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: 1772298
Sex: F
Age: 44
State: IL

Vax Date: 07/01/2021
Onset Date: 07/02/2021
Rec V Date: 10/08/2021
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: None

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: pt was admitted to Hospital for cardiac arrhythmia- SVT

Other Meds: losartan, ibuprofen

Current Illness: hypertension

ID: 1772299
Sex: F
Age: 20
State:

Vax Date: 10/05/2021
Onset Date: 10/05/2021
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:

Allergies: Allergies: Amoxicillin and Penicillin (hives/anaphylaxis); Latex (hives)

Symptom List: Anxiety, Dyspnoea

Symptoms: 13mins post vaccination pt c/o flushing, feeling shaky and hot all over. Pt states that she's a very anxious person. Vitals: BP 149/84, HR 94, RR 16, Temp 99.7 OT Sat 100% RA Pt stayed for 30 mins observation. Pt stable and released for the vaccination site.

Other Meds: Unknown

Current Illness:

ID: 1772300
Sex: M
Age: 36
State: OH

Vax Date: 10/05/2021
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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: Extreme fever started around 4pm day after 2nd dose received until I peaked at 105 degrees at 9pm that evening.

Other Meds: Ropinrole, Vitamin D, Ginkgo biloba

Current Illness: no

ID: 1772301
Sex: F
Age: 86
State: OH

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: None

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headaches, muscle pain and dementia-symptoms

Other Meds: Metoprolol

Current Illness: None

ID: 1772302
Sex: F
Age: 73
State: GA

Vax Date: 02/17/2021
Onset Date: 08/23/2021
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: 08/29/2021 PCR+ COVID-19 test at Hospital

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/23/2021: Runny Nose/Congestion, Shortness of breath/difficulty breathing, Loss of smell or taste, Fatigue or tiredness, Chills, Cough. UI believes they were exposed during their trip from 8/19-8/23. Patient started to experience symptoms the night they returned from their trip. Patient reported symptom onset began with coughing spasms, congestion, fatigue and shortness of breath. Patient then developed severe diarrhea which led them to the ER. Patient was admitted to the hospital for dehydration, pneumonia and renal function observation. Patient was discharged after one week and reported symptoms have completely resolved. Hospitalized 8/29/2021-9/5/2021

Other Meds:

Current Illness:

ID: 1772303
Sex: F
Age: 39
State: TN

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: Site: Pain at Injection Site-Mild, Systemic: metallic taste in mouth happened within 5 minutes of shot-Mild

Other Meds:

Current Illness:

ID: 1772304
Sex: M
Age: 50
State: OH

Vax Date: 04/19/2021
Onset Date: 04/26/2021
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: CT Head and Neck MRI Comprehensive Metabolic Panel

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Acute onset of dizziness while on a small boat on the water. Presented to ED at 10:00. CT of head and neck was normal; MRI was normal. Slow improvement of symptoms with meclizine. Ultimately discharged to home at 17:45. Given meclizine x 2, ondansetron 4mg IV, famotidine 20mg IV, diazepam 5mg IV, and metoclopramide 10mg IV x 2 over the course of his stay,

Other Meds: Levothyroxine 250mcg daily, Ecotrin 81mg daily, Nasacort 2 sprays each nostril daily, Rosuvastatin 20mg daily

Current Illness: none

ID: 1772305
Sex: F
Age: 15
State: GA

Vax Date: 09/08/2021
Onset Date: 09/28/2021
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:

Allergies:

Symptom List: Pharyngeal 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: 1772306
Sex: U
Age: 17
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

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: 1772307
Sex: F
Age: 66
State: IL

Vax Date: 03/04/2021
Onset Date: 03/04/2021
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: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: For 6 hours-Nausea, vomiting, Fir 36 hours- fever, chills, sweating, headache, joint ache.

Other Meds: Calcium, vitamin D

Current Illness: None

ID: 1772308
Sex: F
Age: 62
State: TN

Vax Date: 03/28/2021
Onset Date: 08/10/2021
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: 8/10/2021 After cataract surgery was cancelled due to AFIB or Flutter went directly to doctor who spoke to another doctor who ordered a heart monitor. AFIB was detected on the heart monitor I wore for a week. Started the medication for AFIB Flecainide 100Mg 9/16/21 Met with Heart Surgeon to schedule Surgery9/23/2021-Outpatient Surgery scheduled for Oct 22, 2021

Allergies: Erythromycin Base- Nausea Hydrocodone -Nausea and itching Sulfanilamide- Nausea Fentanyl-Reaction after brain surgery 2014 -itching, Nausea

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

Symptoms: AFIB noticed 8/10/2021 when running a EKG before my cataract surgery.

Other Meds: aspirin 325 Mg once daily Atorvastatin 40 mg 1 tablet daily calcium 1 petites pill per day coenzyme Q10 200mg once daily diazepam 10 mg tablet as needed (one taken morning of Surgery) folic acid 1 mg tablet daily gabapentin 300mg capsule tw

Current Illness: None

ID: 1772309
Sex: M
Age: 52
State: NC

Vax Date: 04/16/2021
Onset Date: 04/20/2021
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: Didn't go to a doctor to confirm if the pain I felt was related.

Allergies: Slight allergy to doxycycline. Slight rash formed after 2 weeks, after 3 weeks it spread to arms, chest and neck. After 4 weeks is was covering all those areas more fully. Then doctor asked me to stop taking. Was prescribed due to "Catch Scratch Fever" - swollen lymph node under arm. It did cure the issue. This was when I was in my early 20s.

Symptom List: Rash, Urticaria

Symptoms: Both after 2nd shot: Minor: Rash at injection site. Small fever for about 1 1/2 days. Tired for 2 days. Mild, but concerning: A couple of days after shot, I felt pain in my chest (peck muscles). Usually I noticed it when I leaned forward or backwards. Was so mild, I didn't go in to see anyone. Was a bit worried, but thought (hoped) it was a pulled muscle - even though I didn't do anything to pull a muscle. Pain went a way after a couple of days. Weeks later, I saw a doctor somewhere that talked about myocarditis. He described symptoms of the mild forms of it similar to what I experienced. I was suddenly concerned that maybe that is what I had. I am in a group that I think is technically allowed to have a booster after 6 months, but now I think I may wait until more data is out, since if I did have Myocardities, I am concerned a 3rd dose could have a more severe reaction.

Other Meds: None.

Current Illness: None

ID: 1772310
Sex: F
Age: 62
State: NY

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: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1772311
Sex: U
Age: 48
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: 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: 1772312
Sex: F
Age: 66
State: AL

Vax Date: 06/23/2021
Onset Date: 06/24/2021
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: EKG normal. Blood test normal. - 6/24/21

Allergies: No known allergies

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

Symptoms: Patient called 911 about 14 hours after receiving vaccine thinking she was having a heart attack (severe pain started in collar bones, moved to left side). EMS did not see anything wrong; patient waited to see if symptoms improved. Went into ER next morning when still having symptoms. ER did not find anything wrong, gave patient pain medication to help with pain. Patient has continued to have symptoms, even until recently still feeling unable to sleep on left side. Has since seen Dr. who has been treating for inflammation.

Other Meds: Armour Thyroid, Loratadine

Current Illness: N/A

ID: 1772313
Sex: M
Age: 13
State: AL

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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 was suppose to receive second dose of Pfizer Covid-19 vaccine but instead received a dose of Moderna Covid-19 vaccine. Child was monitored by a nurse for 30 min for any adverse reactions, mother was notified of vaccine error as well as Dr. with the department.

Other Meds:

Current Illness:

ID: 1772314
Sex: F
Age: 17
State: WA

Vax Date: 03/08/2021
Onset Date: 08/11/2021
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 test

Allergies: No

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

Symptoms: Had a COVID breakout after being fully vaccinated. I was given medication.

Other Meds: Anti depressants

Current Illness: No

ID: 1772315
Sex: M
Age: 83
State: TX

Vax Date: 10/04/2021
Onset Date: 10/07/2021
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: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1772316
Sex: F
Age: 39
State: NY

Vax Date: 10/06/2021
Onset Date: 10/06/2021
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: labs obtained today for cbc, lft, bmp, tsh.

Allergies: latex, shrimp, banana, grape, mango

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: pt describe generalized itching since administration of the flu vaccine that has not stopped since

Other Meds: atorvastatin, ferrous sulfate, HCTZ, losartan, metoprolol, nifedipine

Current Illness: none

ID: 1772317
Sex: F
Age: 61
State: OH

Vax Date: 03/04/2021
Onset Date: 03/15/2021
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: CT Scan; Blood work; EKG.

Allergies: Penicillin; Azithromycin

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

Symptoms: It started about 3:30AM, I got up to use the restroom. The room was spinning and I fell. I thought it was Vertigo. I went back to bed. I thought it would go away and it didn't. I took some Tylenol. By 7AM, my husband took me to the ER. They did a CT scan to make sure I wasn't having a stroke. It ended up being Vertigo. They did an EKG for my heart. It was off and on for about a month. I have not had any issues since. I went in to see my doctor later for a sinus infection and I did mention it to him, but I didn't require any treatment. When I went to my chiropractor and she told me that I was the 5th person that she had seen that had gotten Vertigo after having the shot.

Other Meds: Lipitor; Meloxicam; Multivitamin; Vitamin C; Turmeric Vitamin; Claritin.

Current Illness:

ID: 1772318
Sex: F
Age: 45
State: AZ

Vax Date: 09/24/2021
Onset Date: 09/24/2021
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:

Allergies:

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

Symptoms: PT DEVELOPED METAL TASTE IMMEDIATELY AFTER VACCINATION

Other Meds:

Current Illness:

ID: 1772319
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: n/a

Allergies: n/a

Symptom List: Unevaluable event

Symptoms: an hour after the vaccine headache cheat pain nausea swelling in right arm weak chills

Other Meds: n/a

Current Illness: n/a

ID: 1772320
Sex: M
Age: 22
State: GA

Vax Date: 09/08/2021
Onset Date: 09/28/2021
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: Vaccine error: Vaccine administered past its beyond use date. The vaccine stored in the freezer beyond the timeframe recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1772321
Sex: M
Age: 54
State: WI

Vax Date: 02/03/2021
Onset Date: 10/05/2021
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:

Allergies: No known allergies

Symptom List: Injection site pain, Pain

Symptoms: Patient contracted COVID after being fully vaccinated Runny nose, congestion, sore throat, fatigue

Other Meds: acetaminophen 500mg prn for fever atorvatatin 20mg HS bifidobacterium-lactobacillus cholecalciferol daily gabapentin 300mg QID ibuprofen 400mg prn for pain loratadine-pseudoephedrine daily prn for allergies melatonin 3mg HS prostate vitamin

Current Illness: None documented

ID: 1772322
Sex: M
Age: 37
State: GA

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Vaccine error: Vaccine administered past its beyond use date. The vaccine stored in the freezer beyond the timeframe recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1772323
Sex: F
Age: 40
State: NV

Vax Date: 04/30/2021
Onset Date: 05/02/2021
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: Despite arthritic symptoms and history of rheumatoid arthritis in the family, all tests have come back normal. Waiting on followup with rheumatologist.

Allergies: nka

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

Symptoms: Severe and persistent joint pain in ankles, toes, wrists and fingers. Joint pain led to difficulty walking and inability to operate mouse/keyboard. Treated at urgent care with steroids. That relieved the pain but it returned within one week of ending the steroids. Became increasingly worse and was treated with steroids a second and third time. After third round of treatment, pain has not subsided but is less severe. Treatment continues. Symptoms remain.

Other Meds: buproprion, magnesium

Current Illness: none

ID: 1772324
Sex: M
Age: 74
State: MO

Vax Date: 10/04/2021
Onset Date: 10/04/2021
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: NKDA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient previously received 2 doses of the Moderna vaccine. We incorrectly administered the Pfizer vaccine for the 3rd shot. No adverse reactions to report.

Other Meds: Unknown

Current Illness: Unknown

ID: 1772325
Sex: F
Age: 71
State: IN

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: sore left arm, neck pain, headache, pain on surface of breasts, chills, sweats

Other Meds:

Current Illness:

Date Died: 09/20/2021

ID: 1772326
Sex: M
Age: 90
State: GA

Vax Date: 03/12/2021
Onset Date: 08/28/2021
Rec V Date: 10/08/2021
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: 08/28/2021 PCR+ COVID-19 test at Hospital; 09/10/2021 PCR+ COVID-19 test at Hospital; 09/17/2021 PCR+ COVID-19 test at Hospital

Allergies:

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

Symptoms: Breakthrough COVID-19 case with unknown symptom onset date: Shortness of breath/difficulty breathing, Cough. Hospitalized 8/28/2021-9/10/2021, SOB and low O2 stats (86%) reported, developed pneumonia. Death 9/20/2021. From Records COD= CARDIAC ARREST, COVID-19 PNEUMONIA. Per records, Other Significant Conditions include: None listed. Place of death: HOSPITAL-INPATIENT; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: MIDDLE MANAGEMENT, TELECOMMUNICATIONS .

Other Meds:

Current Illness:

ID: 1772327
Sex: M
Age: 63
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: RA

Lab Data:

Allergies:

Symptom List: Nausea

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: 1772328
Sex: M
Age: 65
State: CA

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

Allergies:

Symptom List: Injection site pain

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1772329
Sex: M
Age: 39
State: GA

Vax Date: 09/08/2021
Onset Date: 09/28/2021
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: 1772330
Sex: M
Age: 52
State:

Vax Date: 10/02/2021
Onset Date: 10/03/2021
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: Symptoms similar to the myocarditis symptoms described on the cdc website

Other Meds:

Current Illness:

ID: 1772331
Sex: M
Age: 56
State: IN

Vax Date: 10/06/2021
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: Tremor

Symptoms: Extremely fatigued, dizziness, and nausea.

Other Meds: Vitamin C, D, E

Current Illness: None

ID: 1772332
Sex: F
Age: 26
State: WA

Vax Date: 10/04/2021
Onset Date: 10/06/2021
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: None.

Allergies: N/A

Symptom List: Erythema, Pruritus

Symptoms: 1) After first dose, menstrual period started although was not scheduled to start at that time, and had abdominal cramps similar to those of period pain. 2) Starting 3 days after injection, redness at injection site and swelling. This has continued to get worse, has become more red and swollen, and has started to itch/hurt.

Other Meds: Prozac

Current Illness: N/A

ID: 1772333
Sex: F
Age: 72
State: MI

Vax Date: 03/15/2021
Onset Date: 10/01/2021
Rec V Date: 10/08/2021
Hospital: Y

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

Lab Data:

Allergies: CompazineAnaphylaxis, Nausea Only, Throat swelling Hylan G-f 20Edema Torecan [Thiethylperazine]Throat swelling LatexHives, Rash Atenolol [Beta Adrenergic Blockers]Other AtorvastatinMyalgia Coreg [Carvedilol]Other Dust Infed [Dextrans]Other IronOther Iron DextranOther MoldNausea Only, Sneezing Polyoxyethylene 40 Sorbitol Septaoleate [Sorbitan] Statins [Hmg-coa-r Inhibitors]Myalgia

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

Symptoms: Hospitalized (10.2.21); COVID-19 positive (10.1.21); fully vaccinated Discharge Provider: MD Primary Care Provider: MD Admission Date: 10/2/2021 Discharge Date: Oct 5, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Precordial chest pain [R07.2] Hypoxia [R09.02] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is a 73-year-old female with history of MGUS, essential hypertension, hypothyroidism, history of prior DVT, no longer on anticoagulation, who presented to the ED with complaints of shortness of breath, cough, and malaise. Patient reported symptoms began on 09/26. Her husband was recently hospitalized for COVID-19 pneumonia and just discharged the day prior. Patient also tested positive for COVID. She is vaccinated. In the ER, CTA showed minimal scattered peripheral ground-glass opacities bilaterally as well as interval development of sclerotic bone lesion in the manubrium. She became mildly hypoxic with ambulation. Patient was admitted to the hospital for further workup and management. Patient was treated with remdesivir and Decadron as well as supportive care for viral illness. Patient was weaned off all oxygen. She is to remain on isolation for 20 days from 9/26/21 per our infection control due to immune compromised status, MRI was performed to further evaluate sclerotic bone lesion which revealed "No marrow replacing process in the manubrium or soft tissue mass. The area of sclerosis seen on the comparison CT is nonspecific but does not have an aggressive appearance". Biopsy deferred due to hypercoaguability after COVID infection. She follows with Hematology in the past. Can be done on routine basis once far removed from Covid infection. Please note MRI in-house done without contrast, unclear reason. If reimaged, would use contrast if no contraindication. Patinet currently ambulatory and not requiring oxygen. Pain controlled on home regimen. Discharged in stable condition.

Other Meds: amoxicillin (AMOXIL) 500 MG capsule aspirin 325 MG tablet beclomethasone diprop HFA (QVAR REDIHALER) 40 MCG/ACT inhaler cevimeline (EVOXAC) 30 MG capsule Cholecalciferol (VITAMIN D) 2000 UNITS CAPS cycloSPORINE (RESTASIS) 0.05 % ophthalmic

Current Illness: 9.7.21: Office Visit - Other osteoporosis without current pathological fracture (Primary Dx); Hypothyroidism, unspecified type; MGUS (monoclonal gammopathy of unknown significance husband + with COVID

ID: 1772334
Sex: F
Age: 23
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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: Patient reports hives, facial, lip and nose edema, and chest pressure. Took allergy med and Tylenol and all resolved today except for some nose edema. Of note she has had dermal fillers in her face and nose 6 years ago,

Other Meds: None

Current Illness: None

ID: 1772335
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: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

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: 1772336
Sex: M
Age: 14
State: GA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
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: 1772337
Sex: F
Age: 56
State: CA

Vax Date: 04/02/2021
Onset Date: 04/15/2021
Rec V Date: 10/08/2021
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: sulfa

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

Symptoms: left arm - frozen shoulder

Other Meds: none

Current Illness: none

ID: 1772338
Sex: M
Age: 17
State: GA

Vax Date: 09/08/2021
Onset Date: 09/28/2021
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: Pain in extremity

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: 1772339
Sex: M
Age: 55
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1772340
Sex: F
Age: 61
State: NH

Vax Date: 03/08/2021
Onset Date: 03/18/2021
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: hb january 6 14 hb march 16 12.7 hb may 27 12.5 hb sept 3 11.5 mcv 82.0 iron 46 iron sat 11% tibc 411 ferritin 6 ng/ml

Allergies:

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

Symptoms: Anemia onset started 2 weeks after my first vaccine found during a blood donation, I have never had anemia prior. my symptoms were just dyspnea with exertion not sudden onset which increased gradually. I had my blood checked every two months . In September my ferritin was 4% along with symptoms of anemia and i am now getting iron transfusions 4 herpes outbreaks within two months after first vaccine

Other Meds: estriol, estradiol, progesterone

Current Illness:

ID: 1772341
Sex: M
Age: 57
State: CA

Vax Date: 09/28/2021
Onset Date: 09/28/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1772342
Sex: F
Age: 58
State: NJ

Vax Date: 02/27/2021
Onset Date: 03/09/2021
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: EKG; CT scan chest and X-ray; blood work

Allergies: None

Symptom List: Vomiting

Symptoms: I had a heart episode, high blood pressure, chronic headache upon awakening, I felt weak felt like I was gonna pass out, I felt faint sweaty, palpitations. I laid down in the shower. My arms went numb and tingly, I had pressure in my jaw. I called 911, the paramedics found me on my bedroom floor I lost consciousness, I went to hospital. They kept me in the ER for a few hours about 6-7 hours.

Other Meds: SYNTHROID; TYLENOL or ibuprofen

Current Illness: I started seeing a rheumatologist for joint pain

ID: 1772343
Sex: F
Age: 60
State: GA

Vax Date: 09/08/2021
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: 1772344
Sex: F
Age: 45
State: AZ

Vax Date: 08/31/2021
Onset Date: 09/01/2021
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: Ekg, blood work at the ER. My provider ordered a general lab work as well.

Allergies: Penicillin, bananas, watermelon, avocado

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

Symptoms: After second Moderna shot I have had ringing in ears. Had elevated blood pressure.

Other Meds: none

Current Illness: None

ID: 1772345
Sex: F
Age: 94
State: CA

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

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Administration error mixed series mRNA vaccine Pfizer and Moderna

Other Meds:

Current Illness:

ID: 1772346
Sex: U
Age: 44
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: RA

Lab Data:

Allergies:

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, 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: 1772347
Sex: F
Age: 42
State:

Vax Date: 09/24/2021
Onset Date: 10/02/2021
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: No

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

Symptoms: Painful skin rashes, allergic contact dermatitis during a week and I don?t feel better now

Other Meds: No

Current Illness: No

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am