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: 1813437
Sex: F
Age: 70
State: AZ

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data:

Allergies: unkown

Symptom List: Dysphagia, Epiglottitis

Symptoms: Moderna vaccine given from vial that had been punctured 23 hours prior

Other Meds: uknown

Current Illness: unknown

ID: 1813438
Sex: F
Age: 40
State: MA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/23/2021
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: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813439
Sex: F
Age: 46
State: MA

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Saw urgent care doc on 10/23

Allergies: Sulfa Iron sucrose Feraheme

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

Symptoms: About five hours after vaccine was administered, experienced sharp pain/pressure in left eye. The intense discomfort passed after a few minutes, but mild soreness lingered, but I didn?t think much of it. (Thought I had something stuck in my eye.) But a few minutes later, I looked in the mirror and noticed a significant amount of blood in the white of my eye die to a broken blood vessel. I called the on-call staff at my PCP?s office and they recommended a warm compress and a follow-up with urgent care. I saw urgent care today and they confirmed that the blood is localized and unless my vision changes, things should be ok. I?m still experiencing some discomfort, but the blood should reabsorb on its own. I wanted to report in case this is helpful.

Other Meds: Sertraline Zonisamide Lansoprazole

Current Illness: N/A

ID: 1813440
Sex: F
Age: 69
State: OH

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Gave 0.5 ml instead of. 0.25ml

Other Meds: None

Current Illness: None

ID: 1813441
Sex: M
Age: 42
State: MA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/23/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813442
Sex: M
Age: 52
State: MA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/23/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813443
Sex: F
Age: 48
State: TN

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: Entire right side of my body, every muscle and joint aching, especially my right wrist, neck and buttock. As day went on the massive headache started and now extremely fatigued.

Other Meds:

Current Illness:

ID: 1813444
Sex: F
Age: 66
State: MA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/23/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813445
Sex: M
Age: 67
State: MA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/23/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813446
Sex: M
Age: 74
State: TN

Vax Date: 10/02/2021
Onset Date: 10/03/2021
Rec V Date: 10/23/2021
Hospital: Y

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

Lab Data: Creatinine 1.6 (10/3/21) and 6.1 on discharge (10/20/21) ALT 33 (10/4/21) , 2020 (10/10/21), >5000 (10/11/21), 126 (10/21/21) AST 30 (10/4/21), 2110 (10/10/21), 7133 (10/11/21), 46 (10/21/21)

Allergies: Hydrocodone, Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: The patient reports that Sunday 10/3/21 he had low grade fever, cough, chills and shortness of breath. On Monday 10/4/21 he came to the ER at Erlanger East for evaluation. Initial vital signs with pressure 214/65, heart rate 64, respiratory rate 20, temperature 99.4, oxygen saturation 84% on room air. His white blood cell count was 17, rapid COVID-19 test negative, creatinine 1.6 (baseline 2.3), sodium 122. CXR with infiltrates. Patient was admitted on Rocephin and Zithromax. Blood cultures drawn on 10/4/21 remained negative. Evaluated on 10/5 he reported that he was feeling much better. Sodium was improving up to 127 and creatinine remained around baseline. The patient was able to go down to room air and he was saturating above 90% on room air until 10/8 when he required oxygenation. He was still hypertensive and he was placed on Procardia XL and metoprolol although he just got 2 or 3 doses of the beta-blocker due to bradycardia. On 10/8 the patient started worsening clinically. He had hallucinations and he became hypoxic that morning at 88% on room air therefore he was placed initially on 3 L nasal cannula. A repeat confirmatory COVID-19 test was ordered. Repeated CT scan demonstrated some improvement on infiltrates with some edema however clinically the patient was worse and he became more confused agitated and disoriented. CT scan of the head did not show any abnormalities. His sodium got low again. His D-dimer was elevated but he could not have CTA done due to renal function and he was not stable to lay flat for VQ scan so he was a started empirically on heparin drip. Antibiotics were broadened to Zyvox and cefepime. The patient had alternating periods of encephalopathy and being fully alert and oriented. On 10/9 the patient was placed on Vapotherm 40 L 100% FiO2 but throughout the morning he was able to go down to 70% FiO2. His renal function got significantly worse and he also developed hyperkalemia. His confirmatory COVID-19 test came back negative and his sodium continued to get worse again. Pulmonary and nephrology at East saw the patient and he was a started on bicarb drip. Overnight from 10/9 into 10/10 the patient was having Kussmaul respirations around 40 times per minute, diaphoretic, not following commands, heart rate in the 30s blood pressure with systolic in the 100s. Lactic acid was around 10. He was more encephalopathic and with decreased responsiveness. He developed bradycardia in the 20s and received 1 dose of atropine plus Levophed. The patient was intubated and transferred downtown. Critical care concluded that his respiratory failure was mainly due to volume overload due to worsening renal failure. The patient was a started on CRRT for volume management. Patient also was found having shock liver although he did not have significant hypotension but he was significantly bradycardic. Hepatitis panel and all the testing for check liver etiologies came back negative. Patient was able to be extubated on 10/13. Nephrology recommended continuation of hemodialysis. His bradycardia improved. He was transferred to the floor eventually. His encephalopathy was a slowly resolving. On 10/19 he had a permacath for dialysis. Patient is going to be discharged to inpatient rehab and he will continue dialysis 3 times per week. He will likely need HD long term

Other Meds:

Current Illness: CKD (baseline Cr 2.3), HTN, Hyperlipidemia, BPH, Anxiety

ID: 1813447
Sex: M
Age: 16
State:

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
Hospital: Y

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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Pt developed severe myocarditis with elevated troponin levels.

Other Meds:

Current Illness:

ID: 1813448
Sex: F
Age: 73
State: MA

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/23/2021
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: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813449
Sex: M
Age: 73
State: OH

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: None

Other Meds: None

Current Illness: None

ID: 1813450
Sex: M
Age: 31
State: TN

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Patient received a dose of J&J vaccine and came in to get the Moderna booster. Communication we received from corporate looked like those who received J&J would get a dose of 0.5ml so that is the dose that this patient received. We learned much later in the day that he should have received a dose of 0.25ml. Spoke to patient to inform him of the incorrect dosage and he was fine with it and feeling fine as well.

Other Meds:

Current Illness:

ID: 1813451
Sex: F
Age: 49
State: IA

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: N/A

Allergies: none

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

Symptoms: 101.6 Fever, chill, headache, body ache, dizzy, nausea for 30 hours. Injection site is still red and hurts to the touch 72 hours later

Other Meds: Magnesium, Omega 3,6,9, Glucosamine/chondroitin

Current Illness: still had achy eyes when i would get tired

ID: 1813452
Sex: F
Age: 69
State: NY

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/23/2021
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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Fever-Mild, Additional Details: Patient has reported round-shaped redness, warmth, and itching around the injection site since 10/19/2021 at approximately 9:00pm. Since then, the patient stated that the symptoms have improved. The patient is counseled to seek medical attention if desired.

Other Meds:

Current Illness:

ID: 1813453
Sex: F
Age: 51
State: WI

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Influenza vaccine, DTap vaccine

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

Symptoms: Patient came back to the pharmacy about an hour after her injection. She reported that she was feeling itchy and she started getting red blotches/hives/rash on her chest, neck, upper arms, and back. She had no signs of shortness of breath, tightness in chest, or difficulty breathing. Patient had Benadryl at home so she stated that she was going to go home and take some Benadryl.

Other Meds: Omeprazole, levothyroxine, hydroxychloroquine

Current Illness:

ID: 1813454
Sex: F
Age: 68
State: NY

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/23/2021
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: Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Additional Details: pt had similar symptoms upon second dose but about a week after receiving. Third dose she exhibited symptoms that day or next. still has swollen eye, voice sounds like she has a cold. dr was called but did not want her taking any antihistamines

Other Meds:

Current Illness:

ID: 1813455
Sex: M
Age: 28
State: MA

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/23/2021
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: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813456
Sex: M
Age: 23
State: SC

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: none

Allergies:

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

Symptoms: Patient experienced heaviness on chest and elevated of BP (147/107) 19 minutes after receiving dose. 16 minutes after episode started BP decreased to 130/62 and patient felt better. Patient a reported a similar incident after receiving his 1st dose.

Other Meds:

Current Illness:

ID: 1813457
Sex: F
Age: 82
State: OH

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: None

Other Meds: None

Current Illness: None

ID: 1813458
Sex: F
Age: 54
State: CA

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1813459
Sex: F
Age: 36
State: PA

Vax Date: 09/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/23/2021
Hospital: Y

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

Lab Data: Wound cultures (10/4/21) Lab work (10/4 through 10/19) almost daily.

Allergies: Vancomycin, Penicillin

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

Symptoms: Shortly after my initial 1st dose I ended up with a serious infection and abscess in my right arm need almost 2 weeks of iv antibiotic therapy as well as surgical intervention. Never in my life have I had issues with medication however this even I did not respond to any oral antibiotics causing my infection to worsen. My doctor said this may be a result of the vaccination.

Other Meds: None

Current Illness: None

ID: 1813460
Sex: M
Age: 81
State: NJ

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: pcn

Symptom List: Injection site pain, Pain

Symptoms: pt reported diarrhea approximately 1 hour after given moderna booster

Other Meds: unknown

Current Illness: unknown

ID: 1813461
Sex: F
Age:
State: WA

Vax Date:
Onset Date: 04/16/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: None

Allergies: Tetracycline, scallops, chocolate, wine, coffee, potatoes, corn, most fruit (especially peaches), tobacco, perfumes, natural gas and other petroleum derivatives

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pronounced dizzyness each morning from about 8:00 a.m. to about 10:00 a.m. Lasted for about 2 weeks, then got less pronounced each day for a third week. Some residual balance problems persist; for example, increased unsteadiness while walking across a soft or uneven meadow.

Other Meds: Thorne Basic Nutrients (multi-vitamin), extra Vitamin D, extra calcium, strontium, lutein, melatonin, valerian extract. No prescriptions.

Current Illness: Chronic bronchitis; Osteogenesis Imperfecta

ID: 1813462
Sex: F
Age: 34
State: MA

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/23/2021
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: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1813463
Sex: M
Age: 13
State: NJ

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Currently Arm Red and swollen and very painful currently 4cm in diameter and growing.

Other Meds: None

Current Illness: none

ID: 1813464
Sex: F
Age: 24
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Systemic: Chills-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Severe, Systemic: Shakiness-Medium, Systemic: Vomiting-Severe, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1813465
Sex: M
Age: 42
State: TN

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Patient received a dose of J&J vaccine and came in to get the Moderna booster. Communication we received looked like those who got the J&J vaccine would receive the full 0.5ml dose of the Moderna booster so that is what this patient got. We learned later that night that everyone who gets a Moderna booster should receive a 0.25ml dose with the exception of the immunocompromised. Spoke to this patient to inform him that he got the full 0.5ml dose and he was feeling fine, just had a sore arm.

Other Meds:

Current Illness:

ID: 1813466
Sex: M
Age: 83
State: OH

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Nausea

Symptoms: None

Other Meds: Not known

Current Illness: Unknown

ID: 1813467
Sex: F
Age: 49
State: IL

Vax Date: 04/14/2021
Onset Date: 05/12/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: 6-3-21 CT head/neck , with/without contrast blood work up 6-18-21 Blood work up, EKG 7-20-21 MRI of brain and ears with/without contrast 7-24-21 hearing test

Allergies: None

Symptom List: Injection site pain

Symptoms: 24/7 dizziness, muscle twitching, internal vibrations, migraines, tinnitus, disequilibrium, Icy/hot scalp, chest pain, Pulsating headaches, numbness and tingling, blurred vision

Other Meds: Ativan

Current Illness: None

ID: 1813468
Sex: M
Age: 53
State: TX

Vax Date: 07/14/2021
Onset Date: 07/17/2021
Rec V Date: 10/23/2021
Hospital:

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

Lab Data: Extensive bloodwork was performed, but he could find nothing. In June 2021, one month prior to vaccination, I had my annual physical. My annual physical report looked good, and my doctor said everything looked good.

Allergies: None

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

Symptoms: Got vaccine on a Wednesday, that Saturday I had no energy to move around, legs and arms felt very heavy. That Sunday morning, I had a very bad migraine headache. The extreme tiredness lasted for over a week, along with muscle weakness. Second week, met with with my Dr., who did extensive bloodwork, but could not find anything, so he suggested I get some rest. The tiredness, muscle fatigue and weakness continued, along with headaches. By the third week, I had developed tinnitus in my left ear. My ENT said said my ears and hearing are good, and that maybe the tinnitus would go away, I still have tinnitus in my left ear. It seemed that now I was also allergic to some foods and drinks I always consumed.

Other Meds: Aspirin

Current Illness: None

ID: 1813469
Sex: F
Age: 73
State: AZ

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: DOSE GIVEN 23 HOURS AFTER PUNCTURE

Other Meds:

Current Illness:

ID: 1813470
Sex: M
Age: 74
State: OH

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: No

Symptom List: Tremor

Symptoms: None

Other Meds: No

Current Illness: Unknown

ID: 1813471
Sex: M
Age: 19
State: MA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/23/2021
Hospital: Y

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

Lab Data: Cardiac MRI 10/19/2021

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Myocarditis

Other Meds: None

Current Illness: None

ID: 1813472
Sex: M
Age: 65
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janssen

Other Meds:

Current Illness:

ID: 1813473
Sex: F
Age: 36
State: TN

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Patient received a dose of J&J vaccine and came in to get the Moderna booster. Communication we received from corporate looked like those who received the J&J shot would get the full 0.5ml dose of the Moderna booster so that is what this patient got. Much later that evening, we learned that everyone gets 0.25ml of the Moderna booster with the exception of those who are immunocompromised. Spoke to patient to inform her that she received the full 0.5ml dose and she was actually very happy about it.

Other Meds:

Current Illness:

ID: 1813474
Sex: F
Age: 29
State: MO

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

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janssen

Other Meds:

Current Illness:

ID: 1813475
Sex: M
Age: 51
State: SC

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: No record of known allergies

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

Symptoms: Vaccine may have been administered outside of the room temperature window. Janssen is good for 2 hours at room temperature. Vial was out of the refrigerator for longer than 2 hours time.

Other Meds: Do not have a record of Medications patient is currently or previously taking.

Current Illness: No record of prior illnesses

ID: 1813476
Sex: F
Age: 64
State: AR

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Metformin

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

Symptoms: Chills, fever, soreness in arm

Other Meds:

Current Illness:

ID: 1813477
Sex: F
Age: 55
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janessen

Other Meds:

Current Illness:

ID: 1813478
Sex: M
Age: 61
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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 of mixed series mRNA vaccine with Pfizer, Moderna or Janessen

Other Meds:

Current Illness:

ID: 1813479
Sex: M
Age: 68
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janessen

Other Meds:

Current Illness:

ID: 1813480
Sex: F
Age: 66
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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 of mixed series mRNA vaccine with Pfizer, Moderna or Janessen

Other Meds:

Current Illness:

ID: 1813481
Sex: M
Age: 45
State: TN

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Patient received a dose of the J&J vaccine and came in to get the Moderna booster. Communication we received from corporate looked like those who got J&J would receive the full 0.5ml dose of the Moderna booster so that is what this patient got. Much later in the evening, we learned that everyone who gets a Moderna booster should get 0.25ml with the exception of those who are immunocompromised. Spoke to this patient to inform that he got the full 0.5ml dose and he was fine with it. Patient was feeling fine, just had a sore arm.

Other Meds:

Current Illness:

ID: 1813482
Sex: F
Age: 58
State: IL

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: No known allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient requested a booster dose for the Covid Vaccine. She originally receive Johnson and Johnson for her initial vaccination and requested Moderna for her booster. Dose was administered at the 0.5 mL dose as opposed to the correct 0.25 mL dose appropriate for a Moderna Booster. At the time of report, patient has not experienced any side effects from the vaccine.

Other Meds: daily 50+ multivitamin, Vitamin c, vitamin b12, potassium, magnesium, fish oil, garlic, calcium/Vitamin D, and milk thistle

Current Illness: Patient received Pneumovax 23 and Fluzone 2021-2022 15 days prior

ID: 1813483
Sex: M
Age: 68
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janessen

Other Meds:

Current Illness:

ID: 1813484
Sex: F
Age: 12
State: VA

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/23/2021
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: PATIENT BEGAN TO BECOME UNRESPONSIVE ABOUT 5 MINUTES AFTER RECEIVING VACCINES. PATIENT RESTED AND USE ICE PACK TO COOL OFF. WE CONTINUE TO OBSERVE PATIENT FOR ANOTHER 1O MINUTES AND SHE RETURNED TO BASELINE

Other Meds: NONE

Current Illness:

ID: 1813485
Sex: F
Age: 65
State: MO

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/23/2021
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: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janssen.

Other Meds:

Current Illness:

ID: 1813486
Sex: F
Age: 63
State: MO

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

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

Lab Data:

Allergies:

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

Symptoms: Administration of mixed series mRNA vaccine with Pfizer, Moderna or Janssen

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am