: 48
State: WA

Vax Date: 04/07/2021
Onset Date:
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: CAT scan- mass on the right side of my thyroid.

Allergies: Bee venom; Contrast dye

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

Symptoms: I had knee surgery and fainted after it. I had to get a CAT scan to rule out blood clots and they found I had a mass on the right side of my thyroid. It was about 5.7cm and it grew to like 6.4cm by the time it was taken out. I had the surgery on Monday 10/4/2021. They also did blood work to figure out to see if the rest of my thyroid is functional. Right now I am on pain management.

Other Meds: Hydrochlorothiazide; Allergy medicine; Tramadol; Magnesium; Vitamin D; Mix vitamins.

Current Illness: None

ID: 1768251
Sex: F
Age: 25
State: GA

Vax Date: 03/23/2021
Onset Date: 03/29/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Waiting for cycle to finish returning to normal before returning to Dr. I already spend way too much annually on obgyn visits.

Allergies: Latex

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

Symptoms: Change in menstrual cycle schedule (still experience mild symptoms during original schedule time), menstrual cycle increased from 1 week to 2 weeks, pain with menstrual cycle decreased, blood during menstrual cycle also appeared different (looked really dark and old). Now (September/October) cycle is returning to normal across all levels, extreme levels of pain are also returning.

Other Meds: Wellbutrin Sr 200

Current Illness: Na

ID: 1768252
Sex: F
Age: 64
State: FL

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Severe pressure behind right eye, severe headache and hot flashes returned. There was so much pressure behind my right eyeball that I thought my eyeball was going to pop out of the eye socket. The pressure lasted for 2 full days. Before the pressure it felt like someone was stabbing me with a nail in my right eye. I rarely ever had a headache before the vaccine (maybe 1 mild one a year) and now I get headaches daily/ Hot flashes have returned and not gone away. I hadn't had a hot flash in 10+ years and now they are back since taking the vaccine.

Other Meds: mirapex

Current Illness: none

Date Died: 10/06/2021

ID: 1768253
Sex: M
Age: 72
State: TN

Vax Date: 03/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only.

Other Meds:

Current Illness:

ID: 1768254
Sex: F
Age: 58
State:

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: Patient described shooting pain in left breast and swelling of the breast the day following vaccine administration. Patient applied ice to the area and reports that there was no pain in the arm the vaccine was received in.

Other Meds:

Current Illness:

ID: 1768255
Sex: F
Age: 39
State: GA

Vax Date: 09/12/2021
Onset Date: 09/13/2021
Rec V Date: 10/07/2021
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: Nonstop, heavy menstrual bleeding. Ongoing. Severe cramping. Nonstop headaches that sometimes turn to migraines. (Never had a headache in my life.) Tic. Popping ears constantly and involuntarily.

Other Meds:

Current Illness:

ID: 1768257
Sex: M
Age: 80
State: MI

Vax Date: 03/17/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: Unknown

Allergies: No Known Allergies

Symptom List: Unevaluable event

Symptoms: SOB, cough and weakness. Feeling ill for about 1 week with cough, weakness and general malaise. So weak that he fell at home and hit his head.

Other Meds: Unknown

Current Illness: Unknown

ID: 1768258
Sex: F
Age: 93
State: CO

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/07/2021
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: None

Allergies: None

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

Symptoms: Severe Covid fog. Because patient is 93 she was not able to recognize that something was wrong until late in the day when things keep going wrong. Even then it didn't occur to her or her daughter that it was related to the vaccine. This was also the side effect patient suffered after her second Shingles shot in August.

Other Meds: Albuteral, Baby Aspirin, B complex vitamin, D vitamin, Diclofenac, Diltiazem, Donepezil, Duloxetine, Famotidine, Furosemide, Gabapentin, Levothyroxine, Metoprolol, Multi vitamin, Omega 3, Omeprazole, Spironolactone, Symbicort, Tylenol

Current Illness: None

Date Died: 08/25/2021

ID: 1768259
Sex: F
Age: 71
State: GA

Vax Date: 02/12/2021
Onset Date: 08/24/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: 08/24/2021 PCR+ COVID-19 test

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Breakthrough COVID-19 case with unknown symptom onset date: altered mental status. Hospitalized 8/24/2021-8/25/2021. Death 8/25/2021. Per medical records, patient presented to ER with altered mental status. Patient was emergently intubated and was admitted to ICU. Patient's previous medical history and symptoms were unable to be obtained due to patient's clinical condition. Per patient's husband, she was recently released from hospital and had recently had COVID-19. Patient expired on 08/25/2021. Vital records data not available yet.

Other Meds:

Current Illness:

ID: 1768260
Sex: F
Age: 79
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
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: 1768261
Sex: M
Age: 63
State: CA

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: none

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

Symptoms: sudden chills with almost incontrollable shaking, headache, temp to 100.8, aches and joint pain

Other Meds: metphormin, glipizide, lotensin, omeprazole, amlodipine, magnesium, potassium, tamsulosin, crestor

Current Illness:

ID: 1768262
Sex: F
Age: 68
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

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

Other Meds:

Current Illness:

ID: 1768263
Sex: F
Age: 59
State: MN

Vax Date: 12/23/2020
Onset Date: 10/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Rapid test at Pharmacy on 10.4 11:15 am resulted positive. PCR spit test at Clinic on 10.4 3:15pm resulted positive.

Allergies: Nickel allergy

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Body/muscle aches, chills, diarrhea, cough, loss of sense of taste and smell

Other Meds: Citalopram, Bubroprion HCL, Simvastatin, Multivitamin, D3, Biotin, Vitamin E, Estrogen supplement.

Current Illness: None

ID: 1768265
Sex: F
Age: 35
State: TX

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
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: I have not seen a doctor for my reaction. I have looked up to see if this was a occurrence with the vaccine. So far I?ve read that it?s nothing to worry about but, I just want to make record of it that it?s happened with the third shot and my previous two shot before this had not caused me any symptoms or problems before.

Allergies: Codeine

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

Symptoms: On second day after shot, in evening, started to feel and notice swollen lymph nodes in armpit and shoulder/collar bone on right side of arm. This was for my booster shot, as I work in the hospital constantly in contact with newborns and their parents.

Other Meds: No

Current Illness: No

ID: 1768266
Sex: F
Age: 66
State: KY

Vax Date: 03/31/2021
Onset Date: 08/24/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: SARS CoV + SARS CoV 2 Antigen Positive on 9/6/2021

Allergies:

Symptom List: Nausea

Symptoms: Breakthrough case after Covid vaccination. Dose #1 3/3/2021 Dose # 2 3/21/2021. C/O fever, runny nose, loss of taste/smell, headache, fatigue, cough, and sore throat/ onset 8/24/2021

Other Meds:

Current Illness:

ID: 1768267
Sex: F
Age: 42
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

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

Other Meds:

Current Illness:

ID: 1768268
Sex: F
Age: 63
State: FL

Vax Date: 01/06/2021
Onset Date: 02/02/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: 9/9/21 Ekg, CT Lung with contrast, Cardiac Echo, Labs, Liver ultrasound

Allergies: Macrobid

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

Symptoms: 9/8/21 Went to ER for petechiae on bilateral legs, feeling tired, low grade temp, SOB on exertion and irregular heartbeat. Admitted to hospital for thrombocytopenia and cardiomyopathy.

Other Meds: Levothyroid, Pantoprazole, Atorvastatin, Estradiol

Current Illness: Covid

ID: 1768269
Sex: M
Age: 91
State: CO

Vax Date: 02/20/2021
Onset Date: 10/03/2021
Rec V Date: 10/07/2021
Hospital: Y

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: Patient had a positive COVID PCR on 10/03/2021 after receiving both vaccine doses

Other Meds:

Current Illness:

ID: 1768270
Sex: F
Age: 76
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
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: 1768271
Sex: F
Age: 57
State: NY

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 10/07/2021
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: Blood work, echocardiogram, ultrasound, cat scan, blood transfusions, upper endoscopy, colonoscopy, capstudy, cardiac monitoring (outpatient) MRI

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Flu symptoms at first, then becoming worse Positive covid test September 10, 2021 GI bleed 9/21/21 Hospitalized 9/22/21 Severe Tachycardia/tachypnea/shortness of breath during hospitalization Hgb from. 14 to 8 in 5 days

Other Meds: Metoprolol, Isosorbide, lisinopril, Armour thyroid, pantoprazole,cymbalta, tizanidine

Current Illness: HTN, CAD, High cholesterol, GERD, hypothyroid

ID: 1768272
Sex: M
Age: 77
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

Date Died: 08/11/2021

ID: 1768273
Sex: F
Age: 83
State: GA

Vax Date: 02/01/2021
Onset Date: 08/09/2021
Rec V Date: 10/07/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Shortness of breath/difficulty breathing, Nausea/Vomiting, Loss of smell or taste, Cough

Other Meds:

Current Illness:

ID: 1768274
Sex: F
Age: 74
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
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: Asthenia, Chills, Headache, Myalgia

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

Other Meds:

Current Illness:

ID: 1768275
Sex: F
Age: 35
State: MA

Vax Date: 03/26/2021
Onset Date: 05/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: None.

Allergies: Amoxicillin, Metoclopramide for my milk supply

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

Symptoms: I had my baby in August 24, 2020 so I wasn't sure if this was normal. I got my period right after the first shot and it was pretty normal except bleeding a bit longer than usual and subsequent periods everything lasted longer including the cramps, mood swings, bleeding, bloating, and swelling. The most erratic period was the one I had in May which was one month after the 2nd vaccine where I had cramping that lasted 4 days before my period started. The period lasted 4-5 days. Subsequent periods, I've had days of cramping, usually a couple of days, and then the period starts and that was never the case for me before taking Pfizer. When I brought my son in for his wellness check I spoke to my Doctor about it and I talked to my gynecologist too and they said at my age that they're not going to do much but I can go on hormonal birth control or do an ablation but we're not sure if we want more kids or not so I did not take them up on that so I just take ibuprofen.

Other Meds: Multivitamin, Probiotic, Flonase (every morning).

Current Illness: None.

ID: 1768276
Sex: M
Age: 65
State: KS

Vax Date: 03/05/2021
Onset Date: 06/22/2021
Rec V Date: 10/07/2021
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: Cat Scan,Blood tests

Allergies: none

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

Symptoms: Stroke June 22, loss of left side , still doing rehab

Other Meds: 70/30 Insulin, Plavix

Current Illness: none

ID: 1768277
Sex: F
Age: 25
State: GA

Vax Date: 04/03/2021
Onset Date: 09/01/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Covid Test- Negative (8/31/2021) Covid Test- Positive (9/2/2021)

Allergies: none

Symptom List: Pain in extremity

Symptoms: I started to feel symptoms on the morning of Wednesday, September 1, 2021. My partner started to feel sick a few days before me. On August 31, I took a COVID test and it was negative. When I felt sick on Wednesday, my partner was sick as well and he tested positive COVID. I took another COVID test on Thursday, September 2nd and it was positive. My symptoms got worse over 3 or 4 days with a fever from 99 to 101, extreme exhaustion, fatigue, and fogginess. After a few days I started to feel better. The fever went away but I lost my sense of smell and taste. My fever was going away, but my neurological symptoms felt like they were getting worse. The fever and exhaustion had got better since being quarantined. It has been about a month, but I have still experienced a little bit of exhaustion, fogginess, and not feeling like doing as much as I used to. About a few ago I started to smell and taste again. I feel like I am about 95% better now. I couldn't work for two weeks because of the exhaustion I had and feeling like all I wanted to do was sleep.

Other Meds: none

Current Illness: none

ID: 1768278
Sex: F
Age: 60
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
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: 1768279
Sex: F
Age: 59
State: CO

Vax Date: 05/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient was treated in the hospital for a positive COVID test after receiving both doses of Pfizer

Other Meds:

Current Illness:

ID: 1768280
Sex: M
Age: 55
State: MO

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
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: Adhesive Band-Aids Latex

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

Symptoms: Patient had received the Mederna Vaccine the first 2 doses of COVID 19 vaccine. Patient came in and received the Pfizer vaccine for COVID 19 . as the 3rd dose. Patient did not have any signs or symptoms of adverse reaction to having received the 3rd dose as the Pfizer rather than the Mederna.

Other Meds: UNKNOWN

Current Illness: Unknown

ID: 1768282
Sex: F
Age: 45
State: NJ

Vax Date: 09/27/2021
Onset Date: 09/30/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: none yet - completed routine covid antigen testing on 9/27 9/29, 10/4 7 10/6 as per work policy also tested 10/5 due to symptoms per work policy all antigen tests were negative.

Allergies: seasonal allergies vomited after demerol X1

Symptom List: Vomiting

Symptoms: receive vaccine on 9/27 on 9/28 experienced pain and burning at injection site with headache and general malaise with photophobia on 9/30 in the evening notice hands and finger with tingling and numbness next morning on 10/1 also noticed it in both of my feet . on 10/2 mid day noticed neck stiffness, It didn't go away contacted my PCP on 10/5, at this time no other treatment recommended except monitor for worsening symptoms and advised to contact my Occupation health as Ii received it from work . on 10/6 woke up with a headache in notified my practitioner advised to continue to monitor and Tylenol for headache I also contacted occ health on 10/6 only recommendation given was this website and told to complete this form and to continue to follow up with my PCP. As of today 10/7 I still have numbness and tingling, pins and needles in my hand and feet, stiff neck, mild headache and pain and burning at the site of the injection and unable to lift my arm without pain in my shoulder and armpit.

Other Meds: none

Current Illness: none

ID: 1768283
Sex: M
Age: 77
State: MI

Vax Date: 02/23/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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: Unknown

Allergies: No Known Allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: SOB, cough with clear sputum, nausea and diarrhea, subjective fevers and chills.

Other Meds: Unknown

Current Illness: Unknown

ID: 1768284
Sex: M
Age: 77
State: CO

Vax Date: 03/17/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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:

Allergies:

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

Symptoms: Patient had a positive COVID PCR test on 10/04/2021 after receiving both vaccines

Other Meds:

Current Illness:

ID: 1768285
Sex: M
Age: 66
State:

Vax Date: 10/06/2021
Onset Date:
Rec V Date: 10/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

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

Other Meds:

Current Illness:

ID: 1768286
Sex: F
Age: 88
State: WI

Vax Date: 04/06/2021
Onset Date: 10/02/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data:

Allergies: Bacitracin, Lipitor

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

Symptoms: Patient was admitted to observation level of care on 10-2 with weakness, diarrhea and AKI. Patient is noted to be positive for covid upon testing at admission.

Other Meds:

Current Illness:

ID: 1768288
Sex: M
Age: 47
State:

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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