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: 1780814
Sex: M
Age: 57
State: NC

Vax Date: 07/30/2021
Onset Date: 08/06/2021
Rec V Date: 10/13/2021
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: MRI , multiple scans,

Allergies: None reported

Symptom List: Dysphagia, Epiglottitis

Symptoms: joints neck sore

Other Meds: AtorVastain 20 mg/ DiltXR 180 mg take 1 capsule by mouth/ Metformin HCL 500 mg tablet take 1 two times a day/ Metoprolol Tartrate Take 1 tablet 2 times a day/ Chlorthalidone 25 mg one a day/ Enalapril Maleate 10 mg tab/ 325 Aspirin Daily

Current Illness: Open heart surgery 4 years ago

ID: 1780815
Sex: F
Age: 68
State: IL

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1780816
Sex: F
Age: 31
State: VT

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1780817
Sex: F
Age: 44
State: MI

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

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

Lab Data: Cxr, VQ scan, blood work, heart ECHO.

Allergies: Levaquin, avelox, corporate, compazine, phentyl, shellfish and iodine.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Shortness of breath, low oxygen saturation. Admitted to hospital and placed on oxygen. DDimer elevated, liver enzymes elevated.

Other Meds: Pepcid 20mg, adderall 20mg, multivitamin, vitamin b-12, vitamin D, calcium citrate, Tylenol, qvar, stilito.

Current Illness: None

ID: 1780818
Sex: F
Age: 72
State: OH

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/13/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: Patient reported on 10/11/21 extreme dizziness, nausea and lack of energy following 3rd dose of pfizer administered and was asking is this was normal. Patient had some of these symptoms following second dose, but not nearly this bad nor long lasting. Stated that she will never get another dose of this vaccine if it is recommended later

Other Meds:

Current Illness:

ID: 1780819
Sex: F
Age: 76
State: KY

Vax Date: 01/28/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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 presents to the ER with 10 days with a fatigue and difficulty breathing. She has been vaccinated against Covid. She started to feel bad and she tells me she quarantine herself however her symptoms have gotten much worse over the last couple days. She tells me typically she can walk without any assistance however currently she is needing a wheelchair and was unable to get off the toilet herself here in the emergency department. SARS-CoV-2 positive on 10/12/21. Now with oxygen requirements.

Other Meds:

Current Illness:

ID: 1780820
Sex: M
Age: 73
State: OH

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

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Systemic: Body Aches Generalized-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: patients wife called reporting severe dizziness, nausea and lack of energy in husband with booster dose administered 10/8/21. He had experienced the same but to lesser degree following dose 2, and this time it was worse and well into 4 th day. Suggested they call their doctor, she stated that they will not be getting any further doses if recommended in the future

Other Meds:

Current Illness:

ID: 1780821
Sex: F
Age: 75
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Site: Pain at Injection Site-Medium, Additional Details: The nurse gave patient 150mcg. Patient felt painfu at site of injection yesterday, but she is okay now

Other Meds:

Current Illness:

ID: 1780822
Sex: F
Age: 40
State:

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: I had no reaction to my first two Pfizer COVID vaccines in Dec 2020 and January 2021 other than a very sore arm (worse than other vaccines). I received my booster on October 11 2021 and had a very sore arm but also developed within 24 hours a very sore axilla area on the same side with swollen axillary lymph nodes in the same side. I am almost 48 hours out from the injection and the symptoms have not subsided. This did not occur with my first two doses and has never occurred with any other vaccine I have ever received.

Other Meds: Daily probiotic Turmeric supplement for arthritic inflammation

Current Illness:

ID: 1780823
Sex: F
Age: 94
State: MA

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1780824
Sex: F
Age: 28
State: PA

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Ringing in ears started the day I got my first shot, or very shortly thereafter. It has not stopped. It's constant. Nothing my doctor has tried helped.

Other Meds: Birth control

Current Illness: None

ID: 1780825
Sex: F
Age: 38
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1780826
Sex: F
Age: 30
State: SC

Vax Date: 07/16/2021
Onset Date: 07/16/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: Sulfa, Penacillin

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

Symptoms: Fever--101 oral, severe body aches, chills, nausea, vomiting, malaise. 48 hours

Other Meds: 3mg Melatonin nightly, 25mg Unisom nightly PRN

Current Illness:

ID: 1782200
Sex: M
Age: 51
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782201
Sex: F
Age: 36
State: NY

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 10/13/2021
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, Blood work, Urinalysis

Allergies: Penicillin

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

Symptoms: Shortness of breath, tightness in chest.

Other Meds: 0

Current Illness: Head cold 2 weeks prior

ID: 1782202
Sex: M
Age: 85
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782203
Sex: F
Age: 39
State: CA

Vax Date: 08/15/2021
Onset Date: 08/15/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: "August period was 10th-13th. 8-15-21 received vaccine 3 hours after injection lower abdominal pain started. 8-16-21 lower abdominal contracting pain affected lower abdominal and lower back. Sept 16 spotting of blood started after going to bathroom lasted 2 days. Sept 20 period started extremely heavy went through 3 pads major cramping. Sept 21 woke up in night to extreme bleeding went through 1 pad. 2-3 pads a day lasted until Sept 24 ended. Stopped 2 days began Sept 27 heavy bleeding lasted 2 days ended Sept 27-28 ended." Per patient's recollection

Other Meds: n/a

Current Illness: No

ID: 1782204
Sex: M
Age: 74
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782205
Sex: F
Age: 36
State: NY

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Around 7pm my stomach was hurting and I had diarrhea. There was a greenish yellowish liquid coming out after there was no more stool to pass. Around 11pm my body started aching and I was feeling cold and had chills. My head started pounding from the front to back of my head. I was unable to lift my right arm up. Around 12:45am 10/6/21 I had a fever of 101.2. My muscles in my back and neck and lower legs got painful. I was shaking the entire night and was unable to rest. I took an advil and was able to fall asleep around 4 in the morning. I attempted to work and clocked in that morning but the body pain made it unbearable. I contacted my jobs clinic to report the adverse symptoms. My job instructed me to take off and rest. I am currently experiencing pain in my neck, upper back and back of the head that will not go away. I am currently seeking a specialist.

Other Meds: None

Current Illness: None

ID: 1782206
Sex: M
Age: 26
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782207
Sex: F
Age: 81
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782208
Sex: M
Age: 43
State: VA

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

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

Lab Data:

Allergies: NKDA

Symptom List: Unevaluable event

Symptoms: Hallucinating, Fever, Chills, Sweating, loss of appetite, muscle aches and pain, all joints hurts

Other Meds: norvasc (blood pressure)

Current Illness: None

ID: 1782209
Sex: M
Age: 69
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782210
Sex: M
Age: 59
State: NY

Vax Date: 03/05/2021
Onset Date: 03/09/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: They checked my BP, did an EKG and checked my blood. My BP was raised and I was referred to my PCP about it.

Allergies: I am allergic to vibramycin.

Symptom List: Injection site pain, Pain

Symptoms: After receiving my vaccine, I started to feel pretty lousy. I had flu like symptoms, my blood pressure elevated and my heart rate increased. I called my doctor about my experience and ended up going to the ER, and they ran some tests. They checked my BP, did an EKG and checked my blood. I was referred back to my PCP for a follow-up. This feeling lasted about 1 1/2 -2 weeks.

Other Meds: I was not taking any medication.

Current Illness: I was not experiencing any illness.

ID: 1782211
Sex: F
Age: 90
State: NC

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782212
Sex: M
Age: 91
State: NC

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1782213
Sex: F
Age: 26
State: TX

Vax Date: 08/03/2021
Onset Date: 08/12/2021
Rec V Date: 10/13/2021
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: Cephalosporins

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Full body, measles like rash that lasted nearly a month

Other Meds: Metformin and inostitol with vitamin d and folate

Current Illness:

ID: 1782214
Sex: F
Age: 70
State: NC

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1782215
Sex: F
Age: 13
State: CA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 10/13/2021
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: na

Allergies: NA

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

Symptoms: No adverse event. Moderna was accidentally given to 13 yr old as workflow was not followed. Staff identified the error when they were looking at dose 2 appts. Parents declined to proceed with dose 2 since it's not approved for authorization yet.

Other Meds: NA- this was an administration error that we are reporting

Current Illness: NA

ID: 1782216
Sex: F
Age: 90
State: PA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1782217
Sex: F
Age: 42
State: MI

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies: Latex

Symptom List: Injection site pain

Symptoms: The patient experienced flu-like symptoms the next day, but also muscle spasms. The muscle spasms continued to worsen over the next few days, until on 10/3 the patient said they could not move at all. The muscle spasms lessened after that, but continue to occur.

Other Meds: Omeprazole Ketotifen Eye Drops Montelukast Hydrocodone-Acetaminophen Baclofen Cyclobenzaprine Naratriptan Escitalopram

Current Illness:

ID: 1782218
Sex: F
Age: 73
State: OH

Vax Date: 04/07/2021
Onset Date: 04/14/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data: 04/23/2021 ekg, chest x-rays, blood test , nuclear stress test all was good except EKG when I was in Afib

Allergies: Aspirin

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

Symptoms: Basically I started feeling anxiousness and thinking it was because we were remodeling, my fit bit kept alerting me that my heart rate was going up and down even at rest. I went to Doctor who sent me to Emergency room because my Doctor did an EKG and I was in full Afib and they admitted me that night. In the emergency room they were trying all different things to get my heart rate down. Finally meds start working leveling my heart rate. Then I went home and two days later I was sitting and having fluttering in my chest my heart rate was 150-160 I went back to the hospital. They ended up doubling my meds metoprolol. I was fine til just recently on vacation we were at lunch with our granddaughter I had a drink which I don't normally drink, we went to pool car back to Condo for dinner and I started having a flutter in my chest, I went to ER the doctor said it was perfect storm traveling being dehydrated from travel having one alcohol drink and being out in sun. He suggested drinking more water.

Other Meds: Advair; Celexa; Hydrochlorothiazide; Magnesium; B12; D3; Potassium; Calcium

Current Illness: none

ID: 1782219
Sex: M
Age: 9
State: MI

Vax Date: 10/12/2021
Onset Date:
Rec V Date: 10/13/2021
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: NKDA

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

Symptoms: No adverse events witnessed while in office.

Other Meds: Quillichew ER 20mg

Current Illness:

ID: 1782220
Sex: F
Age: 87
State: CA

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Nausea-Severe

Other Meds:

Current Illness:

ID: 1782221
Sex: F
Age: 81
State: MI

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/13/2021
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: None

Symptom List: Erythema, Pruritus

Symptoms: Headache, chills, sleepiness; nausea, vomiting, achy muscles, weakness. Took an Advil which initiated this he vomiting which caused me to drop to floor and couldn?t get up. Called 911. Opted not to go to hospital. Advised to sip liquids due to having one kidney. Felt more comfortable staying at home in bed.

Other Meds: None; Influenza

Current Illness: None

Date Died: 09/08/2021

ID: 1782222
Sex: F
Age: 46
State: GA

Vax Date: 05/01/2021
Onset Date: 09/01/2021
Rec V Date: 10/13/2021
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:

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

Symptoms: Patient was hospitalized. Patient died due to COVID-19. Patient was fully vaccinated.

Other Meds:

Current Illness:

ID: 1782223
Sex: M
Age: 63
State: TX

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Diluent Administered Instead of Vaccine-

Other Meds:

Current Illness:

ID: 1782224
Sex: F
Age: 54
State: TX

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Diluent Administered Instead of Vaccine-

Other Meds:

Current Illness:

ID: 1782225
Sex: F
Age: 86
State: CA

Vax Date: 04/09/2021
Onset Date: 09/29/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: No

Allergies: Sulfa; Diltiazem; Cipro; Oxybutynin Chloride; Acyclovir; Tramadol; Dairy; Salt; Canola Oil; Whole Grains; Dried Fruits; Grapes; Cantaloupe; Papaya; Banana; Beef; Very little Pork; Preservatives

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

Symptoms: I had a increase in the itchy spots on both sides joints (toes connect, ankles, knees, fingers where my bases touch, shoulder). This has happen before not so severe, painful and frequent. On Oct 1,2021 the doctor recommended for me to stop Atenolol and chart my blood pressure for being cold causing my blood pressure to drop.The lowest BP 83/67 with a pulse rate of 73 and the highest BP 150/84 with a pulse of 78. I have a appt this week with a Nephrologist for my kidneys.

Other Meds: Nitro Patch 0.1 NG_HR; Atenolol( doctor has taken me off for a week); Levothyroxine 150 mg; Pantoprazole; Eliquis 2.5 mg 2 a day; Triamcinolone; Acetonide 0.1% cream; Ketoconazole cream;Vit C; Vit D; Omega Vit; Zinc; Lotion for dry skin

Current Illness: No

ID: 1782226
Sex: M
Age: 66
State: MA

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782227
Sex: F
Age: 51
State: IN

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

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

Lab Data:

Allergies: Sulfa

Symptom List: Pain in extremity

Symptoms: Bleeding gums. There have been no changes to daily habits nor diet that might cause bleeding gums.

Other Meds: Levothyroxine 125, Vyvanse 70, atorvastatin 10, multi-vitamin

Current Illness: none

ID: 1782228
Sex: M
Age: 52
State: MA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/13/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1782229
Sex: M
Age: 46
State: KY

Vax Date: 04/15/2021
Onset Date: 10/04/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: PCR Test administered on 10/04/2021 at Hospital

Allergies: Unknown

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

Symptoms: Patient Contracted COVID-19

Other Meds: Unknown

Current Illness: Unknown

ID: 1782230
Sex: F
Age: 87
State: MN

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

Date Died: 09/20/2021

ID: 1782231
Sex: M
Age: 68
State: GA

Vax Date: 02/12/2021
Onset Date: 09/01/2021
Rec V Date: 10/13/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Patient was hospitalized. Patient died due to COVID-19. Patient was fully vaccinated.

Other Meds:

Current Illness:

ID: 1782232
Sex: F
Age: 59
State: NJ

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: A headache began at 2:00 am. the next day. The headache lasted all day. By 3:30 pm (the next day) I had body aches that got progressively worse all day and I was extremely tired. By 6:00 pm I also had chills and I felt cold. This lasted all night. In the morning I felt tired, but the body aches, chills and headache were gone.

Other Meds: none

Current Illness: none

ID: 1782233
Sex: M
Age: 84
State: FL

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Wrong Dose of Vaccine - Too High-

Other Meds:

Current Illness:

ID: 1782234
Sex: M
Age: 76
State: MN

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/13/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1782235
Sex: F
Age: 81
State: KY

Vax Date: 02/17/2021
Onset Date: 10/01/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: Antigen Test administered on 10/01/2021 at Nursing Home.

Allergies: Unknown

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

Symptoms: Patient Contracted COVID-19

Other Meds: Unknown

Current Illness: Unknown

ID: 1782236
Sex: F
Age: 32
State: NY

Vax Date: 10/04/2021
Onset Date: 10/09/2021
Rec V Date: 10/13/2021
Hospital:

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

Lab Data: None

Allergies: No.

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

Symptoms: I experience a small amount of painless vaginal bleeding on10/09/2021. Then today, 10/13/2021, a larger amount of painless vaginal bleeding was present. My gynecologist office opens at 9am I will be making an appointment.

Other Meds: Ibuprofen.

Current Illness: No.

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am