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: 1808348
Sex: F
Age: 44
State:

Vax Date: 07/26/2021
Onset Date: 09/03/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Significant fluctuations in hormone levels requiring prescription hormone medication to correct. Issues unresolved.

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Disruption to hormones and menstrual cycle, leading to change in bleeding, disruption to otherwise normal cycle, cramping, bloating, eventual missed periods, patient accrued additional medical costs for diagnosis and lab work.

Other Meds: None

Current Illness: None

ID: 1808349
Sex: M
Age: 71
State:

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: instead of giving booster, additional dose was given

Other Meds:

Current Illness:

ID: 1808351
Sex: M
Age: 15
State: GA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/22/2021
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: 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: 1808352
Sex: F
Age: 37
State: KY

Vax Date: 04/28/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Tested Positive for Covid

Other Meds:

Current Illness:

ID: 1808353
Sex: M
Age: 67
State: GA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/22/2021
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: 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: 1808354
Sex: F
Age: 72
State:

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: instead of giving booster, additional dose was given

Other Meds:

Current Illness:

Date Died: 10/19/2021

ID: 1808355
Sex: M
Age: 85
State: TN

Vax Date: 02/04/2021
Onset Date: 10/17/2021
Rec V Date: 10/22/2021
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: Case fully vaccinated with Moderna with second dose administered on 2/4/2021. Tested positive for COVID 19 on 10/17/2021. Was admitted to hospital on 10/14/2021. Expired on 10/19/2021 while still hospitalized.

Other Meds:

Current Illness:

ID: 1808356
Sex: M
Age: 51
State: VA

Vax Date: 03/23/2021
Onset Date: 06/23/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data: CT Scan - 2 Strokes on the left side of the brain that affected the left side of my body (also caused issues with my speech).

Allergies: Contrast Dye

Symptom List: Pharyngeal swelling

Symptoms: I experienced two strokes upon being rushed to hospital on 06/23/2021 (could not walk and has to be transported by ambulance during the night). The ER doctors did a CT Scan and diagnosed me with a stroke because the right side of my body was unresponsive. I was placed on a blood thinner prescription Eliquis and released from the hospital after a 5-days stay. I had to return to go to therapy to learn to walk again and then went to outpatient therapy for 3-months.. I am still taking the Eliquis until further notice from my PCP.

Other Meds: No

Current Illness: No

ID: 1808357
Sex: F
Age: 74
State: MI

Vax Date: 03/26/2021
Onset Date: 04/16/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: Amoxicillin; Morphine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I noticed that my arthritis in my spine was bothering me more than usual as well as my hips. I went to physical therapy because my neck was bothering me as well but that was more muscular, I think. I went to the doctor who sent me to physical therapy. There was a pinched nerve in my spine. If that did not work, he said I'd be sent for am MRI. They PT did help a little, but I still have issues. I don't have nerve pain anymore, but my back still bothers me. When the pain got bothersome, I would take Motrin. As of right now, things have been about the same as it was initially, I had painted the whole side of my house with no issues and after the 2nd dose, I noticed pain all of a sudden and was limited in how much I could work which was strange.

Other Meds: Thyroid; Antacid; Vitamin D; Multivitamin

Current Illness: No

ID: 1808358
Sex: F
Age: 72
State: GA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/22/2021
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: 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: 1808359
Sex: F
Age: 39
State: WA

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Leg Ultrasound to check for blood clots- normal, CT scan of lower body- normal

Allergies: wheat, soy, corn, sunflower

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

Symptoms: As of 08/2021 I have had worsening numbness in both my arms and nerve pain underneath my thighs. I have also had in increase in headaches. I have tried physical therapy, acupuncture, massages, chiropractors etc. Most medicines given to me make me sick so I cant take them. Nothing has helped so far. I still feel these symptoms currently.

Other Meds: none

Current Illness: none

ID: 1808360
Sex: F
Age: 76
State: MN

Vax Date: 03/13/2021
Onset Date: 10/21/2021
Rec V Date: 10/22/2021
Hospital: Y

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: Hospitalized for bacterial endocarditis did have a cough and dyspnea with this short term.

Other Meds:

Current Illness:

ID: 1808361
Sex: F
Age: 39
State: CO

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: Penicillin Clyndamycine Keflex Vancomycn Pine nuts Shellfish

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

Symptoms: Swollen lymph node

Other Meds: Magnesium, Amitriptyline, Heather

Current Illness: None

ID: 1808362
Sex: F
Age: 71
State:

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: instead of giving booster, additional dose was given

Other Meds:

Current Illness:

ID: 1808363
Sex: F
Age: 34
State: NM

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: None

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

Symptoms: During observation period, while walking around, patient started to feel signs and symptoms of fainting (she stated she's had multiple incidents of fainting in her lifetime, due to various reasons), so she laid on the ground to prevent injuring herself in case she did faint. As associate got her a chair to sit on and I came to check up on her. She did not have any rash, swelling or difficulty breathing. She didn't want or need any type of treatment. I gave her a drink just in case, while we waited for her friend to come pick her up. I stayed with her then walked her out to the car. At this time, she was feeling better, and doesn't have the fainting feeling she had earlier. I asked the friend to contact us if anything else changes.

Other Meds: None

Current Illness: None

ID: 1808364
Sex: F
Age: 17
State: GA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/22/2021
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: 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: 1808366
Sex: F
Age: 57
State: TX

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/22/2021
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: Flu shot

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

Symptoms: Severe headache, blurred vision, severe pain in jaw, severe fatigue, chills, fever, no appetite, nausea, vomiting, differences in taste and smell.

Other Meds: Vitamin C

Current Illness: None

ID: 1808367
Sex: F
Age: 20
State:

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: 24 hours after shot: chills, nausea, muscle aches (legs, back), fatigue, pain at injection site, abdominal cramps

Other Meds:

Current Illness:

ID: 1808368
Sex: M
Age: 72
State:

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: instead of giving booster, additional dose was given

Other Meds:

Current Illness:

ID: 1808369
Sex: M
Age: 56
State: AL

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

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

Lab Data:

Allergies: No known drug allergies

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

Symptoms: Patient called the pharmacy and reported having pain 8/10, difficulty breathing deeply, and shoulder pain radiating to her back with some numbness in the arm that was vaccinated. I told her to immediately seek medical attention (told her to go to the ED) due to the difficulty breathing.

Other Meds: Prescription medications: Albuterol HFA inhaler; Cephalexin 500mg (1 BID for 5 days); Mupirocin 2% ointment; Ventolin HFA inhaler

Current Illness: No known illnesses at time of vaccination or 1 month prior.

ID: 1808370
Sex: F
Age: 16
State: GA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/22/2021
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: 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: 1808371
Sex: M
Age: 34
State: IA

Vax Date: 10/01/2021
Onset Date: 10/11/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Labs and physical exam at oncology clinic on 10/18/2021, including CBC w/ diff, CMP, TSH, LDH, ESR.

Allergies:

Symptom List: Unevaluable event

Symptoms: Pain of the neck behind the angle of the jaw started in the evening on 10/11/2021. Thought to be just stiffness from awkward nap taken after 28 hour work shift ending that morning. Next morning the pain was worse and associated with a new swelling/mass about 2x1cm in that same space. Pain worse at the end of the day requiring ibuprofen to help with sleep for the subsequent 2 nights. Made appointment to see oncologist for 10/18/2021. Pain subsided over subsequent days, but mass remained. Labs drawn at appointment were mostly reassuring other than slightly elevated ESR (was 16, previously 4 when healthy earlier this year, 86 when diagnosed with cancer). Plan to follow clinically and if mass doesn't resolve, to obtain CT and biopsy. Significant psychological unease throughout this time, since a second cancer would have very poor prognosis.

Other Meds:

Current Illness:

ID: 1808372
Sex: F
Age: 50
State: TX

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: None

Allergies: Latex; Tdap; AUGMENTIN; AVELOX; iodine; peaches; figs

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

Symptoms: About 2-3 hours later my heart was elevated - racing heartbeat, nausea and body itching. I called vaccination site and told them. Everyday it got better but the nausea was worst and every now and then I have a high heart rate. I had my cardiology and said it was a common side effect.

Other Meds: Calcium; magnesium

Current Illness: No

ID: 1808374
Sex: F
Age: 56
State: GA

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/22/2021
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:

Symptom List: Injection site pain, Pain

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: 1808375
Sex: F
Age: 89
State: MA

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

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

Lab Data:

Allergies: fentanyl; lisinopril; losartan; umeclidinium

Symptom List: Injection site pain, Menorrhagia

Symptoms: This Resident received the two Moderna vaccinations prior to today. At clinic on the unit, this Resident received the Pfizer booster. No noted advers reactions.

Other Meds:

Current Illness:

ID: 1808376
Sex: M
Age: 62
State:

Vax Date: 10/12/2021
Onset Date: 10/14/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Approx 2 days after receiving vaccine, client began to experience "strange" feelings, "being in a fog", not able to take a deep breath. I advised today(10/22) that he seek urgent care

Other Meds: Aspirin, vitamins

Current Illness: none

ID: 1808377
Sex: U
Age: 33
State: VA

Vax Date: 09/21/2021
Onset Date: 09/25/2021
Rec V Date: 10/22/2021
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: iodine

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: hives onset 4 days after Pfizer covid19 vaccine #1 on 21 SEP 2021, these resolved within 2 wks, then patient had recurrent of hives on 20 OCT 2021, which was about 1 week after receiving Pfizer covid19 #2 (patient also received flu vaccine on 18 OCT 2021 / Influenza, injectable, quadrivalent, preservative GlaxoSmithKline)

Other Meds: Clobetasol Propionate 0.05%, Ointment, Topical (STRONG STEROID) APPLY 1 TO 2 TIMES EVERY DAY TO SCALP doxycycline hyclate, 100 MG, TABLET, ORAL TAKE 1 TABLET BY MOUTH TWICE EVERY DAY WITH FOOD Eletriptan 40 mg oral tablet TAKE 1 TABLE

Current Illness: none

ID: 1808379
Sex: M
Age: 77
State: WI

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

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

Lab Data: covid positive PCR result on 10/01/2021

Allergies: Fluoxetine, Ace Inhibitors, Simvastatin, turkey

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient was in to be seen by provider and asked if he could get 3rd dose of Pfizer since he was at the right age for it and it had been over 6 months since he completed the 2 dose series. Then was asked the questions by staff in the protocol regarding whether he had any monoclonal antibodies in the last 90 days and he answered "no". He met the criteria then based on his answers to the questions and was given the booster of Pfizer vaccine. The our staff asked his wife the same questions since she was also asking for the booster. She admitted that she had the monoclonal antibodies and was told then that she would not qualify and needed to wait 90 days before she got a booster at which time this patient said that

Other Meds: Amoxicilin as needed for dental procedures, atenolol,

Current Illness: covid-19 infection

ID: 1808380
Sex: M
Age: 56
State: GA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1808381
Sex: F
Age: 67
State: SC

Vax Date: 09/08/2021
Onset Date: 09/22/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: 10/12/21 EKG, BMP and Thyroid Panel ( Primary Care Physician) 10/15/21 EKG (Cardiologist) 11/5/21 Scheduled Echocardiogram

Allergies: NKDA

Symptom List: Nausea

Symptoms: Approximately 2 weeks after receiving the Pfizer Covid 19 booster vaccination I began having persistent heart palpitations, I followed up with my Primary Care Physician, an EKG was done, reading showed NSR with PACs and PVCs. At that time blood work was done (BMP and Thyroid Panel), results were normal. A follow up appointment with my Cardiologist's office showed a similar EKG reading. An Echo Cardiogram is scheduled for November 5th 2021.

Other Meds: Levothyroxine 75mcg, HCTZ 12.5mg, ASA 81mg and Multivitamin, Cranberry supplement

Current Illness: none

ID: 1808382
Sex: F
Age: 60
State: PA

Vax Date: 04/15/2021
Onset Date: 04/20/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Injection site pain

Symptoms: Left Eye feels bruised and swollen and headaches.

Other Meds: Levothyroxine

Current Illness: Arthritis

ID: 1808383
Sex: M
Age: 73
State: PA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: I can attach a PDF of the waveform of the test if there is a way to do that.

Allergies: aspirin

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

Symptoms: I normally exercise by walking indoors, ususally 5000 steps a day, with two canes. On the day following the vaccination, I had reached 1500 steps but was finding the effort unexpectedly difficult, and was feeling warm. I used the EKG function on my Samsung Watch and it read Atrial Fibulation detected, This has never happened before (or since) under normal exercise circumstances.

Other Meds:

Current Illness: Multiple Sclerosis, Glaucoma

ID: 1808384
Sex: M
Age: 76
State: AR

Vax Date: 05/22/2021
Onset Date: 10/17/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data: covid pcr positive 10/17/21

Allergies: NKDA

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

Symptoms: hospitalization with covid after being fully vaccinated

Other Meds: unknown

Current Illness: unknown

ID: 1808385
Sex: F
Age: 75
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
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: 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:

Date Died: 09/27/2021

ID: 1808386
Sex: M
Age: 81
State: TN

Vax Date: 02/12/2021
Onset Date: 09/15/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Case fully vaccinated with Moderna with second dose administered on 2/12/21. Tested positive for COVID 19 on 9/15/2021. Admitted to Medical Center on 9/14/2021. Case expired on 9/27/2021 while still hospitalized.

Other Meds:

Current Illness:

ID: 1808387
Sex: F
Age: 69
State: GA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 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: 1808389
Sex: M
Age: 53
State: WI

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: Will have labs drawn on 10/26/2021

Allergies: None

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

Symptoms: Client received vaccine on 10/18/2021 at 4:50 pm adverse reaction begin same date (10/18/2021) at 5:20 pm. Reaction of hives on arms, swelling and bubble bump on right hand. Right side of face, cheeks, and gums swollen. Rash underarms, groin area, and abdomen began later that day. Right side to left side of mouth swollen. Rash was uncomfortable and had burning sensation. Had slurred speech from swollen mouth. Did not have any respiratory distress. Contact PCP, made aware, was told to continue daily Zyrtec, then added Benadryl to help with swelling and rash reaction.

Other Meds: None

Current Illness: None

ID: 1808390
Sex: M
Age: 24
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
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: 1808391
Sex: F
Age: 47
State: MA

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data: patient will be seen by today

Allergies: Aspirin, Ibuprofen, Naproxen, NSAIDS, Shrimp

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

Symptoms: patient received COVID 19 Vaccine Lot number FF2589 Exp 12/31/2021 in Left Deltoid . She reported have red itchy rash on arms about 30 minutes after vaccine was administered. the rash progressed to her face and Torso within a few hours. she also reported accompanying headaches which is mitigated with Tylenol

Other Meds:

Current Illness:

ID: 1808392
Sex: M
Age: 30
State: GA

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/22/2021
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: 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: 1808393
Sex: F
Age: 33
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
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: 1808394
Sex: F
Age: 19
State: NV

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

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Patient received the vaccine and moved outside of the immunization room and into the chairs surrounding the pickup area. I was notified that the patient was having a reaction to the vaccination by the patient's father. When I ran over to the patient, she was still seated in the chair. The patient had a blank stare forward and her father was asking if she was alright, to which she did not respond. At that time, the patient's head tilted backwards and her eyes we closed. I had caught her head before it hit anything and moved it back to a neutral position. I asked her father to keep the patient's head in a neutral position while I contacted EMS. While on the phone with EMS, I went back over to the patient and she came back around approximately 10 to 15 seconds after I had returned, so total loss of consciousness was under 1 minute. When I had come back, the patient was complaining of feeling very hot and sweaty. I placed 2 ice packs on the sides of the patient's neck. At this point, the patient felt as if she was ok to move into the immunization room for some privacy. When she stood up, she said that she felt much better. We got the patient into the immunization room and she was feeling much better and acting normal again, laughing and talking with her family and I. At the time EMS came, she had stated that she had felt fine. EMS took the patient vitals and refused transport. The patient left the pharmacy under care of her parents.

Other Meds:

Current Illness:

ID: 1808395
Sex: F
Age: 74
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
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: 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: 1808396
Sex: M
Age: 30
State: GA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/22/2021
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: 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: 1808397
Sex: M
Age: 74
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: 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: 1808398
Sex: M
Age: 31
State: AZ

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/22/2021
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: Penicillin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Vaccine was received at 7:05 PM on 10/21/2021. A dose of acetaminophen 500mg PO once was administered prior to the vaccine at 5:00 PM. No adverse events were noticed during the 15-minutes observation period. On 10/22/2021 at 6:45 AM (at the time I woke up), I felt fatigue and mild body aches. Around 9:00 AM that same day, I started having fever (body temperature was not measured). Throughout the day, adverse events of fatigue, body aches, fever, mild cough started worsening. At 1:00 PM, another dose of acetaminophen 500mg PO was administered. It seems that the symptoms are resolving upon administration of acetaminophen tablet. The cough is not severe. The cough is very mild and it doesn't occur every time.

Other Meds: Acetaminophen 500mg PO once on 10/21 prior to the vaccine (5 PM) and another dose of acetaminophen 500mg PO once on 10/22 at 1:00 PM.

Current Illness: None.

ID: 1808399
Sex: M
Age: 69
State: GA

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/22/2021
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: 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: 1808400
Sex: M
Age: 52
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
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: 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: 1808401
Sex: F
Age: 33
State: IL

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/22/2021
Hospital: Y

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

Lab Data: X rays were performed on my elbow.

Allergies: None to report

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

Symptoms: I got an inflammation in my elbow in the opposite arm of my injection. I went to a urgent care and er. they gave me an antibiotic (keflex) and then two days later they switched me to a different antibiotics (augmentim) the augmentim gave me an adverse reaction that hospitalized me for less than a day. Im expected to deliver on march 21 2022.

Other Meds: The only thing was Prenatal once day, in a pill form.

Current Illness: none

ID: 1808402
Sex: F
Age: 71
State: UT

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/22/2021
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: 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:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am