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: 1813920
Sex: F
Age: 17
State: NY

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/24/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: The patient is 17 years old but received a pfizer booster shot which is only approved in 18 years or older. No adverse events occurred.

Other Meds: None

Current Illness: None

ID: 1813921
Sex: F
Age: 65
State: MO

Vax Date: 10/21/2021
Onset Date: 10/22/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: none yet. will make appt with ENT/otolaryngologist tomorrow (10/25/2021)

Allergies: none known

Symptom List: Anxiety, Dyspnoea

Symptoms: ears began ringing day after vaccination, has not stopped even though other side effects (fever, nausea, fatigue) have abated.

Other Meds: daily vitamins (one-a-day, calcium, fish oil); no prescriptions

Current Illness: had first-time ever reaction to flu vaccine 2 weeks prior that put me in bed for a day (fever, chills). May have been due to getting the larger dose for older people for the first time.

ID: 1813922
Sex: F
Age: 15
State: WA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 10/24/2021
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: None

Allergies: None

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

Symptoms: ERROR: Age- UNAUTHORIZED AGE GROUP (15 years old, Pfizer EUA approved only for children 16 years and older. Parent signed consent form with incorrect DOB indicating age greater than 16yo). Event discovered and forwarded for VAERS reporting. Signs and symptoms: None known Diagnosis and treatment: None known Outcome: No adverse reaction reported

Other Meds: Not reported

Current Illness: Not reported

ID: 1813923
Sex: F
Age: 14
State: WA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None Known

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: ERROR: UNUATHORIZED AGE GROUP (14 years old, Pfizer EUA approved only for persons 16 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 yo). Event discovered and forwarded for VAERS reporting. Signs and symptoms: None known Diagnosis and treatment: None known Outcome: No adverse reaction reported

Other Meds: None Known

Current Illness: None

ID: 1813924
Sex: M
Age: 95
State: OK

Vax Date: 03/06/2021
Onset Date: 09/17/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: Rapid Test on 9/17/2021 Confirmatory PCR on 9/17/2021

Allergies: NKDA

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

Symptoms: Tested positive for Covid 19 on 9/17/2021 - mild respiratory symptoms, but 3 days of lowered oxygen saturation requiring oxygen

Other Meds: unknown

Current Illness: unknown

ID: 1813925
Sex: F
Age: 16
State: WA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 10/24/2021
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: None known.

Allergies: None

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

Symptoms: Error: unauthorized age group (16-year-old, Moderna EUA approved only for persons 18 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813926
Sex: F
Age: 17
State: WA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None.

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Error: unauthorized age group (17-year-old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813927
Sex: F
Age: 58
State: CT

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data:

Allergies: Celiac disease. Penicillin walnuts pecans and almonds

Symptom List: Pharyngeal swelling

Symptoms: I was nauseous and dizzy within five minutes of receiving the vaccine. Over the first two days the symptoms continue to get worse until I went to the doctor on Friday. When I went to the doctor they prescribe some nausea medication. I was feeling Very unwell and have taken the day off from work. Over this weekend the nausea symptoms have gotten worse and I am weak. I am still very nauseous and weak And have the chills

Other Meds: Levoxly. 1.25 mg

Current Illness: None was 100% healthy before the vaccine

ID: 1813928
Sex: F
Age: 11
State: WA

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 10/24/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: ERROR: Age- UNAUTHORIZED AGE GROUP (11 years old, Pfizer EUA approved only for children 12 years and older. Parent signed consent form with incorrect DOB indicating age greater than 12yo). Event discovered and forwarded for VAERS reporting. Signs and symptoms: None known Diagnosis and treatment: None known Outcome: No adverse reaction reported

Other Meds: Not reported

Current Illness: Not reported

ID: 1813929
Sex: F
Age: 11
State: WA

Vax Date: 06/05/2021
Onset Date: 06/05/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: ERROR: Age- UNAUTHORIZED AGE GROUP (11 years old, Pfizer EUA approved only for children 12 years and older. Parent signed consent form with incorrect DOB indicating age greater than 12yo). Event discovered and forwarded for VAERS reporting. Signs and symptoms: None known Diagnosis and treatment: None known Outcome: No adverse reaction reported

Other Meds: Not reported

Current Illness: Not reported

ID: 1813930
Sex: F
Age: 34
State: VA

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Full body aches, joint pain, rash spreading

Other Meds: Meloxicam, cyclobenzaprine, bupropion XL, B complex supplement, vitamin d supplement

Current Illness: None

ID: 1813932
Sex: M
Age: 22
State: CA

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/24/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data: none

Allergies:

Symptom List: Rash, Urticaria

Symptoms: itching around site of injection followed by diffuse skin scaly itchy skin with peeling of ski of both upper extremities

Other Meds:

Current Illness:

ID: 1813933
Sex: F
Age: 15
State: WA

Vax Date: 03/23/2021
Onset Date: 03/23/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None Known

Allergies: None

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

Symptoms: ERROR: UNUATHORIZED AGE GROUP (15 years old, Pfizer EUA approved only for persons 16 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 yo). Event discovered and forwarded for VAERS reporting. Signs and symptoms: None known Diagnosis and treatment: None known Outcome: No adverse reaction reported

Other Meds: None Known

Current Illness: None

ID: 1813934
Sex: M
Age: 17
State: WA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 10/24/2021
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: None.

Allergies: None

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

Symptoms: Error: unauthorized age group (17-year-old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813935
Sex: F
Age: 17
State: WA

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: ERROR: Age- UNAUTHORIZED AGE GROUP (17 years old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18yo). Event discovered and forwarded to for VAERS reporting. Signs and symptoms: None known Diagnosis and treatment: None known Outcome: No adverse reaction reported

Other Meds: Not reported

Current Illness: Not reported

ID: 1813936
Sex: F
Age: 65
State: IL

Vax Date: 02/12/2021
Onset Date: 03/01/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: See above

Allergies: None

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Tingling in hands, legs, feet, also feeling of legs and hands falling asleep without any cause I.e. just sitting comfortably in a chair, legs uncrossed would cause the feelings of numbness and tingling. This had nothing happened before and was happening often during the day. Saw physician who ran a few blood tests and Vitamin B6 came back a low normal, three months later B6 went even lower and shows deficiency . Currently, taking B complex vitamin to I rease B6 levels my B 12 was within normal limits. Tingling sensations and numbness subsided after about 1 week and occasionally still occurs but not with the intensity it did before, the physician did not think it was related to the Moderna shot but I waited an extra week to get my second dose on 3-19-21, versus sooner just in case. I will be getting my Moderna booster soon since it is only half the initial dose, I am less hesitant. If it were the full dose which is higher than the amount of vaccine in Pfizer, I wouldn?t be getting it. I am very sensitive to, medications and normal only take half doses of any script I am given.

Other Meds: Tylenol Fish oil Glucosamine Fosamax 70 mg

Current Illness: None

ID: 1813937
Sex: M
Age: 15
State: WA

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None known.

Allergies: None

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

Symptoms: Error: unauthorized age group (15-year-old, Pfizer EUA approved only for persons 16 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813938
Sex: F
Age: 48
State: MI

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

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

Lab Data:

Allergies: Bactrim

Symptom List: Ear pain, Hypoaesthesia

Symptoms: At 11pm, on 10/22/2021, I began to get body aches, and hives on my face and neck. At 1 am I began to dry heave for approximately 20 minutes, nausea continued on and off throughout the day of 10/23/2021. At approximatly 12 pm on 10/23 I developed intesne pain in my bones, from the neck, spine to my legs and hives around the injection site on my left arm and also on my stomach, as well as hot and cold sweats. I began taking tylonal and benedryl to treat symptoms at approximately 4pm on 10/23 and slept from 4:30 on and off through the night waking at 8:30am on 10/24/2021 with a slight headache, but the hives are beginning to fade and the bone pain is dull at the time of this report.

Other Meds: Feverfew Ferrous Sulfate B-Complex Sumatriptan Pamelor 50mg

Current Illness: Migraines

ID: 1813939
Sex: F
Age: 17
State: WA

Vax Date: 03/26/2021
Onset Date: 03/26/2021
Rec V Date: 10/24/2021
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: Error: unauthorized age group (17-year-old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813940
Sex: F
Age: 15
State: WA

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None known.

Allergies: None

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

Symptoms: Error: unauthorized age group (15-year-old, Pfizer EUA approved only for persons 16 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813941
Sex: F
Age: 24
State: WA

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 10/24/2021
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: No known allergies.

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

Symptoms: "A single dose of an mRNA COVID-19 is incorrectly administered either before or after administration of Janssen COVID-19 vaccine." (Pfizer Lot No. EWO173 administered IM LD on 9/5/21 - post vaccine patient reported prior J&J received on 3/20/21) Signs and symptoms: None Diagnosis and treatment: No adverse reaction observed or reported. Patient observed for 15 minutes per CDC protocol. Patient released from mobile vaccination clinic in unremarkable, stable condition. Diagnosis: Vaccine error related to administration of mRNA COVID-19 after previous administration of Janssen COVID-19 vaccine. Supervisor reported event to site manager for VAERS reporting.

Other Meds: Not stated by patient.

Current Illness: None.

ID: 1813942
Sex: F
Age: 15
State: OH

Vax Date: 08/21/2021
Onset Date: 09/12/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: Routine bloodwork (10/15/2021) - came back normal.

Allergies:

Symptom List: Unevaluable event

Symptoms: Long lasting period of 28 days. Spotting for 9 days after and 3 days before. Cramps, dizziness, headaches. Extremely heavy flow.

Other Meds: Qvar, Pro-Air, FloNase, Singulair, Dicyclomine

Current Illness: E-Coli

ID: 1813943
Sex: M
Age: 17
State: WA

Vax Date: 03/17/2021
Onset Date: 03/17/2021
Rec V Date: 10/24/2021
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: None

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

Symptoms: Error: unauthorized age group (17-year-old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813945
Sex: F
Age: 17
State: WA

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: N/a

Allergies: None stated

Symptom List: Injection site pain, Pain

Symptoms: Under age administration of Pfizer Pfizer vaccine (17 years old - booster dose approved for 18 years and above - even if age approved, does not meet criteria for at risk group) Signs and symptoms: none Diagnosis and treatment: Patient accompanied by parent. Patient observed for 15 minutes per CDC protocol, no adverse reaction observed. Patient released from mobile vaccination clinic in unremarkable, stable condition. No treatment required. Diagnosis: vaccine error related to age of minor child, does not quality for booster Supervisor reported event to site manager for VAERS reporting

Other Meds: None stated

Current Illness: None stated

ID: 1813946
Sex: F
Age: 91
State: OK

Vax Date: 07/07/2021
Onset Date: 09/20/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: Abbott Binax Now Rapid test on 9/20/2021 Confirmatory PCR on 9/20/2021

Allergies: Bactrim, Tramadol

Symptom List: Injection site pain, Menorrhagia

Symptoms: Tested positive for Covid-19 on 09/20/2021; mild respiratory symptoms, fatigue, loss of appetite

Other Meds: unknown

Current Illness: unknown

ID: 1813947
Sex: U
Age: 15
State: WA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None known.

Allergies: None

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

Symptoms: Error: unauthorized age group (15-year-old, Pfizer EUA approved only for persons 16 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813948
Sex: M
Age: 67
State: NY

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient was given full dose (0.5ml) Moderna for a 3rd booster dose instead of 0.25ml - patient states they did not have any negative outcomes from the vaccine

Other Meds: N/A

Current Illness: N/A

ID: 1813949
Sex: F
Age: 11
State: WA

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None.

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Error: unauthorized age group (11-year-old, Pfizer EUA approved only for children 16 years and older. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813950
Sex: F
Age: 17
State: WA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 10/24/2021
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: None known.

Allergies: None

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

Symptoms: Error: unauthorized age group (17-year-old, Moderna EUA approved only for persons 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813952
Sex: F
Age: 23
State: CT

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/24/2021
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: The spot around my shot is really sore, swollen, itchy and red.

Other Meds:

Current Illness:

ID: 1813953
Sex: M
Age: 15
State: WA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None known.

Allergies: None

Symptom List: Injection site pain

Symptoms: Error: unauthorized age group (15-year-old, Pfizer EUA approved only for persons 16 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813954
Sex: M
Age: 15
State: WA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 10/24/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Error: unauthorized age group (15-year-old, Pfizer EUA approved only for children 16 years and older. Parent signed consent form with incorrect DOB indicating age greater than 16 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813955
Sex: F
Age: 17
State: WA

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None known.

Allergies: None

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

Symptoms: Error: unauthorized age group (17-year-old, Moderna EUA approved only for persons 18 years and older at time of administration. Parent signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: None known

Current Illness: None

ID: 1813956
Sex: F
Age: 66
State: NY

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Tremor

Symptoms: Patient was given 0.5ml instead of the correct 0.25ml booster dose as a third dose - pt states no symptoms at this time

Other Meds: N/A

Current Illness: N/A

ID: 1813957
Sex: M
Age: 17
State: WA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 10/24/2021
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: Error: unauthorized age group (17-year-old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813958
Sex: F
Age: 86
State: OK

Vax Date: 01/12/2021
Onset Date: 09/24/2021
Rec V Date: 10/24/2021
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: Abbott Binax Now Rapid Test 09/24/2021 Confirmatory PCR 9/24/2021

Allergies: Penicillin, codeine, aspirin, sulfa, sulfa antibiotics

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

Symptoms: Tested positive for Covid 19 on 9/24/2021; mild respiratory symptoms

Other Meds: unknown

Current Illness: unknown

ID: 1813959
Sex: M
Age: 65
State: NY

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/24/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Severe Tinnitus in both ears

Other Meds: Vit E, Multi-Vitamine, Aspirin, Saw Palmetto, CoQu10 Celecox-ib 200mb, Tadalafil 5mg, Losartin 12.5mg, Rosuvastatin 20mg

Current Illness: none

ID: 1813960
Sex: M
Age: 17
State: WA

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None.

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Error: unauthorized age group (17-year-old, Moderna EUA approved only for adults 18 years and older. Patient signed consent form with incorrect DOB indicating age greater than 18 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813961
Sex: F
Age: 11
State: WA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Error: unauthorized age group (11-year-old, Pfizer EUA approved only for children 12 years and older. Parent signed consent form with incorrect DOB indicating age greater than 12 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813962
Sex: F
Age: 42
State: CO

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/24/2021
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: N/a at this time; if continues on Monday will see physician.

Allergies: Dairy, mushrooms, wasp venom

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

Symptoms: Swelling , pain, and heat at injection site beginning a few hours offer receiving booster dose. Did not have any pain, swelling, heat with Modern dowsed 1 and 2. Pain and swelling not reversing with Tylenol and ice. Submitting this report 18 hours post injection.

Other Meds: Mirena, gabapentin, Adderall, Paxil, albuterol (PRN), Allegra, Flonase Potassium, L-tyrosine, calcium, vitamin d, b complex, calcium maleate, l-theanine

Current Illness:

ID: 1813963
Sex: M
Age: 63
State: IN

Vax Date: 10/01/2021
Onset Date: 10/23/2021
Rec V Date: 10/24/2021
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: Nickel

Symptom List: Pain in extremity

Symptoms: Fever, dizziness, mild congestion.

Other Meds: Atomoxitine. Duloxitine. Oxcycodone

Current Illness: None

ID: 1813964
Sex: F
Age: 11
State: WA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: None.

Allergies: None

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

Symptoms: Error: unauthorized age group (11-year-old, Pfizer EUA approved only for children 12 years and older. Parent signed consent form with incorrect DOB indicating age greater than 12 years). Event discovered and forwarded for reporting. Signs and symptoms: None known. Diagnosis and treatment: None known. Outcome: No adverse reaction reported.

Other Meds: Not reported

Current Illness: Not reported

ID: 1813965
Sex: F
Age: 55
State: TX

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: The web sight is about to time out.

Allergies: Sulfer Codine

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

Symptoms: About 7:30 pm I stated to feel bad. I was freezing. My heart was beating very hard felt like it was going to jump out of my chest. I was shaking uncontrollable. I had a headache. No fever that I was aware of. Could not go to sleep. Had to go to the bathroom every 30 minutes, I think because I was so cold. The next morning I didn't feel well. The headache would not go away. My leggs started cramping really bad. I called the doctor and said I think I have blood clots. I had a ultrasound done, no blood clots. nothing wrong with me except I got the shot. Due to the headaches I went to a specialist had a MRI on my brain and a MRA on my brain. nothing wrong with me except I got the shot. I went to see another specialist because my heart is beating unusually. I am having High blood pressure spikes and crazy dizzy spells. Had EKG and Heart Echo. Nothing wrong with me except I got the Shot.

Other Meds: Losartan 50MG twice daily, Montelukast 10mg once daily, Fluticasone 50mcg 2 sprays daily, Omeprazole 40mg as needed, Levothyroxin 75 mcg once daily,Pravastatin 20mg once daily. Fish oil 1600mg 2 daily, Flaxseed oil 1300mg one daily, Vitami

Current Illness: None

ID: 1813966
Sex: F
Age: 39
State: IL

Vax Date: 04/01/2021
Onset Date: 09/15/2021
Rec V Date: 10/24/2021
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: None

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: Missed miscarriage Baby passed a week before I knew she had passed (11 weeks)

Other Meds: None

Current Illness: No

ID: 1813967
Sex: F
Age: 50
State: RI

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/24/2021
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: Headache, head pressure left side. Broken blood vessel left eye

Other Meds: Lisinopril. Topiramate, lorazepam, omeprazole

Current Illness:

ID: 1813968
Sex: F
Age: 89
State: OK

Vax Date: 01/10/2021
Onset Date: 09/20/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: Abbott Binax Now Rapid Test - 9/20/2021 Confirmatory PCR

Allergies: sulfa antibiotics, lactose intolerance, codeine, metronidazole, flagyl

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tested positive for Covid 19 on 09/20/2021 - mild congestion for 3 days

Other Meds: unknown

Current Illness: unknown

ID: 1813969
Sex: M
Age: 37
State: AK

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/24/2021
Hospital: Y

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

Lab Data: Cardic MRI, echocardiogram, EKG, troponin levels, X-rays,

Allergies: None

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

Symptoms: Myrocarditis and parocarditis

Other Meds: Synthroid

Current Illness: Hashimoto Disease

ID: 1813970
Sex: F
Age:
State: MI

Vax Date:
Onset Date:
Rec V Date: 10/24/2021
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: None

Allergies: Metronidazole, nitrofuran

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Body aches, feeling feverish with no temperature, headache, dizziness, hives all over body, sore arm at injection site

Other Meds: Ibuprofen and Tylenol

Current Illness: None known

ID: 1813971
Sex: F
Age: 58
State: CA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: took PCR covid test on 10/19 due to concern over lengthy vaccine reaction - it was negative

Allergies: none

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

Symptoms: Fever for 115 hours (nearly five days) between 100.2 and 102.8, despite taking round the clock, and beyond the maximum doses, of Tylenol and Motrin moderate to severe headache for 115 hours (nearly five days), despite taking round the clock, and beyond the maximum doses, of Tylenol and Motrin loss of appetite for five days fatigue for five days

Other Meds: statin 10mg/day

Current Illness: none

ID: 1813972
Sex: F
Age: 78
State: KY

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/24/2021
Hospital:

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

Lab Data: N/A

Allergies: Sulfa, PPI, Macrolides

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

Symptoms: Arm developed a large, softball-sized welt.

Other Meds: N/A

Current Illness: N/A

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am