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: 1772245
Sex: F
Age: 51
State: CO

Vax Date: 08/16/2021
Onset Date: 09/19/2021
Rec V Date: 10/08/2021
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: penicillin, tomatoes, cinnamon

Symptom List: Dysphagia, Epiglottitis

Symptoms: About 4 weeks after shot I received my period after being in menopause

Other Meds: zinc, multi vitamin, D3

Current Illness: none

ID: 1772246
Sex: F
Age: 41
State: NE

Vax Date: 09/13/2021
Onset Date: 09/20/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Blood pressure

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: After the vaccine, a week and a half after in the morning I experienced shortness of breath and I could feel my heartbeat when I laid down at night and I could feel it in my head. I bought a blood pressure cuff and it's been 150-160. They put me on two medications and I've had horrible migraines every single day. I've been on a heart monitor twice and I'm going for my third today 10/08/2021. I've never had high blood pressure before.

Other Meds: Clonazepam; hydrocodone; multivitamins; ondansetron HCl; lisinopril; two other stomach medications but don't remember the name for them

Current Illness: None

ID: 1772247
Sex: M
Age: 3
State: KS

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: High dose flu given to 3 year old inadvertently. No s/s at time of call to mother.

Other Meds:

Current Illness:

ID: 1772248
Sex: F
Age: 57
State: NC

Vax Date: 04/06/2021
Onset Date: 04/12/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: D-dimer, Ultrasound, TEST done for inflammation, ( ANA12+profile ( RDL ), Sedrate Test ( ESR ), CRP TEST, CBC Lab work- DIFF

Allergies: Augmentin, Latex, Nickle ( metal ), Aluminum, Titanium Dioxide

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Six days after I received the vaccine, I experienced blurred vision and loud tinnitus. I felt weak and shaky, my whole body just felt like it was shaking. I was having inflammation zingers. I felt like my body was inflamed and bad brain fog. Two days after that I started having pain in my left leg below my calf muscle and behind my knee. Whenever the knee pain started happening, I started to get worried, the pain started on 4/14/21 in my left leg. On 4/16/21, I still felt shaky, weak legs, headache over my ears, and felt borderline nauseated and felt like I was going to pass out. On 4/21/21, I experienced tinnitus through the roof. I went to doctor on 4/26/21 and she ordered a D-dimer test. The test came back elevated. I then had an ultrasound done on 4/27/21 at Radiology. The US came back negative for blood clots. I had another appointment with on 4/30/21, she determined the lymph nodes in my legs were inflamed and that was causing the leg pain. The leg pain still comes and goes. I have experienced numbness in my toes. Another MD feels that it may be the beginning of neuropathy, but I have not had that checked out yet. I am waiting to have an upcoming surgery to have the metal in my neck removed to see if that helps resolve the issues. The vaccine may have triggered an inflammation response to the metal in my body since I have an allergy to metal. ( I have metal in my neck from a surgery a couple years ago, I have a known metal allergy but was not told when surgery was done that metal was placed in my neck. )

Other Meds: Vitamin C (2,000mg 1 xday ), B Complex ( 1xday ), Vitamin E ( 268mg 1xday ), Zinc ( 15mg 1xday ), Selenium ( 100mcg 1xday ), Magnesium ( 350mg 1xday ), Vitamin D3 ( 2,000IU 1xday )

Current Illness: Inflammatory reaction- Metal in body ( noticed symptoms about a month before receiving vaccine )

ID: 1772249
Sex: F
Age: 67
State: GA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Patient had a swollen red ring on arm which went towards the back of the arm. Daughter told me she thought it looked like it was given sub-q in back of arm. She had doctor look at it. They wanted me to report it to Vaers. Patient came in today and showed me picture of reaction and I saw her arm today and it looks much better, but still has an irritated ring.

Other Meds:

Current Illness:

ID: 1772250
Sex: F
Age: 53
State: KY

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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:

Allergies:

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

Symptoms: EXPIRED/BEYOND USE DATE VACCINE GIVEN

Other Meds:

Current Illness:

ID: 1772251
Sex: F
Age: 70
State: IN

Vax Date: 06/15/2021
Onset Date: 06/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: none

Allergies: milk

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Sore right arm that resulted in large lump. Felt bruised and patient feels like has had a loss in muscle mass. She now experiences weakness in arm. Still sore to date.

Other Meds: none

Current Illness: not ill

ID: 1772252
Sex: M
Age: 16
State: IN

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

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

Lab Data: We called 911. The paramedics did arrive and assess him. Mom and the paramedics both decided the patient was okay to go home.

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Patient appeared to have his back arched and then went limp. Mom caught him. He was not out for more than a few seconds. Did not his head or fall to the ground.

Other Meds:

Current Illness:

ID: 1772253
Sex: M
Age: 3
State: KS

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: High dose flu given inadvertently to 3 year old. No s/s at time of call to mother.

Other Meds:

Current Illness:

ID: 1772254
Sex: F
Age: 29
State:

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 10/08/2021
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: ALLERGIC TO FLU VACCINE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: hives soon after receiving vaccine

Other Meds:

Current Illness:

ID: 1772255
Sex: F
Age: 44
State: WA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: ER- EKG; bloodwork; chest x-ray and gave me some fluids and some Toradol for the pain. Nothing showed up on test results.

Allergies: Medications - Codeine and have two others but can't remember what they are.

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

Symptoms: That evening, when I received the vaccination, I had tingling behind my teeth and like a small throbbing behind my teeth. Small headache that lasted 40 minutes. Pain in my ears and a muffling sensation. The next day, which was Tuesday, I felt ok when I woke up but was somewhat stiff with body stiffness throughout the day though. That went on all day and into the night. I stayed home Wednesday from work. Early Thursday morning, right leg pain and throbbing in right groin area and that hurt pretty bad. I took Ibuprofen for that. When I woke up Thursday morning, I had chest pressure and that lasted through out the day. I went to Urgent-Care, ER yesterday. I still feel the tightness in my chest. The doctor prescribed some medication for inflammation - Naproxen. He said possibly I have inflammation on the lining of my lungs so he is treating me for that. When I went in to the hospital, I had blood pressure reading of 144/99 and that's high for me.

Other Meds: No

Current Illness: No

ID: 1772256
Sex: F
Age: 76
State: GA

Vax Date: 09/17/2021
Onset Date: 09/28/2021
Rec V Date: 10/08/2021
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: 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: 1772257
Sex: M
Age: 14
State: OR

Vax Date: 10/04/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data: Admitted to Hospital on 10/7 after presenting to the ED 10/6. TPN -I HS 14,382 nl TTE

Allergies: NA

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

Symptoms: Acute myocarditis ~48 hours after vaccination with shortness of breath and chest pain, TPN elevation

Other Meds: none

Current Illness: none

ID: 1772258
Sex: F
Age: 73
State: GA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/08/2021
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:

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

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: 1772259
Sex: M
Age: 73
State: OR

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: none

Allergies: Xanax

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

Symptoms: This vaccination was inadvertently given to resident instead of another resident at the adult foster home. This writer failed to identify the patient correctly. Resident had no local reaction at the injection site. Nor did he have an allergic reaction.

Other Meds: Seroquel, temazepam, Kepra, morphine, Lexapro, lamotrigine, Ty

Current Illness: COPD, dimentia, seizre disorder, no acute ilnesses

ID: 1772260
Sex: F
Age: 43
State: CO

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient received dose #3 only a week after dose #2 after telling clinician that they did not receive dose #2 and it was entered into system by mistake. Found administration forms showing they did receive dose #2.

Other Meds:

Current Illness:

ID: 1772261
Sex: M
Age: 50
State: AR

Vax Date: 04/08/2021
Onset Date: 08/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: COVID on 08/31/2021- positive.

Allergies: None

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

Symptoms: I started having fever, loss of taste and smell, chills. I got tested for COVID on 08/31/2021 and it came back positive. I took some medications to help with the symptoms.

Other Meds: None

Current Illness: None

ID: 1772262
Sex: U
Age: 22
State: GA

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 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: 1772263
Sex: F
Age: 42
State: ND

Vax Date: 10/05/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: Sulfa antibiotics and prednisone

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Experienced under both arm pits a rash that is described as a rug burn that is painful. Doesn't think there is swelling of the lymph nodes?

Other Meds:

Current Illness:

ID: 1772264
Sex: M
Age: 68
State: KS

Vax Date: 09/29/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: CXR, Chest CT

Allergies:

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

Symptoms: Fever, cough, infiltration on chest CT.

Other Meds:

Current Illness:

ID: 1772265
Sex: F
Age: 77
State: IL

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: Penicillin's, Sulfa and Tetracycline (severe )

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

Symptoms: severe pain in left arm down to fingers and sore neck , extreme fatigue slept for 20 hours, Diarrhea that lasted 12hours

Other Meds: Lipitor 40mg, Lasix 20mg, Losartan 25mg, Metoprolol ER 150mg BID , Warfarin 3mg, Ditropan 5mg daily, Trazodone, Spironolactone 25mg, Biotin, Magnesium, multi vitamin

Current Illness: no

ID: 1772266
Sex: F
Age: 62
State: GA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/08/2021
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: Unevaluable event

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: 1772267
Sex: F
Age: 65
State: KY

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

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

Lab Data:

Allergies:

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

Symptoms: EXPIRED VACCINE GIVEN

Other Meds:

Current Illness:

ID: 1772268
Sex: M
Age: 62
State: ID

Vax Date: 08/06/2021
Onset Date: 08/10/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Bloodwork 9/8/2021 Overnight Oximetry 9/16/2021 Brain MRI 9/24/2021 Unable to work since Vaccination #2 due to adverse symptoms 9/8/2021

Allergies: Pollens

Symptom List: Injection site pain, Pain

Symptoms: Severe Brain Fog, Blurry Vision, Memory issues, mental clarity, Confusion, Sleep issues, dizziness, severe watery eyes, Bad headaches, nausea

Other Meds: Rosuvastatin, Olmesartin, Montelukast, Wixela Ihub

Current Illness: none

ID: 1772270
Sex: F
Age: 80
State: IL

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

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

Lab Data: None so far.

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Two hours after receiving the Covid 19 booster vaccine, my heart experienced a rapid beating with palpitations. My blood/pressure was up and down as high as 171/96 when I usually have a normal blood/pressure. This continued for 8 hours. I called my family doctor at 11:00 pm and he said not to worry about a stroke or heart attack as this was a reaction to the vaccine. He advised to push fluids and in the morning to call if worse. I went to doctor's office 3 days later to be checked out. He couldn't hear anything wrong. He said to give it a couple of days and rest and push fluids. Eight days later I am still experiencing a faster heartbeat than normal. I'm not sure what to do next.

Other Meds: Centrum Silver vitamins, 1x a day, Vitamin D, 1000IU, 1x a day.

Current Illness: Slight scratchy throat from allergies. No fever present.

ID: 1772271
Sex: M
Age: 29
State: OH

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

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

Lab Data:

Allergies:

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

Symptoms: Patient came to clinic to state he was needing his second dose of Pfizer which he received "about a month ago". Patient was adamant he received the vaccine at the clinic, but we had no record of it. He also lost his white CDC card so didn't have that to show. He was asked multiple times if Pfizer was the one he needed, and he said yes every time. After pt received the Pfizer vaccine as a second dose, he was told to check with the pharmacy in the store to see if maybe they gave him his first dose there since we do not share the same registration system. He did and found out his fist COVID dose was actually Moderna and it was given 129 days prior.

Other Meds:

Current Illness:

ID: 1772272
Sex: F
Age: 35
State: WA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/08/2021
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: N/A

Allergies: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received initial COVID-19 vaccine, which was Johnson & Johnson. She received a Pfizer vaccine as a booster. Complaint of sore arm and dull headache. Spoke with health department and no revaccination required.

Other Meds: N/A

Current Illness: N/A

ID: 1772273
Sex: F
Age: 11
State: WI

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

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

Lab Data: none

Allergies: Milk derivatives

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Severe pain at injection site, pruritic rash on abdomen and lower extremities

Other Meds: none

Current Illness: none

ID: 1772274
Sex: M
Age: 45
State: CO

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Client received dose #3 after denying receiving dose #2 a week prior even though dose #2 was in database. Able to find the administration record for dose number #2 so he was confused or dishonest.

Other Meds:

Current Illness:

ID: 1772275
Sex: M
Age: 55
State: PA

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild

Other Meds:

Current Illness:

ID: 1772276
Sex: F
Age: 46
State: PA

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

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

Lab Data: CTA 10/1/21

Allergies: Wellbutrin - hives

Symptom List: Injection site pain

Symptoms: On 10/1 I developed an occlusion of left ulnar artery and partial occlusion of left radial artery. I presented to the ER with an ischemic index finger and thumb. Diagnosis was made by CTA. Per vascular surgery I was on a heparin drip overnight. The next morning circulation was documented via doppler and I was discharged on plavix, xerelto, and nifedipine. It is now one week out and I am still being treated. The thought is vasculitis and vasospasm and not thrombosis but they aren't sure.

Other Meds: Xeljanz (held for 7 days following booster vaccine) Celebrex Effexor prednisone omeprazole myrbetriq lipitor flaxseed oil lutein vit B 12 vit D Mg citrate folexin adult MVI

Current Illness: none

ID: 1772277
Sex: M
Age: 22
State: GA

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 10/08/2021
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: 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: 1772278
Sex: F
Age: 57
State: IN

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1772279
Sex: M
Age:
State: KY

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: EXPIRED VACCINE GIVEN

Other Meds:

Current Illness:

ID: 1772280
Sex: F
Age: 65
State: CA

Vax Date: 03/19/2021
Onset Date: 04/14/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Holter Monitor 06/2021; Cardiologist; Echo Cardiogram and stress test; Cardiac Ablation

Allergies: Amoxicillin-rash

Symptom List: Erythema, Pruritus

Symptoms: I have a history of SVT which happens twice a year normally. It has increased in frequency and severity since I got the second dose of the vaccine. My Arthritis has also been much more painful than normal. A few weeks after the second dose I was experiencing faintness and rapid heart rate when I tried to go on my normal walks. When I had the Supraventricular Tachycardia it was going up in heart rate and then I start to feel faint. I feel a tightness in my chest and it got higher than 200. I wore a Holter Monitor for two weeks. I have fainted four times. It has been five months and the symptoms did not improve until I was prescribed Flecainide. I also use some breathing exercises which help a little. I am scheduled for a Cardiac Ablation on 10/14/2021.

Other Meds: N/A

Current Illness: N/A

ID: 1772282
Sex: F
Age: 37
State: VA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
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: Physical exam

Allergies: denied

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

Symptoms: PAIN; ARM TINGLING, NUMBNESS

Other Meds: denied

Current Illness: denied

ID: 1772283
Sex: F
Age: 80
State: NJ

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: N/A

Allergies: sulfa meds

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

Symptoms: swollen arm, warm/hot to touch, itching and burning also had fever on tuesday 10/05/2021 which lasted until wednesday 10/06/2021

Other Meds: N/A

Current Illness: N/A

ID: 1772284
Sex: F
Age: 23
State: TX

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

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

Lab Data: None

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: High blood pressure, general weakness and severe chest pains.

Other Meds: None

Current Illness: None

ID: 1772285
Sex: F
Age: 58
State: GA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 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: 1772286
Sex: M
Age: 52
State: GA

Vax Date: 04/23/2021
Onset Date: 08/17/2021
Rec V Date: 10/08/2021
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: 08/28/2021 PCR+ COVID-19 test at

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/17/2021: Sore Throat, Fatigue or tiredness. The Patient was hospitalized Dates: 08/28/2021-09/01/2021. The Patient was located in another state at the time of the call. The Patient stated that the week before he drove he felt as if he was experiencing allergies. The Patient stated that 7 of his family members have tested positive. The Patient stated that he knows he was exposed by family gatherings. Other conditions: immunodeficiency - the Patient has HIV. The Patient is bipolar and is prescribed quetiapine. Also, the Patient takes blood pressure medication, but it was stated that he does not have high blood pressure.

Other Meds:

Current Illness:

ID: 1772287
Sex: F
Age: 66
State: CT

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

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

Lab Data: N/A

Allergies: EGGS, LACTOSE, MILK, FLUOROQUINOLONES

Symptom List: Pain in extremity

Symptoms: PATIENT IS EXPERIENCING COVID ARM, CELLULITIS. ARM IS HOT, SWOLLEN, AND RED. THE BOARDERS ARE GROWING. SHE WAS ORIGINALLY PRESCRIBED KEFLEX AND THEN SWITCHED TO BACTRIM DS.

Other Meds: N/A

Current Illness: N/A

ID: 1772289
Sex: F
Age: 64
State: GA

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/08/2021
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: 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: 1772290
Sex: M
Age: 44
State: MD

Vax Date: 09/17/2021
Onset Date: 10/01/2021
Rec V Date: 10/08/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Site: Pain at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1772291
Sex: F
Age: 57
State:

Vax Date: 01/30/2021
Onset Date: 09/15/2021
Rec V Date: 10/08/2021
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: covid pneumonia, pancreatitis

Other Meds:

Current Illness:

ID: 1772292
Sex: F
Age: 65
State: NJ

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 10/08/2021
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

Allergies: Shellfish; Strawberry; Latex; Bee

Symptom List: Vomiting

Symptoms: After the shot pain in arm at night tired and heaviness almost like jet lag. All I want to do is sleep for the next couple of days. Pain in arm for first week but went away, then it came back. Since it has been on and off pain even up to today. Also, had unusual aches at the joints where had injury 2years before the vaccine. PT finish recently and still has increased pain on bad days.

Other Meds: Advil; Tylenol; Bystolic; Losartan

Current Illness: None

ID: 1772293
Sex: F
Age: 72
State: GA

Vax Date: 09/17/2021
Onset Date: 09/28/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

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: 1772294
Sex: F
Age: 43
State: TX

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

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

Lab Data:

Allergies:

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

Symptoms: Menstrual cycle immediately following both 1st and 2nd vaccine. 3rd period starting October 5th. I have not had periods in 12 years due to Moderna birth control.

Other Meds:

Current Illness:

ID: 1772295
Sex: F
Age: 64
State: NY

Vax Date: 03/05/2021
Onset Date: 03/06/2021
Rec V Date: 10/08/2021
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: Bloodwork in Apr & Aug2021 - elevated CRP inflammatory; X-ray of lower back and MRI - bulging disk and pressure on nerve, having backache since before I got the vaccine. Monogram and MRI - Right breast and recently did another in Oct2021 and no more cancer.

Allergies: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: After the vaccine brain fog. Apr2021 - bloodwork done - elevated CRP inflammatory, Elevated still. Aug 2021 in routine check ups. In August mammograms on right breast had a small lump and been removed and hv to get early stage - after removing it had cancer cells.

Other Meds: Verapamil; Vitamin D; B12

Current Illness: No

ID: 1772296
Sex: F
Age: 30
State: PR

Vax Date: 06/19/2021
Onset Date: 06/19/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: After patient was vaccinated, reports feeling unbalance, paramedic gives her alcohol and takes her vitals BP 130/90, sat 99, pulse 85. She waited 30 minutes for any adverse reaction to vaccine. After 30 minutes when patient was leaving she was feeling unbalance and reports not having breakfast that morning. She had water and her family brought her some breakfast. Paramedic called the ambulance.

Other Meds: n/a

Current Illness: n/a

ID: 1772297
Sex: M
Age: 74
State: KY

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: EXPIRED VACCINE GIVEN

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am