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: 1814025
Sex: F
Age: 60
State: MO

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: LA

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

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

Other Meds:

Current Illness:

ID: 1814026
Sex: F
Age: 63
State: MO

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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

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

Other Meds:

Current Illness:

ID: 1814027
Sex: F
Age: 52
State: AL

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: The patient was given 0.5 ml of moderna for the booster dose instead of 0.5 ml. the patients first series was jhnson and johnson. the patient has had no adverse reactions.

Other Meds:

Current Illness:

ID: 1814028
Sex: M
Age: 49
State: MN

Vax Date: 10/14/2021
Onset Date: 10/20/2021
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 except conversation with Chiropractic

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Ringing and muffling sound in ears, distorted hearing, dizziness, pain in ears, headache, some blurred vision, foggy

Other Meds: Various

Current Illness: None

ID: 1814029
Sex: F
Age: 79
State: WA

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: LA

Lab Data: None

Allergies: Demerol

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

Symptoms: Extreme back pain, general feeling of severe illness, weakness with inability to walk unaided, near collapse.

Other Meds: Advair, Flonase, Zyrtec, Simvastatin, Lexapro, low dose aspirin, vitamins C D B12 and multivitamin, fish oil, CoQ 10, calcium, melatonin.

Current Illness:

ID: 1814030
Sex: F
Age: 49
State: PA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: Bloodwork, echocardiogram, ekg, chest X-ray, heart monitor, hearing tests, mri, rotational chair test, eng

Allergies: None that aware of

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

Symptoms: Passed out & blood pressure dropped low 5 minutes after getting vaccine. Started having various medical issues following this event, mostly started in July: vertigo, tinutis, anxiety, sudden adrenaline rushes, panic attacks, head pressure in temples & back of head,sudden racing heart, heart palpitations, sudden blood pressure drops that cause lightheadness/dizziness where I feel I?m going to pass out.

Other Meds: Rentin A, Valtrex, inhaler for asthma, fish oil, multi vitamin, vitamin d, bio flex, iron, dhea, pregnelone, bio identical hormones: estrogen, progesterone, testosterone

Current Illness: None

ID: 1814031
Sex: M
Age: 55
State: MO

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

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

Other Meds:

Current Illness:

ID: 1814032
Sex: F
Age: 59
State: MO

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

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

Other Meds:

Current Illness:

ID: 1814033
Sex: F
Age: 39
State: NV

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: over 42 days, 1st dose 09/7/21, 2nd dose 10/23/21

Other Meds:

Current Illness:

ID: 1814034
Sex: F
Age: 48
State: IL

Vax Date: 09/26/2021
Onset Date: 09/27/2021
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:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Menorrhagia, EBL 200 ml, large clots

Other Meds:

Current Illness:

ID: 1814035
Sex: F
Age: 44
State: AZ

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:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None yet, still bleeding.

Allergies: Flu vac, TDAP, trees, weeds, animals, pollen, nuts, eggs, lactose, shellfish, hay, apples, plums, smoke, some perfumes

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

Symptoms: Menstruated again out of nowhere. Had already had my monthly cycle. This NEVER happens to me. My left arm is itchy and has a painful sore lump. I have a headache. I am nauseous. I am very tired.

Other Meds: None

Current Illness: None

ID: 1814036
Sex: F
Age: 40
State: CA

Vax Date: 09/15/2021
Onset Date: 10/01/2021
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: Doxycyclin

Symptom List: Rash, Urticaria

Symptoms: Regular menstral cycle started 10/1/2021 ended normally by 10/5/2021. Regular is light for most days and heavy 1 day in the middle. Restarted 10/7/2021 heavy everyday for 7 days until 10/15/2021.

Other Meds: None

Current Illness: None

ID: 1814037
Sex: F
Age: 33
State: TN

Vax Date: 03/22/2021
Onset Date: 03/29/2021
Rec V Date: 10/24/2021
Hospital: Y

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

Lab Data: Hospitalized sept 7

Allergies: Sulfa -Cilin Aspirin Codiene Phenergan

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

Symptoms: Brain fog, inability to concentrate, left arm pain, left face tingling left arm paralysis, tia, blood clots, bilateral artery stenosis, vascular, cognitive issues

Other Meds: Prozac Albuterol Iron Ceterzine

Current Illness:

ID: 1814038
Sex: M
Age: 55
State: AL

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: The patient was given 0.5 ml of moderna for the booster dose instead of 0.5 ml. the patients first series was johnson and johnson. the patient has had no adverse reactions.

Other Meds:

Current Illness:

ID: 1814039
Sex: F
Age: 61
State: NY

Vax Date: 08/26/2021
Onset Date: 08/26/2021
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:

Allergies:

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

Symptoms: Patient received vaccine days after allowable BUD in refrigerator.

Other Meds:

Current Illness:

ID: 1814040
Sex: F
Age: 53
State: MD

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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Latex, iodine, betadine, shellfish, sulphur antibiotics

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

Symptoms: Injection site pain, body aches, leg cramps, shortness of breath, coughing, congestion, headache continuing on day two after vaccine.

Other Meds: Atenolol, Levothyroxin

Current Illness: Hashimotos thyroiditis, sjogren's syndrome disease

ID: 1814041
Sex: M
Age: 18
State: NV

Vax Date: 10/23/2021
Onset Date: 10/23/2021
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:

Allergies:

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

Symptoms: over 42 days, 1st dose 08/15/21, 2nd dose 10/23/21

Other Meds:

Current Illness:

ID: 1814042
Sex: M
Age: 60
State: MO

Vax Date: 10/23/2021
Onset Date: 10/23/2021
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:

Symptom List: Ear pain, Hypoaesthesia

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

Other Meds:

Current Illness:

ID: 1814043
Sex: F
Age: 35
State: CO

Vax Date: 10/24/2021
Onset Date: 10/24/2021
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: non at this time

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient reported about several hours after the receiving the vaccine that her left eye was very swollen and that she felt it had a film over it

Other Meds: not sure

Current Illness: none

ID: 1814044
Sex: F
Age: 37
State:

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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:

Allergies:

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

Symptoms: Patient received vaccine days after allowable BUD in refrigerator.

Other Meds:

Current Illness:

ID: 1814045
Sex: M
Age: 60
State: MO

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: 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: Administration error mixed series vaccine with Pfizer, Moderna or Janssen

Other Meds:

Current Illness:

ID: 1814046
Sex: F
Age: 70
State: IL

Vax Date: 10/19/2021
Onset Date: 10/19/2021
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: Sulfa

Symptom List: Unevaluable event

Symptoms: Sore arm, headache, fatigue. Headache stopped 12 hours after vaccine. Fatigue stopped after 26 hours. Sore arm stopped after 30 hours.

Other Meds: None

Current Illness: None

ID: 1814047
Sex: F
Age: 56
State: NV

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:

Allergies:

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

Symptoms: over 42 days, 1st dose 08/20/21, 2nd dose 10/22/21

Other Meds:

Current Illness:

ID: 1814049
Sex: F
Age: 50
State: MO

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

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

Other Meds:

Current Illness:

ID: 1814050
Sex: F
Age: 36
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received vaccine days after allowable BUD in refrigerator.

Other Meds:

Current Illness:

ID: 1814051
Sex: M
Age: 55
State: MO

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1814052
Sex: M
Age: 47
State: WA

Vax Date: 05/04/2021
Onset Date: 05/05/2021
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:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tinnitus Within a day after 2nd shot Both ears

Other Meds:

Current Illness:

ID: 1814053
Sex: F
Age: 39
State: CA

Vax Date: 03/29/2021
Onset Date: 03/29/2021
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: Client stated that headache began within 15 minutes of receiving first Moderna dose while in the observation room. Client then stated when she arrived home her symptoms then proceeded with vomiting several times that night, body aches, fever of 39-40 degrees Celsius, Left deltoid pain and rash at injection site. Client stated, "I had to take tylenol 500 mg twice, first dose I took before bed for my fever, pain, and body aches. I applied vapor rub ointment to my rash on my left shoulder where I received the vaccine." Injection site pain and rash lasted for 1 day. Headache and body aches lasted for 3 days. Client denied taking any antihistamine medication for symptoms. Client stated, "At the time of vaccination I did not know I was pregnant. Shortly after I found out and confirmed that I was indeed pregnant during my first dose vaccination." Client denied having any current medical conditions and medications. Client stated that she was hypertensive during her previous pregnancy 9 years ago and would take an Ace inhibitor medication (stated the medication in Spanish as "alonopril" but unable to determine English equivalent). Client had concerns today during second Moderna dose due to still being pregnant and whether or not she should proceed with vaccination. At 5:03 PM Co Lead PHN notified PHN and stated that there are no contraindications with pregnancy and 30 minute observation would be recommended. It is unknown if the symptoms after first dose of Moderna are unknown due to pregnancy or due to the covid-19 Moderna vaccination. Co Lead PHN relayed observation guidance and recommendations to client and her husband. Client and husband were in agreement to proceed with vaccination at 5:17 PM. Client completed 30 minute observation and was seen exiting facility safely with steady gait and husband at her side.

Other Meds: None at the time of vaccination of first dose.

Current Illness: None

ID: 1814054
Sex: M
Age: 83
State: MO

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:
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: Administration error mixed series vaccine with Pfizer, Moderna or Janssen.

Other Meds:

Current Illness:

ID: 1814055
Sex: M
Age: 42
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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: Patient received vaccine days after allowable BUD in refrigerator.

Other Meds:

Current Illness:

ID: 1814056
Sex: M
Age: 62
State: VA

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

Lab Data: n/a

Allergies: n/a

Symptom List: Injection site pain

Symptoms: n/a

Other Meds: n/a

Current Illness: n/a

ID: 1814057
Sex: F
Age: 71
State: MO

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1814059
Sex: F
Age: 89
State: MO

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

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

Symptoms: Administration error mixed series vaccine with Pfizer, Moderna or Janssen.

Other Meds:

Current Illness:

ID: 1814060
Sex: F
Age: 68
State: IL

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: Normal Blood Pressure and basics. Stayed in Hospital ER for 4 hours until swelling went down.

Allergies: N/A

Symptom List: Tremor

Symptoms: Swelling of Face and Lips. Headache, fever, chills, dizzy. sick to stomach.

Other Meds: Zyrtec, Hydroxyzine (25 mg), Levocetirzine (5mg)

Current Illness: Hives

ID: 1814061
Sex: F
Age: 16
State: OH

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

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

Lab Data: Heart rate, respiration rate, and blood pressure.

Allergies: Patient reports no allergies.

Symptom List: Erythema, Pruritus

Symptoms: About 10 minutes after administering patient's second dose of the Pfizer COVID vaccine, patient's father called attention saying "she's not doing well." Patient passed in and out of consciousness for about 5-10 minutes. At that time EMS was call and patient regained consciousness. She reported loss of vision, thirst, and feeling hot. EMS arrived, checked vitals, and patient left on own accord with parent.

Other Meds: Patient reports no medications.

Current Illness: Patient reports no other illness.

ID: 1814062
Sex: M
Age: 51
State: MO

Vax Date: 10/23/2021
Onset Date: 10/23/2021
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:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1814064
Sex: M
Age: 70
State: MO

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: 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: Administration error mixed series vaccine with Pfizer, Moderna or Janssen.

Other Meds:

Current Illness:

ID: 1814065
Sex: M
Age: 70
State: CO

Vax Date: 03/05/2021
Onset Date: 09/14/2021
Rec V Date: 10/24/2021
Hospital: Y

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: Patient vaccinated with Pfizer on 2/12/21 and 3/5/21. patient is immunocompromised (hx of mantel cell lymphoma). Tested positive for COVID 9/14/21, admitted to hospital on 9/30/21 - has been in ICU ever since (likely won't be leaving...)

Other Meds:

Current Illness:

ID: 1814066
Sex: F
Age: 63
State: TX

Vax Date: 10/21/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient stated that her left arm starting feeling hot on Sat, Oct 23rd in the afternoon. When she woke up on Sun, Oct 24rd there was blistering of the skin and it was very red. She went to urgent care immediately and got treated for the reaction.

Other Meds:

Current Illness:

ID: 1814067
Sex: M
Age: 23
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: Patient received vaccine days after allowable BUD in refrigerator.

Other Meds:

Current Illness:

ID: 1814069
Sex: M
Age: 67
State: UT

Vax Date: 10/01/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Mild shinglez

Other Meds: Multi vitamin Sawpalmantto Fish oil Flax seed

Current Illness: None

ID: 1814070
Sex: F
Age: 31
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
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:

Allergies:

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

Symptoms: Vaccine administered days after BUD established by manufacturer in refridgerator

Other Meds:

Current Illness:

ID: 1814071
Sex: F
Age: 9
State: GA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: BLOOD PRESSURE WAS CHECKED EVERY 5 MINUTES. INITIALLY LOW HOWEVER RETURNED TO NORMAL AFTER 10 MINUTES.

Allergies:

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

Symptoms: SYNCOPE OCCURRED APPROXIMATELY 1-2 MINUTES FOLLOWING IMMUNIZATION. PATIENT WALKED A FEW FEET AND COLLAPSED. PATIENT APPEARED TO SHAKE BRIEFLY. SHE WAS ASSESSED IMMEDIATELY AND OBSERVED. APPEARED TO BE VASOVAGAL SYNCOPE. PATIENT WAS OBSERVED FOR 20 MINUTES FOLLOWING EPISODE AND NO OTHER SYMPTOMS OCCURRED.

Other Meds:

Current Illness:

ID: 1814072
Sex: F
Age: 29
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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:

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

Symptoms: Vaccine administered days after BUD established by manufacturer in refrigerator.

Other Meds:

Current Illness:

ID: 1814073
Sex: M
Age: 72
State:

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: Vaccine administered days after BUD established by manufacturer in refridgerator

Other Meds:

Current Illness:

ID: 1814074
Sex: F
Age: 27
State: LA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
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: NOT AVAIL

Allergies: NOT KNOWN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PATIENT MAY HAVE RECEIVED WRONG VACCINE. PATIENT SHOULD HAVE GOTTEN MODERNA, BUT SYSTEM SHOWS PFIZER

Other Meds: NOT KNOWN

Current Illness: NOT KNOWN

ID: 1814075
Sex: F
Age: 47
State: MA

Vax Date: 04/01/2021
Onset Date: 10/14/2021
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: 10-15-2021 positive PCR covid test

Allergies: None

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

Symptoms: Breakthrough COVID.

Other Meds: None

Current Illness: None

ID: 1814076
Sex: F
Age: 38
State: NY

Vax Date: 10/18/2021
Onset Date: 10/22/2021
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: IM
Vax Site: LA

Lab Data: None.

Allergies: Dairy intolerance

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Headache after 4 days. Pain moves from back of head near neck to front of head near forehead. Pain is acute. Have not taken anything for it.

Other Meds: IUD

Current Illness: None

ID: 1814077
Sex: F
Age: 55
State: NC

Vax Date: 10/24/2021
Onset Date: 10/24/2021
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: Patient did not receive follow up as symptoms resolved within 4-6 hours.

Allergies: NKDA

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

Symptoms: Patient let me know before receiving this vaccine that she had a reaction to her first Moderna shot given about a month ago. About 30 minutes post-vaccination she began experiencing tingling/burning/neuropathy/pins & needles like feeling on the left side of her face, mouth, and left arm. She said it felt like when her chronic neuropathy flares but in places she usually does not experience pain in. She experienced no trouble breathing or swelling of extremities. The feeling did not worsen over time. She felt completely back to normal after about 4-6 hours. After a considerable discussion she decided to go ahead and receive her 2nd Moderna. I had her wait in the pharmacy for 30 minutes. At the end of the 30 minutes she was experiencing the exact same reaction, no signs of anaphylaxis. I offered to call her an ambulance and she declined. Her husband is a medical professional and will be watching over her for the rest of the day. I instructed her if her symptoms worsened by the end of the evening or any signs of respiratory distress appeared to call 911. I also asked that she call me to let me know how she was feeling later on in the day.

Other Meds: Gabapentin

Current Illness: None

ID: 1814078
Sex: F
Age: 42
State:

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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:

Allergies:

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

Symptoms: Vaccine administered days after BUD established by manufacturer in refrigerator.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am